RESUMEN
Abstract Comparison of Amphotericin B Induced Nephrotoxicity between 6 Hours vwesus 24 Hours Continuous Infusion: A Randomized Controlled Trial On-umar Banpamai MD* Kumthorn Malathum MD*** Somnuek Domrongkitchaiporn MD*** Weerawat Manosuthi MD**** Sasivimol Rattanasiri MSc (Biostatistics)***** *Division of Infectious Diseases, Department of Medicine, BMA Medical College and Vajira Hospital **Division of Infectious Diseases, Department of Medicine, Ramathibodi Hospital, Mahidol Unrversity ***Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Mahidol Unrversity **** Department of Medicine, Bamrasnaradura Institute *****Clinical Epidemiology Unit, Ramathibodi Hospital, Mahidol Unrversity Objective: To compare nephrotoxicity and infusion-related reactions between 6 hours versus 24 hours infusion of amphotericin B. Study design: Prospective, randomized controlled study. Subjects: Seventy-two patients who required amphotericin B therapy for various indications, between August 2004 and March 2005 at Department of Medicine, Ramathibodi Hospital and Bamrasnaradura Institute were randomly allocated to receive either 6 hours or 24 hours infusion of amphotericin B. Methods: Thirty-five patients received continuous infusion of amphotericin B for a period of 6 hours as a control group and 37 patients for a period of 24 hours as a study group. Creatinine clearance, serum potassium (k+), serum magnesium ( Mg+ ), fractional excretion of potassium and magnesium were determined in all patients once a week. Infusion-related side effects of both regimens were also recorded throughout the study. Main outcome measures: Creatinine clearance at 7 and 14 days after receiving amphotericin B, infusion-related side effects, fractional excretion of potassium and magnesium. Results: Creatinine clearance at day 7 and day 14 in study group were 83.922.9 and 81.822.5 ml/min. In control group, creatinine clearance at day 7 and day 14 were 62.7 25.3 and 51.718.9 ml/min. These levels in study group were higher than control group significantly (p-value 0.05). The incidence of renal impairment, defined as doubling of baseline serum creatinine, in study and control group were 2.7% and 45.7% that was different significantly (p-value 0.001). The incidences of infusion-related reactions other than thrombophlebitis were significantly lower in study group. Fractional excretion of statistically different between the two groups. Conclusion: The creatinine clearance, the incidence of renal impairment and infusion-related reactions in continuous 24-hour infusion of amphotericin B were lower than 6-hour infusion. Key word: amphotericin B, creatinine clearance, fractional excretion Vajira Med J 2006 ; 50 : 153 - 164
RESUMEN
Abstract Risk Factors of Hospital-Acquired Infection or Colonization by Pan-Drug Resistant Acinetobacter baumanii in Bangkok Metropolitan Administration Medical College and Vajira Hospital On-umar Banpamai MD* Varankana Munsakul MD* Busaba Supawattanabodee MSc(Biostatistics)** * Division of Infectious Diseases, Department of Medicine, BMA Medical College and Vajira Hospital ** Clinical Epidemiology Unit, BMA Medical College and Vajira Hospital Objective: To determine the risk factors of hospital-acquired infection or colonization by pan-drug resistant Acinetobactr baumanii. Study design: Prospective case-control study. Subjects: One hundred and sixty patients with Acinetobacter baumannii infection of colonization admitted to BMA Medical College and Vajira Hospital, Bangkok, Thailand at least 48 hours from January to August 2006 were enrolled. Methods: All subjects were equally divided into two groups: non pan-drug resistant Acinetobacter baumannii as control group and pan-drug resistant Acinetobacter baumannii as study group. Data were gathered by interview, physical examination and reviewing hospital records. Main outcome measures: Risk factors of hospital-acquired infection or colonization by pan-drug resistant Acinetobacter baumannii, length of hospital stay and overall mortality rate. Results: The demographic data were nos different between two groups. Mean age, median of APACHE II score and median of hospital stay before finding Acinetobacter baumannii in the study group were higher than the control group significantly (62.3±18.5 years. vs 51.5±15.4 years, 27 (range 13-36) vs. 12 (range 2-30) and 20 (range 2-98) vs 7 (1-93) respectively, p-value 0.001). The only two significant risk factors for pan-drug resistant Acinetobacter baumannii in multivariate analysis were hospital stay for more than 7 days before finding Acinetobacter baumannii (OR=8.6, 95%CI 3.2-23) and serum creatinine more than 1.5 mg/dl (OR=7.0, 95%CI 2.9-17.1). The length of hospital stay and overall mortality rate in the study group were higher than the control significantly. Conclusion: Hospital stay for more than 7 days before finding Acinetobacter baumannii and serum creatinine more than 1.5 mg/dl were the significant risk factors for pan-drug resistant Acinetobater baumannii. Key word: pan-drug resistant Acinetobacter baumannii, risk factors, length of hospital stay, mortality rate Vajira Med J 2006 ; 50 : 135 - 144