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vancomycin obese

Joseph J Carreno, Ben Lomaestro, John Tietjan, Thomas P Lodise
This study evaluated the predictive performance of a Bayesian PK estimation method (ADAPT V) to estimate the 24-hour vancomycin area under the curve estimation (AUC) with limited PK sampling in adult obese patients receiving vancomycin for suspected or confirmed Gram-positive infections. This was an IRB-approved prospective evaluation of 12 patients. Patients had a median (95% CI) age of 61 years (39 - 71), creatinine clearance of 86 mL/min (75 - 120), and body mass index of 45 kg/m(2) (40 - 52). For each patient, five PK concentrations were measured and 4 different vancomycin population PK models were used as Bayesian priors to estimate the estimate vancomycin AUC (AUCFULL)...
March 13, 2017: Antimicrobial Agents and Chemotherapy
C Lübbert, B Salzberger, J Mössner
The human intestinal microbiome has important metabolic and immunological functions for the host and is part of the defense against pathogens in the gastrointestinal tract. Antibiotics, probiotics, dietary measures, such as prebiotics, and the relatively newly established method of fecal microbiota transplantation (FMT, also known as fecal microbiome transfer) all influence the intestinal microbiome. The FMT procedure comprises the transmission of fecal microorganisms from a healthy donor into the gastrointestinal tract of a patient...
February 24, 2017: Der Internist
Mordechai Grupper, David P Nicolau
PURPOSE OF REVIEW: Skin and soft tissue infections (SSTIs) are prevalent in the obese population, with rising trend expected. Although numerous antibiotics are available for the prevention and treatment of SSTIs, their characterization in obese patients is not a regulatory mandate. Consequently, information that carries importance for optimizing the dosing regimen in the obese population may not be readily available. This review focuses on the most recent pharmacokinetic and pharmacodynamic data on this topic with attention to cefazolin for surgical prophylaxis as well as antibiotics that are active against methicillin-resistant Staphylococcus aureus (MRSA)...
April 2017: Current Opinion in Infectious Diseases
Manjunath P Pai, Joseph Hong, Lynne Krop
Vancomycin area under the curve (AUC) estimates may be skewed in obese adults due to weight-dependent pharmacokinetic parameters. We demonstrate that peak and trough measurements reduce bias and improve the precision of vancomycin AUC estimates in obese adults (n = 75) and validate this in an independent cohort (n = 31). The precision and mean percent bias of Bayesian vancomycin AUC estimates are comparable between covariate-dependent (R(2) = 0.774, 3.55%) and covariate-independent (R(2) = 0.804, 3.28%) models when peaks and troughs are measured but not when measurements are restricted to troughs only (R(2) = 0...
April 2017: Antimicrobial Agents and Chemotherapy
Stephanie Natale, John Bradley, William Huy Nguyen, Tri Tran, Pamela Ny, Kirsten La, Eva Vivian, Jennifer Le
Limited data exist for appropriate drug dosing in obese children. This comprehensive review summarizes pharmacokinetic (PK) alterations that occur with age and obesity, and these effects on antimicrobial dosing. A thorough comparison of different measures of body weight and specific antimicrobial agents including cefazolin, cefepime, ceftazidime, daptomycin, doripenem, gentamicin, linezolid, meropenem, piperacillin-tazobactam, tobramycin, vancomycin, and voriconazole is presented. PubMed (1966-July 2015) and Cochrane Library searches were performed using these key terms: children, pharmacokinetic, obesity, overweight, body mass index, ideal body weight, lean body weight, body composition, and specific antimicrobial drugs...
March 2017: Pharmacotherapy
Celestine Ishiekwene, Monica Ghitan, Margaret Kuhn-Basti, Edward Chapnick, Yu Shia Lin
Staphylococcus lugdunensis (S. lugdunensis) is a coagulase negative staphylococcus (CoNS) that can cause destructive infective endocarditis. S. lugdunensis, unlike other CoNS, should be considered to be a pathogen. We report the first case of S. lugdunensis endocarditis causing ventricular septal defect and destruction of the aortic and mitral valves. A 53-year-old male with morbid obesity and COPD presented with intermittent fever and progressive shortness of breath for 2 weeks. Chest examination showed bilateral basal crepitations, and a grade 2 systolic murmur along the right sternal border...
2017: IDCases
Sean P Kane, Scott D Hanes
INTRODUCTION: To report a case of increases in vancomycin concentrations without additional vancomycin doses being given. CASE STUDY: A 64 year-old morbidly obese female received three total doses of vancomycin for surgical prophylaxis and for ventilator-associated pneumonia. Subsequent vancomycin concentrations from the patient's central venous catheter (CVC) demonstrated increasing drug levels from 27.1 to 45.9mcg/mL despite no additional vancomycin being given and proper line flushing prior to sample collection...
April 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Kassem Hammoud, Michael Brimacombe, Alan Yu, Neil Goodloe, Wael Haidar, Wissam El Atrouni
BACKGROUND: The association between vancomycin trough (VT) and acute kidney injury (AKI) at the recommended doses remains controversial. METHODS: The authors conducted a retrospective, observational cohort study of 500 adult patients who received vancomycin for ≥72 h. Data collected included 2 main predictors: average VT (including only VTs before the occurrence of AKI), first VT and other possible risk factors for AKI. The baseline characteristics/variables between patients with AKI and patients with no AKI were compared...
2016: American Journal of Nephrology
N P Fewel
WHAT IS KNOWN AND OBJECTIVE: There are many methods for dosing vancomycin. The purpose of this commentary was to compare open-access vancomycin dosing websites with and describe how body weight can affect their pharmacokinetic (PK) calculations. COMMENT: A vancomycin dosing website,, was developed to improve the dosing practice at our health system. Nine other vancomycin dosing calculators were identified, including three open-access websites...
April 2017: Journal of Clinical Pharmacy and Therapeutics
Ambar Haleem, Hsiu-Yin Chiang, Ravindhar Vodela, Andrew Behan, Jean M Pottinger, Joseph Smucker, Jeremy D Greenlee, Charles Clark, Loreen A Herwaldt
OBJECTIVE To identify risk factors for surgical site infections (SSIs) after spine operations. DESIGN Case-control study of SSIs among patients undergoing spine operations. SETTING An academic health center. PATIENTS We studied patients undergoing spinal fusions or laminectomies at the University of Iowa Hospitals and Clinics from January 1, 2007, through June 30, 2009. We included patients who acquired SSIs meeting the National Healthcare Safety Network definition. We randomly selected controls among patients who had spine operations during the study period and did not meet the SSI definition...
December 2016: Infection Control and Hospital Epidemiology
Sara Elizabeth Boyd, Esmita Charani, Tracy Lyons, Gary Frost, Alison Helen Holmes
BACKGROUND: Obesity is on course to overtake being underweight as a global disease burden. Obesity alters antibacterial pharmacokinetics (PK) and pharmacodynamics (PD). Historically, drug PK/PD parameters have not been studied in obese populations. This means dose recommendations risk being sub-therapeutic in a population at increased risk of infection. Suboptimal antibacterial prescribing is widely associated with treatment failure, worse clinical outcomes, unnecessary escalation to broad-spectrum therapy and the emergence of antimicrobial resistance (AMR)...
August 18, 2016: Journal of Antimicrobial Chemotherapy
Céline Rens, Françoise Laval, Mamadou Daffé, Olivier Denis, Rosangela Frita, Alain Baulard, Ruddy Wattiez, Philippe Lefèvre, Véronique Fontaine
Tuberculosis is still a cause of major concern, partly due to the emergence of multidrug-resistant strains. New drugs are therefore needed. Vancomycin can target mycobacteria with cell envelope deficiency. In this study, we used a vancomycin susceptibility assay to detect drugs hampering lipid synthesis in Mycobacterium bovis BCG and in Mycobacterium tuberculosis We tested three drugs already used to treat human obesity: tetrahydrolipstatin (THL), simvastatin, and fenofibrate. Only vancomycin and THL were able to synergize on M...
October 2016: Antimicrobial Agents and Chemotherapy
Dorien Reijnders, Gijs H Goossens, Gerben D A Hermes, Evelien P J G Neis, Christina M van der Beek, Jasper Most, Jens J Holst, Kaatje Lenaerts, Ruud S Kootte, Max Nieuwdorp, Albert K Groen, Steven W M Olde Damink, Mark V Boekschoten, Hauke Smidt, Erwin G Zoetendal, Cornelis H C Dejong, Ellen E Blaak
The gut microbiota has been implicated in obesity and cardiometabolic diseases, although evidence in humans is scarce. We investigated how gut microbiota manipulation by antibiotics (7-day administration of amoxicillin, vancomycin, or placebo) affects host metabolism in 57 obese, prediabetic men. Vancomycin, but not amoxicillin, decreased bacterial diversity and reduced Firmicutes involved in short-chain fatty acid and bile acid metabolism, concomitant with altered plasma and/or fecal metabolite concentrations...
July 12, 2016: Cell Metabolism
Hsin Lin, Daniel Dante Yeh, Alexander R Levine
BACKGROUND: Limited data are available assessing vancomycin concentrations in obese critically ill patients. Currently, there are no studies evaluating dosing requirements in this population who receive vancomycin administered as a continuous infusion (CI). The aim of this study was to assess whether there was a difference in the weight-based maintenance dose required to reach a therapeutic vancomycin concentration at 24 hours when given as a CI in obese versus non-obese critically ill patients...
2016: Critical Care: the Official Journal of the Critical Care Forum
Ian G Woodgate, John Rooney, Johnathan S Mulford, R Mark Gillies
INTRODUCTION: This is a report of a mechanical failure of an S-ROM revision total knee prosthesis. The prosthesis was used as a revision implant following deep peri-prosthetic infection in a morbidly obese male. The prosthesis failed on both the femoral and tibial sides at the modular metaphyseal stem junctions and required a further revision using the same type of implant after infection was excluded. CASE PRESENTATION: A 57 year old male had previously undergone a left total knee arthroplasty in 1999 for osteoarthritis...
January 2016: Journal of Orthopaedic Case Reports
Abdulaziz S Alobaid, Maya Hites, Jeffrey Lipman, Fabio Silvio Taccone, Jason A Roberts
The increased prevalence of obesity presents challenges for clinicians aiming to provide optimised antimicrobial dosing in the intensive care unit. Obesity is likely to exacerbate the alterations to antimicrobial pharmacokinetics when the chronic diseases associated with obesity exist with the acute pathophysiological changes associated with critical illness. The purpose of this paper is to review the potential pharmacokinetic (PK) changes of antimicrobials in obese critically ill patients and the implications for appropriate dosing...
April 2016: International Journal of Antimicrobial Agents
Desiree E Kosmisky, Carrie L Griffiths, Megan A Templin, James Norton, Kelly E Martin
BACKGROUND: Optimal dosing of vancomycin in morbidly obese patients (>100 kg and at least 140% of their ideal body weight) has not been determined. Conventional dosing strategies have led to the observation of supratherapeutic trough concentrations (>20 mcg/mL). OBJECTIVE: To evaluate the effectiveness of a new vancomycin dosing protocol in morbidly obese patients in achieving therapeutic trough concentrations between 10 and 20 mcg/mL and to determine patient-specific factors influencing the trough concentration attained...
October 2015: Hospital Pharmacy
Rocío Álvarez, Luis E López Cortés, José Molina, José M Cisneros, Jerónimo Pachón
The increasing number of infections produced by beta-lactam-resistant Gram-positive bacteria and the morbidity secondary to these infections make it necessary to optimize the use of vancomycin. In 2009, the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Disease Pharmacists published specific guidelines about vancomycin dosage and monitoring. However, these guidelines have not been updated in the past 6 years. This review analyzes the new available information about vancomycin published in recent years regarding pharmacokinetics and pharmacodynamics, serum concentration monitoring, and optimal vancomycin dosing in special situations (obese people, burn patients, renal replacement therapy, among others)...
May 2016: Antimicrobial Agents and Chemotherapy
Nuggehally R Srinivas
Owing to availability of scanty pharmacokinetic data, dosing decisions in morbidly obesity is increasingly challenging in the field of anti-infective drugs. However, in recent years data are emerging that describe the pharmacokinetics of anti-infective drugs in morbidly obese subjects. The objectives of the present work were: (1) to collate the recent reports pertaining to the pharmacokinetics in morbidly obese subjects for several anti-infective drugs and provide an overview of the pharmacokinetic data along with the applicable pharmacodynamics and/or clinical outcome; (2) to perform regression analysis on limited dataset for a few drugs to verify the existence of relationships between Cmax/Ctrough versus steady-state volume of distribution (Vss)/clearance to enable data prediction in morbidly obesity subjects; (3) to provide a general discussion on issues and dosing implications...
January 13, 2016: American Journal of Therapeutics
Sun-Young Park, Sang-Dong Lim
Lactobacillus plantarum FH185 was isolated from the feces of healthy adults. In our previous study, L. plantarum FH185 was demonstrated that it has anti-obesity effect in the in vitro and in vivo test. In order to determine its potential for use as a probiotic, we investigated the physiological characteristics of L. plantarum FH185. The optimum growth temperature of L. plantarum FH185 was 40℃. L. plantarum FH185 showed higher sensitivity to novobiocin in a comparison of fifteen different antibiotics and showed higher resistance to polymyxin B and vancomycin...
2015: Korean Journal for Food Science of Animal Resources
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