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antibiotic dosing in icu renal failure

Nasia Safdar, Jackson S Musuuza, Anping Xie, Ann Schoofs Hundt, Matthew Hall, Kenneth Wood, Pascale Carayon
BACKGROUND: Guidelines from the Infectious Diseases Society of America/The American Thoracic Society (IDSA/ATS) provide recommendations for diagnosis and treatment of ventilator-associated pneumonia (VAP). However, the mere presence of guidelines is rarely sufficient to promote widespread adoption and uptake. Using the Systems Engineering Initiative for Patient Safety (SEIPS) model framework, we undertook a study to understand barriers and facilitators to the adoption of the IDSA/ATS guidelines...
2016: BMC Infectious Diseases
Maria Helena Rigatto, Maura S Oliveira, Lauro V Perdigão-Neto, Anna S Levin, Claudia M Carrilho, Marcos Toshiyuki Tanita, Felipe F Tuon, Douglas E Cardoso, Natane T Lopes, Diego R Falci, Alexandre P Zavascki
Nephrotoxicity is the main adverse effect of colistin and polymyxin B (PMB). It is not clear whether these two antibiotics are associated with different nephrotoxicity rates. We compared the incidences of renal failure (RF) in patients treated with colistimethate sodium (CMS) or PMB for ≥48 h. A multicenter prospective cohort study was performed that included patients aged ≥18 years. The primary outcome was renal failure (RF) according to Risk, Injury, Failure, Loss, and End-stage renal disease (RIFLE) criteria...
April 2016: Antimicrobial Agents and Chemotherapy
Athena L V Hobbs, Katherine M Shea, Kirsten M Roberts, Mitchell J Daley
Augmented renal clearance (ARC) has been reported in approximately 30-65% of patients in the intensive care unit (ICU) despite the presence of a normal serum creatinine concentration. In certain ICU patient populations (e.g., patients with sepsis or trauma), the incidence increases to roughly 50-85%. Risk factors for ARC include the following: age younger than 50-55 years, male sex, higher diastolic blood pressure, fewer comorbidities, and a lower Acute Physiology and Chronic Health Evaluation II (APACHE II) or modified Sequential Organ Failure Assessment (SOFA) score at ICU admission...
November 2015: Pharmacotherapy
Pieter A J G De Cock, Joseph F Standing, Charlotte I S Barker, Annick de Jaeger, Evelyn Dhont, Mieke Carlier, Alain G Verstraete, Joris R Delanghe, Hugo Robays, Peter De Paepe
There is little data available to guide amoxicillin-clavulanic acid dosing in critically ill children. The primary objective of this study was to investigate the pharmacokinetics of both compounds in this pediatric subpopulation. Patients admitted to the pediatric intensive care unit (ICU) in whom intravenous amoxicillin-clavulanic acid was indicated (25 to 35 mg/kg of body weight every 6 h) were enrolled. Population pharmacokinetic analysis was conducted, and the clinical outcome was documented. A total of 325 and 151 blood samples were collected from 50 patients (median age, 2...
November 2015: Antimicrobial Agents and Chemotherapy
Ryszard Grenda, Wioletta Jarmużek, Jacek Rubik, Marek Migdał, Maciej Pronicki
UNLABELLED: Rituximab (anti-B CD20 ab.) in recently widely used in renal transplantation. CASE HISTORY: A 10-yr-old patient with end-stage renal failure due to multidrug-resistant NS was transplanted with renal graft from deceased donor and presented immediate recurrence of NS. PF was started on day 3 and patient received MP pulses, however with no effect. Rituximab (4 × 375 mg/m(2)) was administered. Chest radiographs taken at that time were normal. Partial remission was achieved and the patient was discharged in good condition...
August 2015: Pediatric Transplantation
C Welsch, P Augustin, J Allyn, L Massias, P Montravers, N Allou
Venovenous extracorporeal membrane oxygenation (ECMO) is increasingly used in patients with respiratory failure who fail conventional treatment. Postoperative pneumonia is the most common infection after lung transplantation (40%). Imipenem is frequently used for empirical treatment of nosocomial pneumonia in the intensive care unit. Nevertheless, few data are available on the impact of ECMO on pharmacokinetics, and no data on imipenem dosing during ECMO. Currently, no guidelines exist for antibiotic dosing during ECMO support...
February 2015: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Geoffrey Bass, William Healy, Stephen Kirkby, Amy Pope-Harman
SESSION TITLE: Miscellaneous Student/Resident Case Report Posters ISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Disseminated varicella zoster virus (VZV) infection with visceral involvement in lung transplant patients is a rare entity with high morbidity and mortality. VZV reactivation occurs in the presence of cellular immunosuppression.1 Severe disease presents in the transplant population with much of the mortality arising from pulmonary graft dysfunction...
October 1, 2014: Chest
M Kaška, J Martinková, E Havel, J Kočí, A Fousková, D Solichová, L Kujovská, I Selke-Krulichová, I Práznovec, V Salavec
INTRODUCTION: The current efforts of intensivists focused on individual antibiotic treatment in patients suffering from sepsis has inspired us to conduct an open prospective clinical study to assess the relationship between body fluid retention (>10 L/24 hours) and the efficiency of hydrophilic time-dependent antibiotics used in critically ill patients. Polytrauma and abdominal catastrophes are the most frequent causes of systemic inflammatory response syndrome (SIRS). Consequent body liquid retention is taken for a pathophysiological covariate modifying the pharmacokinetics (PK) and pharmacodynamics (PD) of hydrophilic time-dependent antibiotics (betalactams and carbapenems)...
September 2014: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Imran Haider, Muhammad Siddiqui, Wisam Naji, Maria Sheikh, Ayesha Waqar
Penile gangrene is a rare disease. It represents a poor prognostic sign in end stage renal disease (ESRD) patients and an indicator of metastatic vascular calcification. Pathogenesis of this life threatening condition is not clearly understood and treatment is also controversial. We describe the case of a 61-year-old man known to have diabetes mellitus, chronic renal failure on haemodialysis, who was complaining of worsening groin pain for 4 weeks. On examination dry gangrene of glans penis was noted. Cultures from the penis showed multiple organisms...
June 2014: JPMA. the Journal of the Pakistan Medical Association
Ondrej Hloch, Dana Mokra, Jan Masopust, Jan Hasa, Jiri Charvat
BACKGROUND: Capnocytophaga canimorsus is a commensal bacterium found in the saliva of dogs and cats. Clinically significant infections in humans after a bite are often associated with the presence of immune deficiency. Early recognition and appropriate treatment are crucial for patient survival. In addition, patients with immune deficiency are susceptible to serious life-threatening nosocomial infections, which may also influence the prognosis of patients with Capnocytophaga canimorsus infection...
2014: BMC Research Notes
Jennifer E Fugate, Ejaaz A Kalimullah, Sara E Hocker, Sarah L Clark, Eelco F M Wijdicks, Alejandro A Rabinstein
INTRODUCTION: Cefepime, a broad spectrum antibiotic, is commonly prescribed in intensive care units (ICU) and may be an overlooked cause of neurologic symptoms such as encephalopathy, myoclonus, seizures, and coma. We aimed to characterize cefepime neurotoxicity in the ICU. METHODS: We performed a retrospective study of adult ICU patients treated with intravenous cefepime for at least 3 days between January 1, 2009 and December 31, 2011. The primary outcome was the development of cefepime neurotoxicity, with the likelihood of causality ascribed via a modified Delphi method...
2013: Critical Care: the Official Journal of the Critical Care Forum
Monica Rocco, Luca Montini, Elisa Alessandri, Mario Venditti, Amalia Laderchi, Gennaro De Pascale, Giammarco Raponi, Michela Vitale, Paolo Pietropaoli, Massimo Antonelli
INTRODUCTION: Use of colistin methanesulfonate (CMS) was abandoned in the 1970s because of excessive nephrotoxicity, but it has been reintroduced as a last-resort treatment for extensively drug-resistant infections caused by gram-negative bacteria (Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumonia). We conducted a retrospective cohort study to evaluate risk factors for new-onset acute kidney injury (AKI) in critically ill patients receiving high intravenous doses of colistin methanesulfonate and/or other nephrotoxic antibiotics...
2013: Critical Care: the Official Journal of the Critical Care Forum
Thanhtaik Kyaw, Rong Ji
SESSION TYPE: Infectious Disease Student/Resident Case Report Posters IIPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Infections with K. pneumoniae are usually hospital-acquired and occur primarily in patients with diminished resistance. Underlying diabetes was significantly more common with community-acquired infection. Compared with K. pneumoniae isolated from patients with primary bacteremia, abscess-forming organisms have a virulent hypermucoviscosity phenotype and may be associated with metastatic infection...
October 1, 2012: Chest
Mieke Carlier, Sofie Carrette, Jason A Roberts, Veronique Stove, Alain Verstraete, Eric Hoste, Pieter Depuydt, Johan Decruyenaere, Jeffrey Lipman, Steven C Wallis, Jan J De Waele
BACKGROUND: Correct antibiotic dosing remains a challenge for the clinician. The aim of this study was to assess the influence of augmented renal clearance on pharmacokinetic/pharmacodynamic target attainment in critically ill patients receiving meropenem or piperacillin/tazobactam, administered as an extended infusion. METHODS: This was a prospective, observational, pharmacokinetic study executed at the medical and surgical intensive care unit at a large academic medical center...
2013: Critical Care: the Official Journal of the Critical Care Forum
H P Kierdorf
The number of dialysis patients needing intensive medical care is steadily increasing, mostly due to cardiovascular diseases. Of the patients 50% are admitted due to myocardial infarction, malignant arrhythmia or acute cardiac failure and many also due to hyperkalemia and acute volume overload against the background of anuria or oligouria associated with arterial hypertension and hypervolemic hypertensive pulmonary edema. The treatment of an acute cardiac syndrome is comparable to the treatment of patients with healthy kidneys and despite the significantly higher cardiovascular mortality of these patients the acute prognosis is not significantly different to non-dialysis patients...
May 2013: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Lutz Binder, Harald Schwörer, Sebastian Hoppe, Frank Streit, Silke Neumann, Annett Beckmann, Rolf Wachter, Michael Oellerich, Philip D Walson
BACKGROUND: Meropenem is an effective β-lactam antibiotic that is frequently used to treat serious infections in both intensive care unit (ICU) and febrile neutropenic hematology/oncology (Hem/Onc) patients. Studies suggest that to be effective, meropenem concentrations must be maintained above the inhibitory concentrations for the majority of a dosing interval. However, the pharmacokinetics (PK) of meropenem seem to differ in critically ill patients compared with healthy or less ill subjects used to select labeled dosing regimens...
February 2013: Therapeutic Drug Monitoring
Balazs Szamosfalvi, Jerry Yee
ESRD patients are admitted more frequently to intensive care units (ICUs) and have higher mortality risks than the general population, and the main causes of critical illness among ESRD patients are cardiovascular events, sepsis, and bleeding. Once in the ICU, hemodynamic stabilization and fluid-electrolyte management pose major challenges in oligoanuric patients. Selection of renal replacement therapy (RRT) modality is influenced by the outpatient modality and access, as well as severity of illness, renal provider experience, and ICU logistics...
January 2013: Advances in Chronic Kidney Disease
Nicholas L Smith, Ross C Freebairn, Michael A J Park, Steven C Wallis, Jason A Roberts, Jeffrey Lipman
Ensuring effective, safe drug dosing in critically ill patients can be difficult, due to variable and dynamic organ function. An 82-year-old man was admitted to the intensive care unit with severe community-acquired pneumonia, septic shock and progressive organ failure. He required ventilation and continuous renal replacement therapy. He developed seizures which we believe were due to cefepime toxicity. Following the first seizure, we took serial measurements of plasma cefepime levels, and a single measurement of the cerebrospinal fluid (CSF) cefepime level...
December 2012: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Janattul-Ain Jamal, Caleb J P Economou, Jeffrey Lipman, Jason A Roberts
PURPOSE OF REVIEW: Antibiotic dosing for critically ill patients that is derived from other patient groups is likely to be suboptimal because of significant antibiotic pharmacokinetic changes, particularly in terms of drug volume of distribution and clearance. Organ support techniques including renal replacement therapy (RRT) and extracorporeal membrane oxygenation (ECMO) increase the pharmacokinetic variability. This article reviews the recently published antibiotic pharmacokinetic data associated with burns patients, those receiving continuous RRT (CRRT), sustained low-efficiency dialysis (SLED) and ECMO...
October 2012: Current Opinion in Critical Care
Pedro Llinares, José Antonio Iribarren
Community-acquired bacteremias assciated with healthcare and, especially, those of nosocomial origin, are mainly caused by Gram-positive microorganisms. Notable among this group are Staphylococcus spp, with an incidence of methicillin resistance of approximately 30% in S. aureus and of 70% in coagulase-negative staphylococcus, which is higher in patients admitted to intensive care units. Vancomycin has been the most widely used antibiotic in these situations but its toxicity, especially in the kidney, and reports of failure when used for the treatment of methicillin-resistant S...
February 2012: Enfermedades Infecciosas y Microbiología Clínica
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