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https://www.readbyqxmd.com/read/29766208/-adequate-anti-infective-treatment-importance-of-individual-dosing-and-application
#1
A Brinkmann, A C Röhr, A Köberer, T Fuchs, W A Krüger, C König, D Richter, M A Weigand, O R Frey
Sepsis-induced changes in pharmacokinetic parameters are a well-known problem in intensive care medicine. Dosing of antibiotics in this setting is therefore challenging. Alterations to the substance-specific kinetics of anti-infective substances have an effect on the distribution and excretion processes in the body. Increased clearance and an increased distribution volume (Vd ) and particularly compromized organ function with reduced antibiotic elimination are often encountered in patients with sepsis. Renal replacement treatment, which is frequently used in intensive care medicine, represents a substantial intervention in this system...
May 15, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29763469/rapid-diagnosis-of-bloodstream-infections-in-the-critically-ill-evaluation-of-the-broad-range-pcr-esi-ms-technology
#2
Martina Tassinari, Silvia Zannoli, Patrizia Farabegoli, Maria Federica Pedna, Anna Pierro, Antonio Mastroianni, Riccardo Fontan, Luciano Luongo, Giuseppe Sarnataro, Elisa Menegatti, Assunta Caruso, Vittorio Sambri
Bloodstream infection (BSI) and associated sepsis represent a major source of mortality in industrialized countries. Prompt treatment with targeted antibiotics affects both the financial impact and the clinical outcome of BSI: every hour gained in initiating the correct antimicrobial therapy significantly increases the probability of patient survival. However, the current standard-of-care, which depends on blood culture-based diagnosis, are often unable to provide such a fast response. Fast and sensitive molecular techniques for the detection of sepsis-related pathogens from primary blood samples are strongly needed...
2018: PloS One
https://www.readbyqxmd.com/read/29746711/a-monte-carlo-simulation-approach-for-beta-lactam-dosing-in-critically-ill-patients-receiving-prolonged-intermittent-renal-replacement-therapy
#3
Soo Min Jang, Katherine N Gharibian, Susan J Lewis, William H Fissell, Ashita J Tolwani, Bruce A Mueller
Cefepime, ceftazidime, and piperacillin/tazobactam are commonly used beta-lactam antibiotics in the critical care setting. For critically ill patients receiving prolonged intermittent renal replacement therapy (PIRRT), limited pharmacokinetic data are available to inform clinicians on the dosing of these agents. Monte Carlo simulations (MCS) can be used to guide drug dosing when pharmacokinetic trials are not feasible. For each antibiotic, MCS using previously published pharmacokinetic data derived from critically ill patients was used to evaluate multiple dosing regimens in 4 different prolonged intermittent renal replacement therapy effluent rates and prolonged intermittent renal replacement therapy duration combinations (4 L/h × 10 hours or 5 L/h × 8 hours in hemodialysis and hemofiltration modes)...
May 10, 2018: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29742584/predictive-validity-of-sepsis-3-definitions-and-sepsis-outcomes-in-critically-ill-patients-a-cohort-study-in-49-icus-in-argentina
#4
Elisa Estenssoro, Vanina S Kanoore Edul, Cecilia I Loudet, Javier Osatnik, Fernando G Ríos, Daniela N Vázquez, Mario O Pozo, Bernardo Lattanzio, Fernando Pálizas, Francisco Klein, Damián Piezny, Paolo N Rubatto Birri, Graciela Tuhay, Anatilde Díaz, Analía Santamaría, Graciela Zakalik, Arnaldo Dubin
OBJECTIVES: The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; besides, regional information of sepsis outcomes is sparse. Our objective was to evaluate Sepsis-3 definition performance in Argentina. DESIGN: Cohort study of 3-month duration beginning on July 1, 2016. SETTINGS: Forty-nine ICUs. PATIENTS: Consecutive patients admitted to the ICU with suspected infection that triggered blood cultures and antibiotic administration...
May 8, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29741076/monitoring-of-hospital-acquired-pneumonia-in-patients-with-severe-brain-injury-on-first-access-to-intensive-neurological-rehabilitation-first-year-of-observation
#5
Gianfranco Beghi, Antonio De Tanti, Paolo Serafini, Chiara Bertolino, Antonietta Celentano, Graziella Taormina
Nosocomial or hospital acquired pneumonia (HAP) is an illness contracted during a hospital stay, generally with onset 48 hours or more after admission to hospital, or within 14 days of discharge from hospital. HAP is divided into subgroups: Ventilator-associated pneumonia (VAP), accounting for 86% of hospital acquired pneumonia, and stroke-associated pneumonia (SAP). The incidence of SAP in neurological intensive care units (NICUs) is 4.1-56.6%, in medical intensive care units (MICUs) it is 17-50%, in stroke units it is 3...
May 9, 2018: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/29735833/echinocandins-their-role-in-the-management-of-candida-biofilms
#6
Subramanian Swaminathan, Shweta Kamat, Nalini Adele Pinto
The importance of antifungal agents and their clinical implications has received little attention in comparison to antibiotics, particularly in the health-care setting. However, apart from bacterial infections rising in hospitals, the incidences of fungal infections are growing with the development of resistance to conventional antifungal agents. Newer antifungal agents such as echinocandins (ECs) have been extensively studied over the past decade and are recognised as a superior treatment compared with prior antifungals as a first line of therapy in tertiary institutions...
January 2018: Indian Journal of Medical Microbiology
https://www.readbyqxmd.com/read/29732182/drugs-pharmacokinetics-during-veno-venous-extracorporeal-membrane-oxygenation-in-pediatrics
#7
REVIEW
Matteo Di Nardo, Enno Diederick Wildschut
Data evaluating pharmacokinetic/pharmacodynamic (PK/PD) aspect in the pediatric population are scarce especially regarding the pediatric intensive care unit. Dosing of frequently used drugs (sedatives, analgesics, antibiotics and cardiovascular drugs) are mainly based on non "pediatric intensive care unit (PICU)" patients, and sometimes are translated from adult patients. Among PICU patients, the most complex patients are the ones who are critically ill and are receiving mechanical circulatory/respiratory support for cardiac and/or respiratory failure...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29704547/predictive-performance-of-a-gentamicin-population-pharmacokinetic-model-in-two-western-populations-of-critically-ill-patients
#8
Laura H Bukkems, Claire Roger, Caspar J Hodiamont, Jean-Yves Lefrant, Nicole P Juffermans, Jason A Roberts, Reinier M van Hest
: Before population pharmacokinetic (PK) models can be clinically applied to aid in dose selection of antibiotics, external validation of the model is warranted. The aim of this study was to assess the predictive performance of a gentamicin population PK model in intensive care unit (ICU) patients in two independent populations of Western critically ill patients. METHODS: Data from the same ICU as used for the earlier model development (Academic Medical Centre, Amsterdam (AMC)) and from the Centre Hospitalier Universitaire de Nîmes (CHU Nîmes) were collected...
April 25, 2018: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/29700761/development-and-first-evaluation-of-a-novel-multiplex-real-time-pcr-on-whole-blood-samples-for-rapid-pathogen-identification-in-critically-ill-patients-with-sepsis
#9
Kirsten van de Groep, Martine P Bos, Paul H M Savelkoul, Anna Rubenjan, Christel Gazenbeek, Willem J G Melchers, Tom van der Poll, Nicole P Juffermans, David S Y Ong, Marc J M Bonten, Olaf L Cremer
Molecular tests may enable early adjustment of antimicrobial therapy and be complementary to blood culture (BC) which has imperfect sensitivity in critically ill patients. We evaluated a novel multiplex real-time PCR assay to diagnose bloodstream pathogens directly in whole blood samples (BSI-PCR). BSI-PCR included 11 species- and four genus-specific PCRs, a molecular Gram-stain PCR, and two antibiotic resistance markers. We collected 5 mL blood from critically ill patients simultaneously with clinically indicated BC...
April 26, 2018: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/29686180/chromobacterium-violaceum-the-deadly-sepsis
#10
Guntur Darmawan, R N Yasmin Kusumawardhani, Bachti Alisjahbana, Trinugroho Heri Fadjari
Chromobacterium violaceum is a Gram-negative facultatively anaerobic, oxidase-positive bacterium producing a dark violet antioxidant pigment called violacein. It is an opportunistic pathogen and has an ubiquitous distribution, mainly resides in water and soil of tropical and subtropical regions.An-18-year-old man referred to the emergency room with a 5-day history of progressively worsening swelling of the right cheek. He sought consult and hospitalized at another institution for three days prior this admission; however, his condition deteriorated...
January 2018: Acta Medica Indonesiana
https://www.readbyqxmd.com/read/29676403/combined-endoscopic-transorbital-and-endonasal-repair-of-high-flow-orbital-apex-middle-fossa-cerebrospinal-fluid-leak-with-a-nasoseptal-flap
#11
Brandon Lucke-Wold, Gustavo Mendez, David Cua, Paul Akins, Haley Gillham, Jeremy Ciporen
Background and importance: High flow orbital apex or middle fossa cerebrospinal fluid (CSF) leaks can be life threatening and complex to repair. These leaks associated with large dural defects are most commonly repaired with an open temporalis muscle patch or free flaps, but these flaps do not always stop the leak. Clinical Presentation: A 65-year-old patient presented two years after orbital exenteration and radiation for squamous cell carcinoma. He developed multi-organism meningitis and pneumocephalus secondary to a large high-flow orbital apex/middle fossa CSF leak...
2018: Journal of neuroinflammation and neurodegenerative diseases
https://www.readbyqxmd.com/read/29670404/evaluation-of-vancomycin-therapy-in-the-adult-icus-of-a-teaching-hospital-in-southern-iran
#12
Afsaneh Vazin, Motahare Mahi Birjand, Masoud Darake
Background: Vancomycin resistance in intensive care units (ICUs) accounts for significant morbidity and excess costs. The objective of the present study was to determine the appropriateness of vancomycin use in the various ICUs of Nemazee Hospital, Shiraz, Iran. Methods: This prospective study was performed on 95 critically ill patients (48 males and 47 females) who were treated with vancomycin for at least 3 subsequent doses in 6 ICUs during 12 months. Required demographic, clinical, and paraclinical data were collected by a pharmacist...
2018: Drug, Healthcare and Patient Safety
https://www.readbyqxmd.com/read/29657606/early-biliary-drainage-is-associated-with-favourable-outcomes-in-critically-ill-patients-with-acute-cholangitis
#13
Mohammed Aboelsoud, Osama Siddique, Alexander Morales, Young Seol, Mazen Al-Qadi
Introduction: Acute cholangitis (AC) is a clinical condition that requires prompt medical management with IV fluids, antibiotics, and biliary drainage (BD). The optimal timing for BD remains unclear. Aim: To investigate the effect of biliary drainage timing on clinical outcomes in AC. Material and methods: We conducted a retrospective study of patients with AC admitted to the ICU using the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database...
2018: Przegla̜d Gastroenterologiczny
https://www.readbyqxmd.com/read/29656714/epidemiology-of-sepsis-in-intensive-care-units-in-turkey-a-multicenter-point-prevalence-study
#14
Nur Baykara, Halis Akalın, Mustafa Kemal Arslantaş, Volkan Hancı, Çiğdem Çağlayan, Ferda Kahveci, Kubilay Demirağ, Canan Baydemir, Necmettin Ünal
BACKGROUND: The prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey. METHODS: A total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included...
April 16, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29642744/evaluation-of-continuous-infusion-vancomycin-administration-in-a-critically-ill-trauma-population
#15
Brittany D Bissell, Gina Riggi, Christopher Morrison
Vancomycin is a first-line antibiotic for empiric treatment of gram-positive infections in the trauma intensive care unit. When dosed intermittently, difficulties arise from trough collection and drug monitoring. The objective of this study was to evaluate time to goal vancomycin levels comparing a continuous infusion protocol when compared to standard intermittent infusion dosing. This was a retrospective cohort of patients admitted to the trauma intensive care unit between July 2011 and July 2015 receiving vancomycin for at least 48 hours...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29629982/end-of-life-care-in-icus-in-east-asia-a-comparison-among-china-korea-and-japan
#16
So Young Park, Jason Phua, Masaji Nishimura, Yiyun Deng, Yan Kang, Keiichi Tada, Younsuck Koh
OBJECTIVES: To compare physicians' perceptions and practice of end-of-life care in the ICU in three East Asian countries cultures similarly rooted in Confucianism. DESIGN: A structured and scenario-based survey of physicians who managed ICU patients from May 2012 to December 2012. SETTING: ICUs in China, Korea, and Japan. SUBJECTS: Specialists who are either intensivists or nonintensivist primary attending physicians in charge of patients (195 in China, 186 in Korea, 224 in Japan)...
April 6, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29623443/pharmacokinetic-and-pharmacodynamic-considerations-of-antibiotics-of-last-resort-in-treating-gram-negative-infections-in-adult-critically-ill-patients
#17
REVIEW
Mojdeh S Heavner, Kimberly C Claeys, Anne M Masich, Jeffrey P Gonzales
PURPOSE OF REVIEW: We provide an overview of antimicrobials that are considered last resort for the treatment of resistant gram-negative infections in adult critically ill patients. The role in therapy, pharmacodynamic (PD) goals, and pharmacokinetic (PK) changes in critical illness for aminoglycosides, polymyxins, tigecycline, fosfomycin, and fluoroquinolones are summarized. RECENT FINDINGS: Altered PK in septic patients in the intensive care unit (ICU) is observed with many of our agents of last resort...
April 5, 2018: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/29619607/pharmacokinetic-pharmacodynamic-considerations-of-beta-lactam-antibiotics-in-adult-critically-ill-patients
#18
REVIEW
Anne M Masich, Mojdeh S Heavner, Jeffrey P Gonzales, Kimberly C Claeys
PURPOSE OF REVIEW: Beta-lactam antibiotics are commonly prescribed in critically ill patients for a variety of infectious conditions. Our understanding of how critical illness alters beta-lactam pharmacokinetics/pharmacodynamics (PK/PD) is rapidly evolving. RECENT FINDINGS: There is a growing body of literature in adult patients demonstrating that physiological alterations occurring in critically ill patients may limit our ability to optimally dose beta-lactam antibiotics to reach these PK/PD targets...
April 4, 2018: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/29619336/risk-of-acute-kidney-injury-in-critically-ill-surgical-patients-with-presumed-pneumonia-is-not-impacted-by-choice-of-methicillin-resistant-staphylococcus-aureus-therapy
#19
Kelsey B Billups, Erica E Reed, Gary S Phillips, Kurt B Stevenson, Steven M Steinberg, Claire V Murphy
Background: Vancomycin and linezolid are standard treatment options for nosocomial methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. While acute kidney injury (AKI) is commonly attributed to vancomycin, existing data has not definitely confirmed vancomycin as an independent risk factor for AKI. Aims: This study aimed to quantify the incidence of AKI in Surgical Intensive Care Unit (ICU) patients receiving empiric vancomycin or linezolid for nosocomial pneumonia and to identify risk factors for AKI with a focus on MRSA antibiotic therapy...
January 2018: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/29614915/preliminary-experience-of-tigecycline-treatment-in-critically-ill-children-with-ventilator-associated-pneumonia
#20
Shupeng Lin, Lingfang Liang, Chenmei Zhang, Sheng Ye
Objective Ventilator-associated pneumonia (VAP) is a life-threatening complication for children who are treated in a paediatric intensive care unit. Tigecycline treatment of children with VAP has not been well studied. This study aimed to describe tigecycline use in children with VAP in a tertiary care hospital. Methods We conducted a retrospective chart review in a tertiary hospital from May 1, 2012 to May 1, 2017. Results Twenty-four children (20 girls) with median age of 8 months (range, 27 days to 6 years and 9 months) were treated with tigecycline...
January 1, 2018: Journal of International Medical Research
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