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Vancomycin dialysis

Rebecca Maxson, Julia Pate, Jessica Starr
BACKGROUND: Current vancomycin dosing guidelines recommend targeting trough concentrations of 15-20 mg/L in complicated infections to avoid treatment failure and resistance. How to accomplish this in the intermittent hemodialysis (IHD) population has not been adequately described. A weight-based vancomycin dosing protocol for IHD patients was developed to provide standardization of vancomycin dosing for this patient population. Prior to implementation of this protocol, clinical pharmacists used their individual judgment for dosing and monitoring...
October 19, 2016: Renal Failure
Cheston B Cunha, Erika M C D'Agata
PURPOSE OF REVIEW: Rates of multidrug-resistant organisms (MDRO), including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant gram-negative bacteria, continue to rise among the population of chronic hemodialysis. Antimicrobial exposure is the main risk factor for MDRO emergence and dissemination. Up to 30% of antimicrobial doses administered in out-patient dialysis units may not be indicated. Antimicrobial stewardship programs (ASP) improve antimicrobial prescribing patterns...
November 2016: Current Opinion in Nephrology and Hypertension
Shefali Gupta, Shrikara P Mallya, Ashok Bhat, Shrikala Baliga
INTRODUCTION: Aerobic bacterial infections often complicate vascular access in patients receiving haemodialysis, leading to Catheter-Related Blood Stream Infections (CRBSI). Various studies report Gram - positive bacteria, Staphylococcus aureus (S. aureus) in particular, as the most common aetiologic agent. Studies on microbiological analysis in this subset of population from India are very few. AIM: To examine clinical and bacteriological profiles of haemodialysis patients developing CRBSI, the antibiotic susceptibility of the bacteria isolated from these patients and determine nasal carriage of S...
July 2016: Journal of Clinical and Diagnostic Research: JCDR
José L Merino, Hanane Bouarich, M José Pita, Patricia Martínez, Blanca Bueno, Silvia Caldés, Elena Corchete, M Teresa Jaldo, Beatriz Espejo, Vicente Paraíso
INTRODUCTION: The application of antiseptic solution for handling tunnelled catheters is recommended in patients undergoing haemodialysis. These routine antiseptic procedures in handling catheters are crucial to avoid complications. We report an outbreak of Serratia marcescens (S. marcescens) bacteraemia in numerous haemodialysis units of the Community of Madrid. MATERIAL AND METHODS: The first cases of bacteraemia due to S. marcescens were isolated in December 2014...
August 29, 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Thaina Miranda da Costa, Priscylla Guimarães Migueres Morgado, Fernanda Sampaio Cavalcante, Andreia Paredes Damasco, Simone Aranha Nouér, Kátia Regina Netto Dos Santos
This study analyzed clinical and microbiological characteristics of heteroresistant (hVISA) and vancomycin-intermediate Staphylococcus aureus (VISA) from bloodstream infections (BSI) in a Brazilian teaching hospital, between 2011 and 2013. Minimum inhibitory concentrations (MIC) of antimicrobials were determined by broth microdilution method and SCCmec was detected by PCR. Isolates with a vancomycin MIC ≥ 2mg/L were cultured on BHI agar with 3, 4 or 6 mg/L (BHIa3, BHIa4 or BHIa6) of vancomycin and BHIa4 with casein (BHIa4ca)...
2016: PloS One
Philip Simon Webb, Abdallah Al-Mohammad
A man aged 73 years with infective endocarditis presented with septic shock and was started on immediate antimicrobial therapy. His blood culture yielded no organism. Subsequently, he developed a severe allergic reaction to prolonged empirical vancomycin therapy. This manifested as fever, widespread maculopapular rash and severe progressive acute kidney injury ultimately requiring dialysis. In the context of eosinophilia, this was determined to be drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome...
August 29, 2016: BMJ Case Reports
Mauro Pittiruti, Sergio Bertoglio, Giancarlo Scoppettuolo, Roberto Biffi, Massimo Lamperti, Alberto Dal Molin, Nicola Panocchia, Nicola Petrosillo, Mario Venditti, Carla Rigo, Enrico DeLutio
BACKGROUND: The most appropriate lock solution for central venous access devices is still to be defined. GAVeCeLT - the Italian group for venous access devices - has developed a consensus on the evidence-based criteria for the choice and the clinical use of the most appropriate lock solution for central venous catheters (excluding dialysis catheters). METHOD: After the constitution of a panel of experts, a systematic collection and review of the literature has been performed, focusing on clinical studies dealing with lock solutions used for prevention of occlusion (heparin, citrate, urokinase, recombinant tissue plasminogen activator [r-TPA], normal saline) or for prevention of infection (citrate, ethanol, taurolidine, ethylene-diamine-tetra-acetic acid [EDTA], vancomycin, linezolid and other antibiotics), in both adults and in pediatric patients...
August 1, 2016: Journal of Vascular Access
Terry King-Wing Ma, Chi Bon Leung, Kai Ming Chow, Bonnie Ching-Ha Kwan, Philip Kam-Tao Li, Cheuk Chun Szeto
Peritonitis is a debilitating infectious complication of peritoneal dialysis (PD). Drug-resistant bacterial peritonitis typically has a lower response rate to antibiotics. In the past 15 years, newer antibiotics with activities against drug-resistant Gram-positive bacteria have been developed. In most circumstances, peritonitis due to methicillin-resistant staphylococci responds to vancomycin. If vancomycin cannot be used due to allergy and/or non-susceptibility, there is increasing evidence that linezolid and daptomycin are the drugs of choice...
August 2016: Clinical Kidney Journal
John Dotis, Pavlos Myserlis, Nikoleta Printza, Stella Stabouli, Chrysa Gkogka, Antigoni Pavlaki, Fotios Papachristou
Peritoneal dialysis (PD) constitutes the preferred dialysis modality for children requiring renal replacement therapy with peritonitis being one of the most common complications of PD. This study was performed to evaluate the epidemiology, microbiology, and outcomes of PD-associated peritonitis in Greek children for a 10-year period. A total of 27 patients (16 males) with a mean age 121.8 ± 57.2 months were retrospective analyzed. Patients were on PD therapy for a mean duration of 45.2 ± 26.1 months...
August 2016: Renal Failure
Hong Sang Choi, Eun Hui Bae, Seong Kwon Ma, Soo Wan Kim
A 54-year-old woman on continuous ambulatory peritoneal dialysis was admitted, complaining of diffuse abdominal pain. At peritoneal fluid cell count analysis, WBC count was 2990 cells/mm(3), with being neutrophil count 2510 cells/mm(3). She was treated empirically with intraperitoneal cefazolin and ceftazidime. After 6 days, Microbacterium species grew on peritoneal dialysate culture which had been taken on the day of admission. We analyzed 16S ribosomal RNA gene nucleotide sequence and identified it as M. paraoxydans...
May 9, 2016: Japanese Journal of Infectious Diseases
Guillaume Deslandes, Matthieu Gregoire, Régis Bouquié, Aude Le Marec, Sophie Allard, Eric Dailly, Alain Pineau, Emma Allain-Launay, Pascale Jolliet, Gwenaëlle Roussey, Dominique Navas
♦ Objectives: Assess the stability of several antibiotics in peritoneal dialysis (PD) solutions under common conditions of use in pediatrics, particularly in automated PD. ♦ Methods: Amoxicillin, cefazolin, cefepime, ceftazidime, imipenem, cotrimoxazole, tobramycin, vancomycin, and the association of ceftazidime + vancomycin and ceftazidime+ tobramycin, were tested in 3 different PD solutions: bicarbonate/lactate solution with 2 glucose concentrations (Physioneal 1.36 and 3.86%; Baxter Healthcare Corporation, Deerfield, IL, USA) and an icodextrin-containing solution (Extraneal; Baxter Healthcare Corporation, Deerfield, IL, USA)...
May 4, 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Eyð Tausen Magnussen, Amanda Gratton Vang, Torkil á Steig, Shahin Gaini
We present a case where Bacillus cereus was determined to be the causative agent of relapsing peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). The patient, a 70-year-old man from the Faroe Islands, was admitted with relapsing peritonitis four times over a 3-month period. Peritoneal cultures were positive for growth of B. cereus, a rare bacterial cause of peritonitis. The cultures demonstrated susceptibility to vancomycin, and therefore the patient was treated with intraperitoneal vancomycin, intraperitoneal gentamycin and oral ciprofloxacin...
2016: BMJ Case Reports
Sritika Thapa, Peter B Terry, Biren B Kamdar
BACKGROUND: Hemodialysis (HD) catheters are frequently inserted into the superior vena cava (SVC), and can lead to thrombotic complications. However, to our knowledge, HD catheter-related thrombosis leading to subsequent SVC syndrome, bacteremia, and pulmonary emboli has not been described. CASE PRESENTATION: A 28-year-old dialysis-dependent woman with IgA nephropathy developed facial swelling, head pressure, headache, nausea, dizziness and fever 6 weeks after right internal jugular (IJ) HD catheter placement...
2016: BMC Research Notes
Ryan Deweese, Jennifer Slavens, Antara Barua, James Sutton
PURPOSE: A case of eosinophilic peritonitis (EP) with severe cardiovascular compromise in a patient receiving intraperitoneal vancomycin therapy is described. SUMMARY: A woman with a medical history including hypertension, end-stage renal disease, and anemia of chronic disease was hospitalized for complaints of severe abdominal pain and loss of appetite over the preceding four days; she had been undergoing peritoneal dialysis for about one year. Bacterial infection was diagnosed on the basis of peripheral blood and peritoneal fluid analyses showing highly elevated neutrophil and total nucleated cell (TNC) counts...
May 1, 2016: American Journal of Health-system Pharmacy: AJHP
Rashmi Mishra, Nupur Sinha, Richard Duncalf
Clostridium perfringens bacteremia is associated with adverse outcomes. Known risk factors include chronic kidney disease, malignancy, diabetes mellitus, and gastrointestinal disease. We present a 74-year-old man admitted with confusion, vomiting, and abdominal pain. Exam revealed tachycardia, hypotension, lethargy, distended abdomen, and cold extremities. He required intubation and aggressive resuscitation for septic shock. Laboratory data showed leukocytosis, metabolic acidosis, acute kidney injury, and elevated lipase...
2016: Case Reports in Critical Care
Laura Fuchs Bahlis, Luciano Passamani Diogo, Daniel Lemons, Denise Klaus
INTRODUCTION: Polimyxins were originally abandoned due to high rates of nephrotoxicity. However they have been recently reintroduced due to activity against carbapenem-resistant Gram-negative organisms. Recent literature suggests a lower rate of nephrotoxicity than historically reported. OBJECTIVE: To determine the rate of polymixins-associated nephrotoxicity as defined by the RIFLE criteria. METHODS: A retrospective cohort of all adult patients who received polymixin B at a terciary hospital from December 2010 to March 2011was performed...
October 2015: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Kyoung-Ho Song, Hong Bin Kim, Hyung-sook Kim, Myung Jin Lee, Younghee Jung, Gayeon Kim, Jeong-Hwan Hwang, Nak-Hyun Kim, Moonsuk Kim, Chung-Jong Kim, Pyoeng Gyun Choe, Jae-Yong Chung, Wan Beom Park, Eu Suk Kim, Kyoung Un Park, Nam Joong Kim, Eui-Chong Kim, Myoung-don Oh
There have been few clinical studies on the association between the vancomycin 24-h area under the concentration-time curve (AUC24) to minimum inhibitory concentration (MIC) ratio and vancomycin treatment outcomes in methicillin-resistant Staphylococcus aureus (MRSA) infections. To examine this association and to establish a suitable cut-off value for AUC24/MIC, a multicentre prospective observational study was conducted in patients with MRSA bacteraemia. Data were collected on all patients aged ≥18 years with MRSA bacteraemia treated with vancomycin for ≥72 h without dialysis...
December 2015: International Journal of Antimicrobial Agents
Dwarakanathan Ranganathan, Saiyuri Naicker, Steven C Wallis, Jeffrey Lipman, Sharad K Ratanjee, Jason A Roberts
UNLABELLED:BACKGROUND AND OBJECTIVES: Patients with peritoneal dialysis (PD)-associated peritonitis may be advised to store PD-bags with pre-mixed antibiotics at home, although there is a paucity of antibiotic stability studies in the commonly used icodextrin solutions. The purpose of this study was to assess the stability of various antibiotics in PD-bags when stored at different temperatures over a 14-day period. ♦ METHODS: 7.5% icodextrin PD-bags were dosed with gentamicin 20 mg/L (n = 9), vancomycin 1,000 mg/L (n = 9), cefazolin 500 mg/L (n = 9) and ceftazidime 500 mg/L (n = 9) as for intermittent dosing...
July 2016: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Page Crew, Shannon J Heintz, Brett H Heintz
PURPOSE: Vancomycin dosing and monitoring algorithms for patients with end-stage renal disease (ESRD) receiving intermittent hemodialysis are reviewed. SUMMARY: Vancomycin is one of the most commonly administered antimicrobial agents in adult patients with ESRD receiving intermittent hemodialysis. However, despite the availability of many published studies, the single best method of vancomycin administration in this population remains unclear. Many studies evaluating vancomycin dosing in adult patients with ESRD receiving intermittent hemodialysis were limited by a small sample size, inappropriate therapeutic targets, older hemodialysis modalities (e...
November 1, 2015: American Journal of Health-system Pharmacy: AJHP
Eun Hui Bae, Ha Yeon Kim, Yong Un Kang, Chang Seong Kim, Seong Kwon Ma, Soo Wan Kim
BACKGROUND: Incident hemodialysis patients have the highest mortality in the first several months after starting dialysis. This study evaluated the in-hospital mortality rate after hemodialysis initiation, as well as related risk factors. METHODS: We examined in-hospital mortality and related factors in 2,692 patients starting incident hemodialysis. The study population included patients with acute kidney injury, acute exacerbation of chronic kidney disease, and chronic kidney disease...
September 2015: Kidney Research and Clinical Practice
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