Differences in pharmacokinetics and pharmacodynamics of colistimethate sodium (CMS) and colistin between three different CMS dosage regimens in a critically ill patient infected by a multidrug-resistant Acinetobacter baumannii

2013 ◽  
Vol 42 (2) ◽  
pp. 178-181 ◽  
Author(s):  
Sònia Luque ◽  
Santiago Grau ◽  
Marta Valle ◽  
Luisa Sorlí ◽  
Juan Pablo Horcajada ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Critically Ill ◽  
Multidrug Resistant ◽  
Critically Ill Patient ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Dosage Regimens ◽  
Colistimethate Sodium

Critically ill patient with multidrug-resistant Acinetobacter baumannii respiratory infection successfully treated with intravenous and nebulized bacteriophage therapy

2021 ◽  
Author(s):  
Sohail Rao ◽  
Monica Betancourt-Garcia ◽  
Yetunde O. Kare-Opaneye ◽  
Brett E. Swiercezewski ◽  
Jason W. Bennett ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acinetobacter Baumannii ◽  
Critically Ill ◽  
Respiratory Infection ◽  
Bacterial Infections ◽  
Multidrug Resistant ◽  
Critically Ill Patient ◽  
Drug Resistant ◽  
Bacteriophage Therapy ◽  
Chronic Comorbidities

Hospitalized patients are at risk of developing serious multi-drug resistant bacterial infections. This risk is heightened in patients who are on mechanical ventilation, are immunocompromised, and/or have chronic comorbidities. We report the case of a 52-year-old critically ill patient with a multidrug resistant Acinetobacter baumannii (MDR-A) respiratory infection who was successfully treated with antibiotics and intravenous and nebulized bacteriophage therapy.

scholarly journals Population pharmacokinetics and pharmacodynamics modeling to optimize dosage regimens of sulbactam in critically ill patients with severe sepsis caused byAcinetobacterbaumannii

2016 ◽  
pp. AAC.01669-16 ◽  
Author(s):  
Sutep Jaruratanasirikul ◽  
Wibul Wongpoowarak ◽  
Thitima Wattanavijitkul ◽  
Waroonrat Sukarnjanaset ◽  
Maseetoh Samaeng ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multidrug Resistant ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Therapeutic Success ◽  
Dosage Regimens ◽  
Altered Pharmacokinetic ◽  
Alternative Antibiotic ◽  
Volumes Of Distribution

Sulbactam is being considered as an alternative concomitant medication with other effective antibiotics for the treatment of multidrug-resistant (MDR)Acinetobacter baumanniiinfections. Pathophysiological changes in critically ill patients with severe sepsis, resulting in altered pharmacokinetic (PK) patterns for antibiotics, are important factors in determining therapeutic success. The aims of this study were (i) to examine the population PK parameters, and (ii) to assess the probability of target attainment (PTA) for sulbactam in patients with severe sepsis caused byA. baumannii. PK studies were carried out following administration of 2 g of sulbactam every 12 h on the 4thday of drug administration in twenty-seven patients and a Monte Carlo simulation was performed to determine the PTA of achieving 40% exposure time during which the plasma drug concentration remained above the MIC (T>MIC) and 60%T>MIC. The central and peripheral volumes of distribution were 14.56 and 9.55 liters, respectively and total clearances of sulbactam were 2.26 liters/h and 7.64 liters/h in patients aged >65 years and ≤65 years, respectively. The high PTAs (≥90%) for targets of 40%T>MICand 60%T>MICwith a MIC of 4 μg/ml were observed when sulbactam was administered by a 4-h infusion of 1 g every 12 h and 1 g every 8 h, respectively. Sulbactam would be an alternative antibiotic option to coadminister with colistin for the treatment of infections caused by MDRA. baumannii. However, for pathogens with MICs of >4 μg/ml, higher dosage regimens of sulbactam are required.

scholarly journals Transmission of Acinetobacter baumannii by Surgical Masks During the COVID-19 Pandemic

2021 ◽  
Vol 1 (S1) ◽  
pp. s51-s51
Author(s):  
Lisa Saidel ◽  
Abraham Borer ◽  
Orli Sagi
Keyword(s):  
Acinetobacter Baumannii ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multidrug Resistant ◽  
Infection Prevention And Control ◽  
Critically Ill Patient ◽  
Surgical Masks ◽  
Great Persistence ◽  
Healthcare Associated ◽  
Hospital Acquired

Background:Acinetobacter baumannii, one of the major causes of nosocomial infections in modern healthcare systems, is characterized by its great persistence in the environment and by its ability to rapidly develop resistance to many antimicrobials. Most A. baumannii infections occur in intubated critically ill patients, causing ventilator-associated pneumonia which is a leading cause of mortality. During the coronavirus disease 19 (COVID-19) pandemic an increase in hospital-acquired carbapenem-resistant A. baumannii (CRAB) infection and colonization in acute-care hospitals has been described. CRAB healthcare-associated infections are often linked to breaches of infection prevention and control (IPC). Beginning in April 2020, our hospital’s IPC unit ordered mandatory universal masking for all healthcare workers (HCWs). Shortages of personal protective equipment during the COVID-19 pandemic led to extended use of surgical face masks by HCWs in our hospital. We investigated whether the extended use of surgical face masks was linked to an increase of CRAB colonization in our intubated critically ill patients. Methods: Surgical masks were collected from doctors, nurses, and housekeeping staff working in 2 internal medicine departments, each including a 4-bed unit for intubated critically ill patients. All surgical masks were worn continuously for 4–5 hours before removal. “Cases“ were defined as HCWs who treated CRAB colonized critically ill patients. “Controls“ were defined as HCWs who did not enter the critically ill patient unit. Surgical masks were incubated with BHI enrichment broth (HyLabs Rehovot, Israel) for 48 hours at 35°C. BHI was seeded on multidrug-resistant (MDR)–selective CHROMagar plates (HyLabs) and incubated overnight at 35°C. Identification was performed using MALDI-ToF mass spectrophotometry (bioMérieux, France). Susceptibility was tested using Vitek 2 (bioMérieux). Results: In total, 55 HCWs participated in the study: 25 cases and 30 controls. Masks from 10 cases (40%) were colonized with Acinetobacter spp versus only 3 masks (10%) from controls (OR, 5.98; 95% CI, 1.42–25; P = .012). Of 13 masks contaminated with Acinetobacter spp, 8 of 10 contaminated masks among cases were colonized with CRAB, whereas only 1 of 3 masks of controls was colonized with CRAB. Conclusions: During the COVID-19 pandemic, extended surgical mask use while treating patients colonized with CRAB increased mask contamination with this bacterium. Surgical masks should be changed after treating a patient colonized with CRAB the same way gown and glove removal and hand hygiene are performed.Funding: NoDisclosures: None

scholarly journals Optimization and Evaluation of Piperacillin-Tobramycin Combination Dosage Regimens againstPseudomonas aeruginosafor Patients with Altered Pharmacokinetics via the Hollow-Fiber Infection Model and Mechanism-Based Modeling

2018 ◽  
Vol 62 (5) ◽  
Author(s):  
Rajbharan Yadav ◽  
Kate E. Rogers ◽  
Phillip J. Bergen ◽  
Jürgen B. Bulitta ◽  
Carl M. J. Kirkpatrick ◽  
...  
Keyword(s):  
Critically Ill ◽  
Hollow Fiber ◽  
Critically Ill Patient ◽  
Infection Model ◽  
Case Scenario ◽  
Bacterial Killing ◽  
Worst Case ◽  
Content Type ◽  
Dosage Regimens ◽  
Time Kill

ABSTRACTAugmented renal clearance (ARC) in critically ill patients can result in suboptimal drug exposures and treatment failure. Combination dosage regimens accounting for ARC have never been optimized and evaluated againstPseudomonas aeruginosaby use of the hollow-fiber infection model (HFIM). Using aP. aeruginosaisolate from a critically ill patient and static-concentration time-kill experiments (SCTKs), we studied clinically relevant piperacillin and tobramycin concentrations, alone and in combinations, against two inocula (105.8and 107.6CFU/ml) over 72 h. We subsequently evaluated the effects of optimized piperacillin (4 g every 4 h [q4h], given as 0.5-h infusions) plus tobramycin (5 mg/kg of body weight q24h, 7 mg/kg q24h, or 10 mg/kg q48h, given as 0.5-h infusions) regimens on killing and regrowth in the HFIM, simulating a creatinine clearance of 250 ml/min. Mechanism-based modeling was performed in S-ADAPT. In SCTKs, piperacillin plus tobramycin (except combinations with 8 mg/liter tobramycin and against the low inoculum) achieved synergistic killing (≥2 log10versus the most active monotherapy at 48 h and 72 h) and prevented regrowth. Piperacillin monotherapy (4 g q4h) in the HFIM provided 2.4-log10initial killing followed by regrowth at 24 h and resistance emergence. Tobramycin monotherapies displayed rapid initial killing (≥5 log10at 13 h) followed by extensive regrowth. As predicted by mechanism-based modeling, the piperacillin plus tobramycin dosage regimens were synergistic and provided ≥5-log10killing with resistance suppression over 8 days in the HFIM. Optimized piperacillin-tobramycin regimens provided significant bacterial killing and suppressed resistance emergence. These regimens appear to be highly promising for effective and early treatment, even in the near-worst-case scenario of ARC.

scholarly journals Ceftolozane-Tazobactam Pharmacokinetics in a Critically Ill Patient on Continuous Venovenous Hemofiltration

2015 ◽  
Vol 60 (3) ◽  
pp. 1899-1901 ◽  
Author(s):  
Wesley D. Oliver ◽  
Emily L. Heil ◽  
Jeffrey P. Gonzales ◽  
Shailly Mehrotra ◽  
Kathryn Robinett ◽  
...  
Keyword(s):  
Critically Ill ◽  
Multidrug Resistant ◽  
Critically Ill Patient ◽  
Continuous Venovenous Hemofiltration ◽  
Time Curve ◽  
Content Type ◽  
Dosing Interval ◽  
Drug Concentrations ◽  
Extended Infusion ◽  
Susceptibility Breakpoint

Extended-infusion ceftolozane-tazobactam treatment at 1.5 g every 8 h was used to treat multidrug-resistantPseudomonas aeruginosain a critically ill patient on continuous venovenous hemofiltration. Serum drug concentrations were measured at 1, 4, 5, 6, and 8 h after the start of infusion. Prefilter levels of ceftolozane produced a maximum concentration of drug (Cmax) of 38.57 μg/ml, concentration at the end of the dosing interval (Cmin) of 31.63 μg/ml, time toCmax(Tmax) of 4 h, area under the concentration-time curve from 0 to 8 h (AUC0–8) of 284.38 μg · h/ml, and a half-life (t1/2) of 30.7 h. The concentrations were eight times the susceptibility breakpoint for the entire dosing interval.

Sign in / Sign up

Export Citation Format

Share Document