<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2448-8909</journal-id>
<journal-title><![CDATA[Medicina crítica (Colegio Mexicano de Medicina Crítica)]]></journal-title>
<abbrev-journal-title><![CDATA[Med. crít. (Col. Mex. Med. Crít.)]]></abbrev-journal-title>
<issn>2448-8909</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Medicina Crítica A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2448-89092024000600497</article-id>
<article-id pub-id-type="doi">10.35366/119239</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Ajuste de dosis a tasa de filtrado renal; lo que por tradición no ha mejorado el desenlace en la lesión renal aguda inducida por sepsis (AJUST-AKI Trial)]]></article-title>
<article-title xml:lang="en"><![CDATA[Dose adjustment to renal filtration rate; which has traditionally not improved outcome in sepsis-induced acute renal injury (AJUST-AKI Trial)]]></article-title>
<article-title xml:lang="pt"><![CDATA[Ajuste de dose à taxa de filtração renal; o que tradicionalmente não melhorou o resultado da lesão renal aguda induzida pela sepse (AJUST-AKI Trial)]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zamora Guevara]]></surname>
<given-names><![CDATA[Iveth Soledad]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Falla Silva]]></surname>
<given-names><![CDATA[Héctor Miguel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gómez Zeind]]></surname>
<given-names><![CDATA[Ángel Fermín]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cortés Román]]></surname>
<given-names><![CDATA[Jorge Samuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Flores Hernández]]></surname>
<given-names><![CDATA[Yerileys]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[López Fermín]]></surname>
<given-names><![CDATA[Jorge]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Hospital Regional de Alta Especialidad ]]></institution>
<addr-line><![CDATA[ Veracruz]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<volume>38</volume>
<numero>6</numero>
<fpage>497</fpage>
<lpage>502</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-89092024000600497&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-89092024000600497&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-89092024000600497&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  La sepsis, principal causa de lesión renal aguda (LRA) en pacientes de Unidades de Cuidados Intensivos (UCI), se asocia con una alta mortalidad (60-80%). Aunque las terapias de reemplazo renal han avanzado, no existen guías validadas para ajustar dosis de antibióticos en pacientes críticos con LRA. Este trabajo aborda los factores farmacocinéticos y farmacodinámicos que influyen en la antibioticoterapia en estos casos.  Objetivos:  Investigar el impacto del ajuste de dosis de antibióticos en función de la tasa de filtración glomerular (TFG) en pacientes con LRA inducida por sepsis, evaluando desenlaces como días de estancia en UCI, ventilación mecánica y soporte vasopresor.  Material y métodos:  Se realizó un estudio observacional, descriptivo y retrospectivo en una UCI de tercer nivel entre agosto de 2022 y agosto de 2023. Se incluyeron 19 pacientes mayores de 18 años con LRA según los criterios KDIGO y sepsis, comparando aquellos con dosis estándar de antibióticos y dosis ajustadas por TFG. Se utilizó análisis no paramétrico para correlaciones y desenlaces primarios y secundarios.  Resultados:  El 68.4% de los pacientes recibió dosis estándar, mientras que sólo 31.6% tuvo ajustes por TFG. No se encontraron diferencias significativas en días de estancia en UCI (media de 4.21 días), ventilación mecánica (media de 2.47 días) o uso de soporte vasopresor (media de 3.16 días) entre ambos grupos. Tampoco se observó una correlación significativa entre el ajuste de antibióticos y los desenlaces clínicos (r(ho) 0.121, r(ho) de 0.01).  Conclusión:  El ajuste de dosis de antibióticos basado en TFG no demostró beneficios clínicos significativos en los pacientes estudiados. Limitaciones del estudio: su diseño retrospectivo y la falta de determinaciones plasmáticas de fármacos subrayan la necesidad de más investigaciones para optimizar la antibioticoterapia en pacientes críticos con LRA y sepsis.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Sepsis, the main cause of acute kidney injury (AKI) in intensive care unit (ICU) patients, is associated with high mortality (60-80%). Although renal replacement therapies have advanced, there are no validated guidelines for adjusting antibiotic doses in critically ill patients with AKI. This work addresses the pharmacokinetic and pharmacodynamic factors that influence antibiotic therapy in these cases.  Objectives:  To investigate the impact of antibiotic dose adjustment according to glomerular filtration rate (GFR) in patients with sepsis-induced AKI, evaluating outcomes such as days of ICU stay, mechanical ventilation and vasopressor support.  Material and methods:  An observational, descriptive and retrospective study was carried out in a third level ICU between August 2022 and August 2023. Nineteen patients older than 18 years with AKI according to KDIGO criteria and sepsis were included, comparing those with standard antibiotic doses and doses adjusted by GFR. Nonparametric analysis was used for correlations and primary and secondary outcomes.  Results:  68.4% of patients received standard doses, while only 31.6% had GFR adjustments. No significant differences were found in days of ICU stay (mean 4.21 days), mechanical ventilation (mean 2.47 days) or use of vasopressor support (mean 3.16 days) between both groups. There was also no significant correlation between antibiotic adjustment and clinical outcomes (r(ho) 0.121, r(ho) of 0.01).  Conclusion:  Antibiotic dose adjustment based on GFR did not demonstrate significant clinical benefits in the patients studied. Limitations of the study: its retrospective design and the lack of plasma drug determinations underscore the need for further research to optimize antibiotic therapy in critically ill patients with AKI and sepsis.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  Sepse, a principal causa de lesão renal aguda (LRA) em pacientes internados em unidades de terapia intensiva (UTI), está associada a uma elevada mortalidade (60-80%). Embora as terapias de substituição renal tenham avançado, não existem diretrizes validadas para o ajuste das doses de antibióticos em pacientes em estado crítico com LRA. Este artigo aborda os fatores farmacocinéticos e farmacodinâmicos que influenciam a terapêutica antibiótica nestes casos.  Objetivos:  Investigar o impacto do ajuste da dose de antibiótico de acordo com a taxa de filtração glomerular (TFG) em pacientes com LRA induzida por sepse, avaliando resultados como dias de permanência na UTI, ventilação mecânica e suporte vasopressor.  Material e métodos:  Foi realizado um estudo observacional, descritivo e retrospectivo em uma UTI de terceiro nível entre agosto de 2022 e agosto de 2023. Foram incluídos 19 pacientes com mais de 18 anos com LRA de acordo com os critérios KDIGO e sepse, comparando aqueles com doses padrão de antibióticos e doses ajustadas à TFG. A análise não paramétrica foi utilizada para correlações e resultados primários e secundários.  Resultados:  68.4% dos pacientes receberam dose padrão, enquanto apenas 31.6% tiveram ajustes na TFG. Não foram encontradas diferenças significativas nos dias de permanência na UTI (média de 4.21 dias), ventilação mecânica (média de 2.47 dias) ou uso de suporte vasopressor (média de 3.16 dias) entre os dois grupos. Também não se registou uma correlação significativa entre o ajuste dos antibióticos e os resultados clínicos (r(ho) 0.121, r(ho) de 0.01).  Conclusão:  O ajuste da dose de antibióticos com base na TFG não demonstrou um benefício clínico significativo nos pacientes estudados. Limitações do estudo: o seu desenho retrospectivo e a falta de determinações plasmáticas de medicamentos sublinham a necessidade de mais investigação para otimizar a terapêutica antibiótica em doentes em estado crítico com LRA e sepse.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[lesión renal aguda]]></kwd>
<kwd lng="es"><![CDATA[sepsis y choque séptico]]></kwd>
<kwd lng="es"><![CDATA[ajuste de terapia antimicrobiana]]></kwd>
<kwd lng="es"><![CDATA[Unidad de Cuidados Intensivos]]></kwd>
<kwd lng="en"><![CDATA[acute kidney injury]]></kwd>
<kwd lng="en"><![CDATA[sepsis and septic shock]]></kwd>
<kwd lng="en"><![CDATA[antimicrobial therapy adjustment]]></kwd>
<kwd lng="en"><![CDATA[intensive care unit]]></kwd>
<kwd lng="pt"><![CDATA[lesão renal aguda]]></kwd>
<kwd lng="pt"><![CDATA[sepse e choque séptico]]></kwd>
<kwd lng="pt"><![CDATA[ajuste da terapêutica antimicrobiana]]></kwd>
<kwd lng="pt"><![CDATA[Unidade de Terapia Intensiva]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Doi]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Role of kidney injury in sepsis]]></article-title>
<source><![CDATA[J Intensive Care]]></source>
<year>2016</year>
<volume>4</volume>
<page-range>17</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Peerapornratana]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Manrique-Caballero]]></surname>
<given-names><![CDATA[CL]]></given-names>
</name>
<name>
<surname><![CDATA[Gómez]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Kellum]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment]]></article-title>
<source><![CDATA[Kidney Int]]></source>
<year>2019</year>
<volume>96</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>1083-99</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Majumdar]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sepsis-induced acute kidney injury]]></article-title>
<source><![CDATA[Indian J Crit Care Med]]></source>
<year>2010</year>
<volume>14</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>14-21</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Freitas]]></surname>
<given-names><![CDATA[FM]]></given-names>
</name>
<name>
<surname><![CDATA[Zamoner]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Garms]]></surname>
<given-names><![CDATA[DSS]]></given-names>
</name>
<name>
<surname><![CDATA[Oliveira]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Balbi]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
<name>
<surname><![CDATA[Ponce]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The use of antimicrobials in septic patients with acute kidney injury]]></article-title>
<source><![CDATA[J Bras Nefrol]]></source>
<year>2017</year>
<volume>39</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>323-8</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Evans]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Rhodes]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Alhazzani]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Antonelli]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Coopersmith]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[French]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021]]></article-title>
<source><![CDATA[Intensive Care Med]]></source>
<year>2021</year>
<volume>47</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>1181-247</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cotta]]></surname>
<given-names><![CDATA[MO]]></given-names>
</name>
<name>
<surname><![CDATA[Roberts]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Lipman]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Antibiotic dose optimization in critically ill patients]]></article-title>
<source><![CDATA[Med Intensiva]]></source>
<year>2015</year>
<volume>39</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>563-72</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hughes]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Heard]]></surname>
<given-names><![CDATA[KL]]></given-names>
</name>
<name>
<surname><![CDATA[Mughal]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Moore]]></surname>
<given-names><![CDATA[LSP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Optimization of antimicrobial dosing in patients with acute kidney injury: a single-centre observational study]]></article-title>
<source><![CDATA[JAC Antimicrob Resist]]></source>
<year>2022</year>
<volume>4</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>dlac080</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vazquez-Grande]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Kumar]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Optimizing antimicrobial therapy of sepsis and septic shock: focus on antibiotic combination therapy]]></article-title>
<source><![CDATA[Semin Respir Crit Care Med]]></source>
<year>2015</year>
<volume>36</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>154-66</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Im]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Kang]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Ko]]></surname>
<given-names><![CDATA[RE]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[YJ]]></given-names>
</name>
<name>
<surname><![CDATA[Lim]]></surname>
<given-names><![CDATA[SY]]></given-names>
</name>
<name>
<surname><![CDATA[Park]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Time-to-antibiotics and clinical outcomes in patients with sepsis and septic shock: a prospective nationwide multicenter cohort study]]></article-title>
<source><![CDATA[Crit Care]]></source>
<year>2022</year>
<volume>26</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>19</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nowak-Kózka]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Polok]]></surname>
<given-names><![CDATA[KJ]]></given-names>
</name>
<name>
<surname><![CDATA[Górka]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Fronczek]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Gielicz]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Seczynska]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Concentration of meropenem in patients with sepsis and acute kidney injury before and after initiation of continuous renal replacement therapy: a prospective observational trial]]></article-title>
<source><![CDATA[Pharmacol Rep]]></source>
<year>2020</year>
<volume>72</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>147-55</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mohd Hafiz]]></surname>
<given-names><![CDATA[AA]]></given-names>
</name>
<name>
<surname><![CDATA[Staatz]]></surname>
<given-names><![CDATA[CE]]></given-names>
</name>
<name>
<surname><![CDATA[Kirkpatrick]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Lipman]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Roberts]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Continuous infusion vs. bolus dosing: implications for beta-lactam antibiotics]]></article-title>
<source><![CDATA[Minerva Anestesiol]]></source>
<year>2012</year>
<volume>78</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>94-104</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nelson]]></surname>
<given-names><![CDATA[NR]]></given-names>
</name>
<name>
<surname><![CDATA[Morbitzer]]></surname>
<given-names><![CDATA[KA]]></given-names>
</name>
<name>
<surname><![CDATA[Jordan]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
<name>
<surname><![CDATA[Rhoney]]></surname>
<given-names><![CDATA[DH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The impact of capping creatinine clearance on achieving therapeutic vancomycin concentrations in neurocritically ill patients with traumatic brain injury]]></article-title>
<source><![CDATA[Neurocrit Care]]></source>
<year>2019</year>
<volume>30</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>126-31</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Moehring]]></surname>
<given-names><![CDATA[RW]]></given-names>
</name>
<name>
<surname><![CDATA[Sloane]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[LF]]></given-names>
</name>
<name>
<surname><![CDATA[Smathers]]></surname>
<given-names><![CDATA[EC]]></given-names>
</name>
<name>
<surname><![CDATA[Schmader]]></surname>
<given-names><![CDATA[KE]]></given-names>
</name>
<name>
<surname><![CDATA[Fowler]]></surname>
<given-names><![CDATA[VG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Delays in appropriate antibiotic therapy for gram-negative bloodstream infections: a multicenter, community hospital study]]></article-title>
<source><![CDATA[PLoS One]]></source>
<year>2013</year>
<volume>8</volume>
<numero>10</numero>
<issue>10</issue>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
