Journal of intensive care medicine
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J Intensive Care Med · Nov 2010
Antimicrobial treatment and clinical outcomes of carbapenem-resistant Acinetobacter baumannii ventilator-associated pneumonia.
Carbapenem-resistant (CR) Acinetobacter baumannii is an important pathogen in ventilator-associated pneumonia (VAP), but therapeutic options are limited. We describe the clinical outcomes of the largest case series of CR-Acinetobacter VAP reported to date. ⋯ Our results demonstrated that CR-Acinetobacter VAP can be effectively treated with second-line agents. However, colistin-related nephrotoxicity was much higher than recently reported and decreased susceptibility to tigecycline emerged on therapy demonstrating the limitations of alternative regimens.
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Antibacterial resistance is increasing throughout the world, while the development of new agents is slowly progressing. In addition, the increasing prevalence of fluoroquinolone resistance may force many practitioners to choose an aminoglycoside agent in gram-negative regimens. ⋯ Clinical application includes the treatment of bacteremia, endocarditis, health-care and nosocomial pneumonias, intra-abdominal infections, and others. Nephrotoxicity and ototoxicity are potential risks of aminoglycoside therapy that may be minimized with serum monitoring and short courses of therapy.
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J Intensive Care Med · Nov 2010
Preliminary experience with clevidipine in the pediatric population.
Clevidipine is a third-generation calcium channel antagonist of the dihydropyridine group. Like nicardipine, its primary physiologic effect is vasodilation, primarily of the arterial system with limited effects on capacitance vessels. Unlike other direct-acting vasodilators, it has an ultrashort half-life due to its metabolism by nonspecific blood and tissue esterases. ⋯ The clevidipine infusion was started at 0.5 to 1 μg/kg per minute and titrated up to 3.5 μg/kg per minute as needed. No excessive hypotension was noted; however, intermittent doses of metoprolol were required to control reflex tachycardia in 2 of the 10 patients and an elevated triglyceride level was noted in 1 patient. Our preliminary experience demonstrates the efficacy of clevidipine for blood pressure control during the perioperative period.