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Antibiotic AND critical ill AND mortality

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https://www.readbyqxmd.com/read/29116995/prolonged-infusion-piperacillin-tazobactam-decreases-mortality-and-improves-outcomes-in-severely-ill-patients-results-of-a-systematic-review-and-meta-analysis
#1
Nathaniel J Rhodes, Jiajun Liu, J Nicholas O'Donnell, Joel M Dulhunty, Mohd H Abdul-Aziz, Patsy Y Berko, Barbara Nadler, Jeffery Lipman, Jason A Roberts
OBJECTIVE: Piperacillin-tazobactam is a commonly used antibiotic in critically ill patients; however, controversy exists as to whether mortality in serious infections can be decreased through administration by prolonged infusion compared with intermittent infusion. The purpose of this systematic review and meta-analysis was to describe the impact of prolonged infusion piperacillin-tazobactam schemes on clinical endpoints in severely ill patients. DESIGN: We conducted a systematic literature review and meta-analysis searching MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library from inception to April 1, 2017, for studies...
November 7, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29108947/antibiotic-strategies-and-clinical-outcomes-in-critically-ill-patients-with-pneumonia-caused-by-carbapenem-resistant-acinetobacter-baumannii
#2
Chun-An Liang, Ying-Chi Lin, Po-Liang Lu, Huang-Chi Chen, Hsu-Liang Chang, Chau-Chyun Sheu
OBJECTIVES: This study aimed to investigate antibiotic prescribing patterns and effectiveness of different anti-carbapenem-resistant Acinetobacter baumannii (CRAB) strategies for CRAB pneumonia. METHODS: We conducted a multicenter, retrospective study in three hospitals. During 2010-2015, adult ICU patients with CRAB pneumonia treated with at least one antimicrobial agent covering the CRAB isolate in vitro for more than two days were included. We used multivariate logistic regression to analyze the associations of anti-CRAB strategies with ICU mortality and other clinical outcomes...
November 3, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/29091053/multiscale-network-representation-of-physiological-time-series-for-early-prediction-of-sepsis
#3
Supreeth Prajwal Shashikumar, Qiao Li, Gari D Clifford, Shamim Nemati
Sepsis, a dysregulated immune-mediated host response to infection, is the leading cause of morbidity and mortality in critically ill patients. Indices of heart rate variability and complexity (such as entropy) have been proposed as surrogate markers of Neuro-immune system dysregulation with diseases such as sepsis. However, these indices only provide an average, one dimensional description of complex neuro-physiological interactions. We propose a novel multiscale network construction and analysis method for multivariate physiological time series, and demonstrate its utility for early prediction of sepsis...
November 1, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/29063877/optimisation-of-antimicrobial-dosing-based-on-pharmacokinetic-and-pharmacodynamic-principles
#4
REVIEW
Grace Si Ru Hoo, Yi Xin Liew, Andrea Lay-Hoon Kwa
While suboptimal dosing of antimicrobials has been attributed to poorer clinical outcomes, clinical cure and mortality advantages have been demonstrated when target pharmacokinetic (PK) and pharmacodynamic (PD) indices for various classes of antimicrobials were achieved to maximise antibiotic activity. Dosing optimisation requires a good knowledge of PK/PD principles. This review serves to provide a foundation in PK/PD principles for the commonly prescribed antibiotics (β-lactams, vancomycin, fluoroquinolones and aminoglycosides), as well as dosing considerations in special populations (critically ill and obese patients)...
July 2017: Indian Journal of Medical Microbiology
https://www.readbyqxmd.com/read/29058601/role-of-renal-function-in-risk-assessment-of-target-non-attainment-after-standard-dosing-of-meropenem-in-critically-ill-patients-a-prospective-observational-study
#5
Lisa Ehmann, Michael Zoller, Iris K Minichmayr, Christina Scharf, Barbara Maier, Maximilian V Schmitt, Niklas Hartung, Wilhelm Huisinga, Michael Vogeser, Lorenz Frey, Johannes Zander, Charlotte Kloft
BACKGROUND: Severe bacterial infections remain a major challenge in intensive care units because of their high prevalence and mortality. Adequate antibiotic exposure has been associated with clinical success in critically ill patients. The objective of this study was to investigate the target attainment of standard meropenem dosing in a heterogeneous critically ill population, to quantify the impact of the full renal function spectrum on meropenem exposure and target attainment, and ultimately to translate the findings into a tool for practical application...
October 21, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29044341/the-use-of-antimicrobials-in-septic-patients-with-acute-kidney-injury
#6
Fernanda Moreira de Freitas, Welder Zamoner, Durval Sampaio de Souza Garms, Mariele Gobo de Oliveira, André Luis Balbi, Daniela Ponce
Sepsis is the most common cause of death in critically ill patients and it may be associated with multiorgan failure, including acute kidney injury (AKI). This situation can require acute renal support and increase mortality. Therefore, it is essential to administrate antimicrobials in dosis to achieve adequate serum levels, preventing overdosis and drug toxicity or underdosing and risk for resistance to antibiotics and higher mortality. To date, there aren't validated guidelines on antibiotic dosis adjustment in septic patients with AKI and the recommendations are extrapolated from studies conducted in non-critical patients with chronic kidney disease in end stage receiving chronic renal replacement therapy...
July 2017: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/29027128/continuous-infusion-versus-intermittent-bolus-of-beta-lactams-in-critically-ill-patients-with-respiratory-infections-a-systematic-review-and-meta-analysis
#7
REVIEW
Young R Lee, Pamela D Miller, Saeed K Alzghari, Delilah D Blanco, Jackson D Hager, Kailey S Kuntz
BACKGROUND: Critically ill patients display altered pharmacokinetics and pharmacodynamics and are more likely to be infected with more resistant pathogens. Beta-lactam antibiotics exhibit time-dependent pharmacodynamics; therefore, it is postulated that continuous infusion (CI) may optimize these parameters. OBJECTIVE: To perform a systematic review and meta-analysis of the available literature comparing CI versus intermittent bolus (IB) of beta-lactam antibiotics in critically ill adult patients with respiratory infections to determine if clinical benefits exist...
October 12, 2017: European Journal of Drug Metabolism and Pharmacokinetics
https://www.readbyqxmd.com/read/29023567/carbapenem-resistant-enterobacteriaceae-colonization-cre-and-subsequent-risk-of-infection-and-90-day-mortality-in-critically-ill-patients-an-observational-study
#8
COMPARATIVE STUDY
Thomas Howe McConville, Sean Berger Sullivan, Angela Gomez-Simmonds, Susan Whittier, Anne-Catrin Uhlemann
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as an urgent public health threat. Intestinal colonization with CRE has been identified as a risk factor for the development of systemic CRE infection, but has not been compared to colonization with third and/or fourth generation cephalosporin-resistant (Ceph-R) Enterobacteriaceae. Moreover, the risk conferred by colonization on adverse outcomes is less clear, particularly in critically ill patients admitted to the intensive care unit (ICU)...
2017: PloS One
https://www.readbyqxmd.com/read/29023316/septic-shock-resuscitation-in-the-first-hour
#9
Nicholas Simpson, Francois Lamontagne, Manu Shankar-Hari
PURPOSE OF REVIEW: We reviewed the recent advances in the initial approach to resuscitation of sepsis and septic shock patients. RECENT FINDINGS: Sepsis and septic shock are life-threatening emergencies. Two key interventions in the first hour include timely antibiotic therapy and resuscitation. Before any laboratory results, the need for resuscitation is considered if a patient with suspected infection has low blood pressure (BP) or impaired peripheral circulation found at clinical examination...
December 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29017451/multiplex-pcr-point-of-care-testing-versus-routine-laboratory-based-testing-in-the-treatment-of-adults-with-respiratory-tract-infections-a-quasi-randomised-study-assessing-impact-on-length-of-stay-and-antimicrobial-use
#10
Denise Andrews, Yumela Chetty, Ben S Cooper, Manjinder Virk, Stephen K Glass, Andrew Letters, Philip A Kelly, Malur Sudhanva, Dakshika Jeyaratnam
BACKGROUND: Laboratory-based respiratory pathogen (RP) results are often available too late to influence clinical decisions such as hospitalisation or antibiotic treatment due to time delay in transport of specimens and testing schedules. Ward-based i.e. point of care (POC) testing providing rapid results may alter the clinical management pathway. METHODS: FilmArray® RP polymerase chain reaction (PCR) systems were placed in three in-patient and out-patient medical areas...
October 10, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28958655/lymphopenic-community-acquired-pneumonia-l-cap-an-immunological-phenotype-associated-with-higher-risk-of-mortality
#11
Jesus F Bermejo-Martin, Catia Cilloniz, Raul Mendez, Raquel Almansa, Albert Gabarrus, Adrian Ceccato, Antoni Torres, Rosario Menendez
The role of neutrophil and lymphocyte counts in blood as prognosis predictors in Community Acquired Pneumonia (CAP) has not been adequately studied. This was a derivation-validation retrospective study in hospitalized patients with CAP and no prior immunosuppression. We evaluated by multivariate analysis the association between neutrophil and lymphocyte counts and mortality risk at 30-days post hospital admission in these patients. The derivation cohort (n=1550 patients) was recruited in a multi-site study...
October 2017: EBioMedicine
https://www.readbyqxmd.com/read/28947683/headspace-volatile-organic-compounds-from-bacteria-implicated-in-ventilator-associated-pneumonia-analysed-by-td-gc-ms
#12
Oluwasola Lawal, Howbeer Muhamadali, Waqar Ahmed, Iain R White, Tamara M E Nijsen, Royston Goodacre, Stephen J Fowler
Ventilator-associated pneumonia (VAP) is a healthcare-acquired infection arising from the invasion of the lower respiratory tract by opportunistic pathogens in critically ill ventilated patients. The current method of diagnosis requires the culture of an airway sample such as bronchoalveolar lavage, which is invasive to obtain and may take up to seven days to identify a causal pathogen, or indeed rule out infection. While awaiting results, patients are administered empirical antibiotics; risks of this approach include lack of effect on the causal pathogen, contribution to the development of antibiotic resistance and downstream effects such as increased length of intensive care stay, cost, morbidity and mortality...
September 26, 2017: Journal of Breath Research
https://www.readbyqxmd.com/read/28923864/age-related-trends-in-adults-with-community-onset-bacteremia
#13
Ching-Chi Lee, Jiun-Ling Wang, Chung-Hsun Lee, Yuan-Pin Hung, Ming-Yuan Hong, Chia-Ming Chang, Wen-Chien Ko
To understand the epidemiological variation in bacteremia characteristics among differently aged populations, adults with community-onset bacteremia during a 6-year period were studied in a retrospective cohort. A total of 2,349 bacteremic patients were stratified into four age categories: young adults (18-44 years old; 196 patients, 8.3%), adults (45-64; 707, 30.1%), the elderly (65-84; 1,098, 46.7%), and the oldest old (≥ 85; 348, 14.8%). Age-related trends in critical illness (a Pitt bacteremia score ≥ 4) at bacteremia onset, antibiotic-resistant pathogens (ESBL-producing Escherichia coli, Klebsiella species, and Proteus mirabilis [EKP]; methicillin-resistant Staphylococcus aureus [MRSA]; and levofloxacin non-susceptible EKP), inappropriate empirical antibiotic therapy (EAT), and 4-week mortality rate were observed...
September 18, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28915392/impact-of-antibiotic-therapy-in-severe-community-acquired-pneumonia-data-from-the-infauci-study
#14
J M Pereira, J Gonçalves-Pereira, O Ribeiro, J P Baptista, F Froes, J A Paiva
Antibiotic therapy (AT) is the cornerstone of the management of severe community-acquired pneumonia (CAP). However, the best treatment strategy is far from being established. To evaluate the impact of different aspects of AT on the outcome of critically ill patients with CAP, we performed a post hoc analysis of all CAP patients enrolled in a prospective, observational, multicentre study. Of the 502 patients included, 76% received combination therapy, mainly a β-lactam with a macrolide (80%). AT was inappropriate in 16% of all microbiologically documented CAP (n=177)...
September 4, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28906137/treatment-of-achromobacter-ventilator-associated-pneumonia-in-critically-ill-trauma-patients
#15
G Christopher Wood, Brittany L Jonap, George O Maish, Louis J Magnotti, Joseph M Swanson, Bradley A Boucher, Martin A Croce, Timothy C Fabian
BACKGROUND: Achromobacter sp are nonfermenting Gram-negative bacilli (NFGNB) that rarely cause severe infections, including ventilator-associated pneumonia (VAP). Data on the treatment of Achromobacter pneumonia are very limited, and the organism has been associated with a high mortality rate. Thus, more data are needed on treating this organism. OBJECTIVE: To evaluate the treatment of Achromobacter VAP in critically ill trauma patients. METHODS: This retrospective, observational study evaluated critically ill trauma patients who developed Achromobacter VAP...
September 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28866975/influence-of-changing-endotracheal-tube-cuff-management-on-antibiotic-use-for-ventilator-associated-pneumonia-in-a-tertiary-intensive-care-unit
#16
Jai N Darvall, Irani Thevarajan, Simon Iles, Thomas Rechnitzer, Tim Spelman, Nerina Harley
BACKGROUND: Routine deflation of the endotracheal tube (ETT) cuff of critically ill patients receiving MV is common in Australia and New Zealand. Literature about ventilatorassociated pneumonia (VAP) and antibiotic use rates with different ETT cuff maintenance practices is lacking. OBJECTIVE: To determine the impact of a change in ETT cuff maintenance from a minimal leak technique to pressure manometry on the administration of antibiotics for VAP. DESIGN, SETTING AND PARTICIPANTS: A prospective, pre- post observational study conducted in a metropolitan tertiary referral intensive care unit...
September 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/28856066/estimation-of-time-period-for-effective-human-inhalational-anthrax-treatment-including-antitoxin-therapy
#17
Lewis Rubinson, Alfred Corey, Dan Hanfling
INTRODUCTION: Infrequent natural human inhalational anthrax cases coupled with high bioterrorism risk have brought about use of animal models to serve as the basis for approval of novel treatments. For inhalational anthrax, protective antigen (PA) drives much of the mortality, and raxibacumab, an anti-PA monoclonal antibody, has been approved for therapeutic use using the Animal Rule. Given the paucity of human inhalational anthrax clinical data including PA kinetics, the post-exposure period for effective treatment of human disease remains unknown...
July 28, 2017: PLoS Currents
https://www.readbyqxmd.com/read/28837364/to-which-extent-can-we-decrease-antibiotic-duration-in-critically-ill-patients
#18
REVIEW
José Garnacho-Montero, Angel Arenzana-Seisdedos, Jan De Waele, Marin H Kollef
Inadequate empirical antibiotic therapy is associated with higher mortality in critically ill patients with severe infections. Nevertheless, prolonged duration of antibiotic treatment is also potentially harmful. Development of new infections with more resistant pathogens is one of the arguments against the administration of prolonged courses of antibiotics. Areas covered: We aim to describe the optimal duration of antimicrobial therapy in the most common infections affecting critically ill patients. A literature search was performed to identify all clinical trials, observational studies, meta-analysis, and reviews about this topic from PubMed...
November 2017: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/28797895/patterns-of-c-reactive-protein-ratio-predicts-outcomes-in-healthcare-associated-pneumonia-in-critically-ill-patients-with-cancer
#19
Ligia S C F Rabello, Pedro Póvoa, Jose R Lapa E Silva, Luciano C P Azevedo, Fernando Jose da Silva Ramos, Thiago Lisboa, Marcio Soares, Jorge I F Salluh
PURPOSE: Describe the patterns of C-reactive protein relative changes in response to antibiotic therapy in critically ill cancer patients with healthcare-associated pneumonia (HCAP) and its ability to predict outcome. METHODS: Secondary analysis of a prospective cohort of critically ill cancer patients with HCAP. CRP was sampled every other day from D0 to D6 of antibiotic therapy. Patients were classified according to an individual pattern of CRP-ratio response: fast - CRP at D4 of therapy was <0...
July 11, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28759427/negative-pressure-wound-therapy-for-patients-with-complex-abdominal-wounds
#20
Zhi Wang, Ming Bai, Xiao Long, Ru Zhao, Xiaojun Wang
The combination of open abdominal wounds and intra-abdominal infections is challenging to treat and often results in critical illness associated with high mortality. OBJECTIVE: The aim of this study is to evaluate the feasibility of using negative pressure wound therapy (NPWT) to manage complex abdominal wounds and summarize relevant treatment experiences. MATERIALS AND METHODS: A retrospective analysis of records from April 2012 to May 2015 identified 13 hospitalized patients with open abdominal wounds complicated by intra-abdominal infections...
July 2017: Wounds: a Compendium of Clinical Research and Practice
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