International journal of antimicrobial agents
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Int. J. Antimicrob. Agents · Aug 2018
Observational StudyPopulation pharmacokinetics of daptomycin in critically ill patients.
Daptomycin has shown activity against a wide range of Gram-positive bacteria; however, the approved dosages usually seem insufficient for critically ill patients. The aim of this study was to develop a population pharmacokinetic model for daptomycin in critically ill patients and to estimate the success of the therapy by applying pharmacokinetic/pharmacodynamic (PK/PD) criteria. Sixteen intensive care unit patients were included, four of whom underwent continuous renal replacement therapies (CRRT). ⋯ The PK/PD analysis confirmed that 280- and 420-mg/d dosages would not be enough to achieve high probabilities of target attainment for MIC values ≥ 1 mg/L in patients with Clcr ≥ 60 mL/min or in subjects with lower Clcrs but receiving CRRT. In these patients, higher dosages (560-840 mg/d) should be needed. When treating infections due to MIC values ≥ 4 mg/L, even the highest dose would be insufficient.
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Int. J. Antimicrob. Agents · Aug 2018
The impact of antibiotic prescription rates on the incidence of MRSA bloodstream infections: A county-level, US-wide analysis.
To investigate the association of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection with socioeconomic factors and antibiotic prescriptions at the county level. ⋯ MRSA bloodstream infection rates were strongly associated with county-level antibiotic use and socioeconomic factors. If the causality of these associations is confirmed, antimicrobial stewardship programs that extend outside acute healthcare facilities would likely prove instrumental in arresting the spread of MRSA.
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Int. J. Antimicrob. Agents · Aug 2018
Multicenter Study Observational StudyPopulation pharmacokinetics of vancomycin in critically ill patients receiving prolonged intermittent renal replacement therapy.
The aim of this study was to describe the population pharmacokinetics of vancomycin during prolonged intermittent renal replacement therapy (PIRRT) in critically ill patients with acute kidney injury. ⋯ This is the first population pharmacokinetic study of vancomycin in patients receiving PIRRT and we observed large pharmacokinetic variability. Empirically, weight-based doses that are appropriate for the duration of PIRRT, should be selected and supplemented with therapeutic drug monitoring.
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Int. J. Antimicrob. Agents · Aug 2018
Nephrotoxicity of piperacillin/tazobactam combined with vancomycin: should it be a concern?
The combination of piperacillin/tazobactam (TZP) and vancomycin (VAN) provides a wide spectrum of activity against many pathogens acquired in healthcare settings. However, there have been reports of increased potential for nephrotoxicity with this combination. The aim of this study was to evaluate the nephrotoxic effect of TZP+VAN and to compare it with that of TZP and VAN monotherapies as well as VAN + meropenem (MEM), another broad-spectrum combination. ⋯ In the multivariate analysis, the risk of AKI increased 3.5-fold in patients treated with TZP+VAN and 1.7-fold in those who were receiving a potentially nephrotoxic drug when the antibiotic regimen was started compared with patients treated with VAN alone. Combined use of TZP+VAN carries a much higher risk of AKI than either antibiotic monotherapy regimen. Therefore, this broad-spectrum combination should be used cautiously in patients with a high likelihood of developing kidney injury.