Abstract
OBJECTIVE
To evaluate the appropriateness of antibiotic dosing in patients with augmented renal clearance (ARC) admitted to the cardiovascular surgery intensive care unit (CVS-ICU) and the coronary intensive care unit (CICU).
STUDY DESIGN
A descriptive study. Place and Duration of the Study: CVS-ICU and CICU, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkiye, from January 2024 to January 2025.
METHODOLOGY
Adult patients (≥18 years) hospitalised for ≥24 hours, diagnosed with ARC (eGFR ≥130 mL/min/1.73 m2), and receiving antibiotics were included. Dosing appropriateness was assessed based on UpToDate® recommendations. ARC risk was stratified using the ARC scoring system. Data were analysed using descriptive statistics, chi-square test, and Mann-Whitney U test.
RESULTS
Of the 3,334 screened patients, 83 (2.5%) met ARC criteria; 57 received antibiotics and were included in the analysis. At least one dosing error was identified in 84.2% of cases, mostly underdosing (73.1%). The most common antibiotics were cefazolin (42.6%), ampicillin-sulbactam (14.6%), and daptomycin (7.3%). A high ARC risk score was associated with a greater likelihood of dosing errors (90.4% vs. 66.6%; OR = 4.7, p = 0.044). Patients with dosing errors were younger (median 25.5 vs. 50 years, p = 0.004) and received more antibiotics (p = 0.038).
CONCLUSION
Although ARC was uncommon, dosing errors were frequent. Early recognition of ARC and individualised dosing are critical to optimise therapy in ICU patients.
KEY WORDS
Augmented renal clearance, Antibiotic dosing, Cardiovascular surgery intensive care unit, Coronary intensive care unit, Dose adjustment.