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Risk factors for hyperglycemia in hospitalized adults receiving gatifloxacin: a retrospective, nested case-controlled analysis.
Clin Ther. 2008 Jan; 30(1):152-7.CT

Abstract

BACKGROUND

The prevalence of glucose abnormalities has been reported to be greater in hospitalized patients receiving gatifloxacin than in patients receiving ceftriaxone.

OBJECTIVE

The purpose of the current study was to identify risk factors for hyperglycemia in hospitalized patients receiving gatifloxacin.

METHODS

This retrospective, nested case-controlled study was conducted in 69 patients and 69 controls in 2 nonteaching hospitals in Houston, Texas. Classification and regression tree (CART) analysis was conducted to identify break points in continuous variables. Univariate and multivariate logistic regression analyses were also performed.

RESULTS

A total of 138 patients (mean [SD] age, 68.3 [17.3] years; weight, 77.4 [21.1] kg; sex, women/ men, 69.6%/30.4%; race [Hispanic, 58.3%; white, 28.5%; black, 9.2%; other, 4.0%]) were identified. Patients who developed hyperglycemia (blood glucose level > 200 mg/dL) within 72 hours of gatifloxacin administration (cases) were matched 1:1 with patients who received gatifloxacin for > or = 5 days and did not experience hyperglycemia during treatment and for 3 days after the end of treatment (controls). In univariate analysis, cases were more likely than controls to have diabetes (89.9% vs 13.0%; P < 0.001), have a decreased mean (SD) creatinine clearance (CrCl) (53.8 [36.8] vs 69.2 [45.3] mL/min; P = 0.025), be located in the intensive care unit at the time of the event (20.3% vs 7.2%; P = 0.02), have received gatifloxacin doses higher than recommended based on renal function (> 200 mg/d when CrCl < 40 mL/min) (25/69 [36.2%] vs 9/69 [13.0%]), have leukocytosis (mean [SD] white blood cell [WBC] count, 15.5 [7.4] vs 12.8 [6.2] cells/mm3), and have received concomitant total parenteral nutrition (7/69 [10.1%] vs 0 [0%]; P = 0.02) and/or steroids (22/69 [31.9%] vs 8/69 [11.6%]; P = 0.008). CART analysis identified age > 65 years, albumin < 3.2 g/dL, WBC count > 14.5 cells/mm3, and CrCl < 40 mL/min to be more common in hyperglycemic patients. In logistic regression, diabetes (odds ratio [OR] = 233; 95% CI, 19-2784) and excessive dose for renal function (OR = 42; 95% CI, 2-770) were identified as independent predictors for hyperglycemia in patients receiving gatifloxacin. After controlling for diabetes, concomitant steroids (OR = 5.7; 95% CI, 1.5-21.1) and excessive dose for renal function (OR = 4.9; 95% CI, 1.2-20.4) were associated with hyperglycemia in patients receiving gatifloxacin.

CONCLUSIONS

This retrospective, nested case-controlled study found that the risk of hyperglycemia increased in diabetic patients who received concomitant steroids or higher gatifloxacin doses than recommended by the manufacturer's prescribing information. The application of these data should be assessed for other fluoroquinolones used at higher doses.

Authors+Show Affiliations

Division of Infectious Diseases, University of Texas Health Science Center at Houston, Houston, Texas, USA. John.Mohr@cubist.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

18343251

Citation

Mohr, John F., et al. "Risk Factors for Hyperglycemia in Hospitalized Adults Receiving Gatifloxacin: a Retrospective, Nested Case-controlled Analysis." Clinical Therapeutics, vol. 30, no. 1, 2008, pp. 152-7.
Mohr JF, Peymann PJ, Troxell E, et al. Risk factors for hyperglycemia in hospitalized adults receiving gatifloxacin: a retrospective, nested case-controlled analysis. Clin Ther. 2008;30(1):152-7.
Mohr, J. F., Peymann, P. J., Troxell, E., Lodise, T. P., & Ostrosky-Zeichner, L. (2008). Risk factors for hyperglycemia in hospitalized adults receiving gatifloxacin: a retrospective, nested case-controlled analysis. Clinical Therapeutics, 30(1), 152-7. https://doi.org/10.1016/j.clinthera.2008.01.009
Mohr JF, et al. Risk Factors for Hyperglycemia in Hospitalized Adults Receiving Gatifloxacin: a Retrospective, Nested Case-controlled Analysis. Clin Ther. 2008;30(1):152-7. PubMed PMID: 18343251.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for hyperglycemia in hospitalized adults receiving gatifloxacin: a retrospective, nested case-controlled analysis. AU - Mohr,John F,3rd AU - Peymann,Patti J, AU - Troxell,Eric, AU - Lodise,Thomas P, AU - Ostrosky-Zeichner,Luis, PY - 2007/11/15/accepted PY - 2008/3/18/pubmed PY - 2009/9/16/medline PY - 2008/3/18/entrez SP - 152 EP - 7 JF - Clinical therapeutics JO - Clin Ther VL - 30 IS - 1 N2 - BACKGROUND: The prevalence of glucose abnormalities has been reported to be greater in hospitalized patients receiving gatifloxacin than in patients receiving ceftriaxone. OBJECTIVE: The purpose of the current study was to identify risk factors for hyperglycemia in hospitalized patients receiving gatifloxacin. METHODS: This retrospective, nested case-controlled study was conducted in 69 patients and 69 controls in 2 nonteaching hospitals in Houston, Texas. Classification and regression tree (CART) analysis was conducted to identify break points in continuous variables. Univariate and multivariate logistic regression analyses were also performed. RESULTS: A total of 138 patients (mean [SD] age, 68.3 [17.3] years; weight, 77.4 [21.1] kg; sex, women/ men, 69.6%/30.4%; race [Hispanic, 58.3%; white, 28.5%; black, 9.2%; other, 4.0%]) were identified. Patients who developed hyperglycemia (blood glucose level > 200 mg/dL) within 72 hours of gatifloxacin administration (cases) were matched 1:1 with patients who received gatifloxacin for > or = 5 days and did not experience hyperglycemia during treatment and for 3 days after the end of treatment (controls). In univariate analysis, cases were more likely than controls to have diabetes (89.9% vs 13.0%; P < 0.001), have a decreased mean (SD) creatinine clearance (CrCl) (53.8 [36.8] vs 69.2 [45.3] mL/min; P = 0.025), be located in the intensive care unit at the time of the event (20.3% vs 7.2%; P = 0.02), have received gatifloxacin doses higher than recommended based on renal function (> 200 mg/d when CrCl < 40 mL/min) (25/69 [36.2%] vs 9/69 [13.0%]), have leukocytosis (mean [SD] white blood cell [WBC] count, 15.5 [7.4] vs 12.8 [6.2] cells/mm3), and have received concomitant total parenteral nutrition (7/69 [10.1%] vs 0 [0%]; P = 0.02) and/or steroids (22/69 [31.9%] vs 8/69 [11.6%]; P = 0.008). CART analysis identified age > 65 years, albumin < 3.2 g/dL, WBC count > 14.5 cells/mm3, and CrCl < 40 mL/min to be more common in hyperglycemic patients. In logistic regression, diabetes (odds ratio [OR] = 233; 95% CI, 19-2784) and excessive dose for renal function (OR = 42; 95% CI, 2-770) were identified as independent predictors for hyperglycemia in patients receiving gatifloxacin. After controlling for diabetes, concomitant steroids (OR = 5.7; 95% CI, 1.5-21.1) and excessive dose for renal function (OR = 4.9; 95% CI, 1.2-20.4) were associated with hyperglycemia in patients receiving gatifloxacin. CONCLUSIONS: This retrospective, nested case-controlled study found that the risk of hyperglycemia increased in diabetic patients who received concomitant steroids or higher gatifloxacin doses than recommended by the manufacturer's prescribing information. The application of these data should be assessed for other fluoroquinolones used at higher doses. SN - 1879-114X UR - https://www.unboundmedicine.com/medline/citation/18343251/Risk_factors_for_hyperglycemia_in_hospitalized_adults_receiving_gatifloxacin:_a_retrospective_nested_case_controlled_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(08)00057-X DB - PRIME DP - Unbound Medicine ER -