Clinical characteristics and early identification of augmented renal clearance in PICU patients with severe sepsis associated with MRSA infection.

Objectives: To investigate the epidemiological characteristics of Augmented Renal Clearance (ARC) in severe sepsis children with MRSA infection and find risk factors to establish a model predicting ARC onset in PICU. Design: Retrospective study, in which ARC was defined by estimated glomerular filtration rate (eGFR) measured by the modified Schwartz formula above 130 ml/min/1.73 m Setting: One China PICU. Patients: Severe sepsis children with MRSA infection admitted to PICU from May 2017 to June 2022 at Children's Hospital of Nanjing Medical University. Interventions: None. Measurements and main results: 125 of 167 (74.9%) patients with severe sepsis with MRSA infection have occurred ARC during the hospitalization of PICU, of which 44% have an absolute decrease in vancomycin trough level (VTL), patients with ARC have a longer length of stay in both hospital and PICU, lower VTL and require longer anti-infective treatment. 20 different models were established for the early recognition of ARC. Among them, the best performer had an AUC of 0.746 and a high application prospect. Conclusion: ARC is a phenomenon significantly underestimated in pediatric patients with severe sepsis associated with MRSA infection, which can affect 74.9% of these patients and affects the process of anti-infection treatment and clinical outcomes. To achieve early prediction only by specific risk factors is unreliable, a model based on Multivariate Logistic Regression in this study was chosen to be used clinically.