The impact of adjusted treatment on clinical outcomes in patients with severe obesity is unclear. This study included adults with severe obesity admitted for bloodstream infections between 2005 and 2015. The patients were grouped according to the percentage of the appropriateness of the dosage of their antimicrobial treatment: 80–100% = good, 20–79% = moderate, and 0–19% = poor. The association between antimicrobial adjustment and a composite of unfavourable outcomes [intensive care unit stay ≥72 h, duration of sepsis >3 days, length of stay ≥7 days or all-cause 30-day mortality] was assessed using logistic regression. Of 110 included episodes, the adjustment was rated good in 47 (43%) episodes, moderate in 31 (28%), and poor in 32 (29%). Older age, Pitt bacteremia score ≥2, sepsis on day 1, and infection site were independent risk factors for unfavourable outcomes. The level of appropriateness was not associated with unfavourable outcomes. The number of antimicrobials, consultation with an infectious disease specialist, blood urea nitrogen 7–10.9 mmol/L, and hemodialysis were significantly associated with adjusted antimicrobial dosing. While the severity of the infection had a substantial impact on the measured outcomes, we did not find an association between dosing optimization and better outcomes.

中文翻译：

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重度肥胖和血流感染患者的抗菌药物剂量调整是否与更好的结果相关？探索性研究

尚不清楚调整的治疗对重度肥胖患者临床结局的影响。该研究包括2005年至2015年因血液感染而被录入的重度肥胖成年人。根据患者接受抗菌药物治疗的适当性百分比将其分组：80–100％=良好，20–79％=中度，以及0–19％=贫困。使用logistic回归评估了抗生素调整与不良结局[重症监护病房停留≥72小时，脓毒症持续时间> 3天，住院时间≥7天或全因30天死亡率]之间的相关性。在收录的110集中，调整的好率为47（43％），中度为31（28％），差的为32（29％）。年龄较大，皮特菌血症评分≥2，在第1天出现败血症 和感染部位是不良预后的独立危险因素。适当程度与不良结果无关。抗菌药物的数量，与传染病专家的咨询，血尿素氮7–10.9 mmol / L以及血液透析与调整抗菌药物的剂量密切相关。尽管感染的严重程度对所测得的结局有重大影响，但我们并未发现剂量优化与更好的结局之间存在关联。