International journal of antimicrobial agents
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Int. J. Antimicrob. Agents · Jan 2011
Antimicrobial resistance of bacterial isolates from respiratory care wards in Taiwan: a horizontal surveillance study comparison of the characteristics of nosocomial infection and antimicrobial-resistant bacteria in adult Intensive Care Units and two respiratory care facilities for mechanically ventilated patients at a tertiary care centre in Taiwan.
The objectives of this study were to compare the incidence of nosocomial infections (NIs) and the distribution of resistant nosocomial pathogens in adult Intensive Care Units (ICUs) and two respiratory care facilities for prolonged mechanically ventilated patients [i.e. the respiratory care centre (RCC) and the respiratory care ward (RCW)] in a 1100-bed tertiary care hospital in Taiwan from 2003 to 2006. The overall incidences of NI for adult ICUs, the RCC and the RCW were 14.0, 10.3 and 5.0 per 1000 patient-days, respectively. Urinary tract infections, bloodstream infections and pneumonias occurred most frequently. ⋯ In comparison, RCW patients had a higher proportion of NIs caused by S. aureus [odds ratio (OR)=1.9], enterococci (OR=2.2) and Enterobacteriaceae (OR=2.2), but a lower proportion of CoNS (OR=0.3), NFGNB (OR=0.5) and Candida spp. (OR=0.2). RCW patients had higher incidence rates of methicillin-resistant S. aureus (OR=4.91) and extended-spectrum β-lactamase-producing Enterobacteriaceae (OR=4.06) than ICU patients. Further study is needed to delineate the mechanisms responsible for the differences in resistance profile amongst pathogens associated with nosocomial infection in ICUs, RCCs and RCWs.
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Int. J. Antimicrob. Agents · Jan 2011
A higher dose of vancomycin in continuous infusion is needed in critically ill patients.
Compared with intermittent infusion, continuous infusion of vancomycin is cheaper and logistically more convenient, achieves target concentrations faster, results in less variability in serum vancomycin concentrations, requires less therapeutic drug monitoring and causes less nephrotoxicity. Given that critically ill patients may develop very large volumes of distribution as well as supranormal drug clearance, in this study it was shown, despite the limited number of patients studied, that to achieve a target plateau concentration of 25mg/L a daily dose of 3000 mg of vancomycin in continuous infusion is needed following an appropriate loading dose.
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Int. J. Antimicrob. Agents · Dec 2010
ReviewWhat is the pathophysiology of the septic host upon admission?
The enormous case-fatality rate of severe sepsis and septic shock has resulted in considerable efforts being made towards understanding their complex mechanisms of pathogenesis. This has been done with the hope that agents that interfere with the pathways of pathogenesis and modulate the immune response of the host may be candidates for therapy. Disappointing results from most trials of immunomodulators in sepsis have led to understanding that the progression of patients to multiple organ dysfunction syndrome involves blunting of the pro-inflammatory cytokine storm. ⋯ Recent data from the Hellenic Sepsis Study Group demonstrate that components of CARS upon transition from sepsis to severe sepsis/shock differ in relation to the underlying type of infection. These data underscore that the pathogenesis of sepsis presents considerable heterogeneity from one patient to another. That heterogeneity should be taken into consideration when deciding to administer an immunomodulator.
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Int. J. Antimicrob. Agents · Dec 2010
Clearance of vancomycin during continuous infusion in Intensive Care Unit patients: correlation with measured and estimated creatinine clearance and serum cystatin C.
Vancomycin (VAN) dosing requires adjustment to renal function, which is often estimated using the Cockcroft-Gault formula; however, its precision is poor in Intensive Care Unit (ICU) patients. VAN clearance (CL(Van)) during continuous infusion was prospectively determined in 25 ICU patients [14 male, 11 female; age range 31-82 years; body mass index (BMI) 16.5-41.5 kg/m²; Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission 8-36; creatinine clearance 25-195 mL/min] and its correlation with measured creatinine clearance (CL(Crea)), estimated creatinine clearance using the Cockcroft-Gault formula (CL(CG)) and estimated glomerular filtration rate according to Hoek's formula based on serum cystatin C (GFR(Hoek)) was investigated. The correlation between CL(Van) and CL(Crea) was very good (r²=0.88), but it was rather poor with CL(CG) (r² = 0.37) and was acceptable with GFR(Hoek) (r² = 0.70). For VAN dose adjustments in ICU patients, determination of cystatin C may be an interesting and practical alternative to measured CL(Crea), whereas the Cockcroft-Gault formula should be used with caution.