International journal of antimicrobial agents
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Int. J. Antimicrob. Agents · Mar 2008
A novel way to investigate the effects of plasma exchange on antibiotic levels: use of microdialysis.
Plasma exchange (PE) is a treatment modality frequently used for many autoimmune diseases and may cause extracorporeal elimination of antibiotics. No data currently exist on antibiotic concentrations in extracellular fluid during PE. The aim of this study is to describe the effect of PE on the serum and subcutaneous tissue pharmacokinetics of piperacillin administered as a continuous infusion in a critically ill 17-year-old patient with Guillain-Barré syndrome and ventilator-associated pneumonia on Days 1 and 4 of antibiotic therapy. ⋯ On Day 4 this was estimated to be 11%. Using the in vivo sampling technique microdialysis, we have been able to show that a small redistribution of piperacillin from tissue to serum occurs in response to the reducing serum concentrations caused by PE. In critically ill patients, we believe that administration of a beta-lactam antibiotic by continuous infusion should be considered to maintain serum and tissue concentrations of these time-dependent antibiotics.
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Int. J. Antimicrob. Agents · Feb 2008
ReviewVancomycin-resistant enterococci (VRE): transmission and control.
Transmission of vancomycin-resistant enterococci (VRE) can occur through direct contact with colonised or infected patients or through indirect contact via the hands of health-care workers (HCWs), or via contaminated patient care equipment or environmental surfaces. Antibiotic exposure plays an important role in the transmission dynamic of VRE. Until now, the control measures aimed at reducing the incidence of VRE colonisation and infection in hospitals have included: education of HCWs with implementation of hand-washing practices and compliance; wide and targeted surveillance cultures; isolation of VRE-positive patients; pre-emptive isolation of high-risk patients; and restriction of antibiotic use. ⋯ The causes of this could be non-compliance with infection control interventions, overuse of antibiotics, and insensitive microbiological methods for detecting VRE in stool. A scoring system using point values has been demonstrated to be useful in reducing rates of nosocomial VRE colonisation. Future prospective comparative studies of infection control approaches in different epidemiological situations might be useful.