Systemic pharmacokinetics and safety of high doses of nebulized colistimethate sodium in critically ill patients with hospital-acquired and ventilator-associated pneumonia

2019 ◽  
Vol 74 (11) ◽  
pp. 3268-3273 ◽  
Author(s):  
Adela Benítez-Cano ◽  
Marta de Antonio-Cuscó ◽  
Sonia Luque ◽  
Luisa Sorlí ◽  
Jesús Carazo ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Concentrations ◽  
Case Series ◽  
Surgical Patients ◽  
Ventilator Associated Pneumonia ◽  
Colistimethate Sodium ◽  
High Doses ◽  
Hospital Acquired ◽  
Critically Ill Surgical Patients

Abstract Objectives To assess the pharmacokinetics of formed colistin in plasma and the safety of two different high doses of colistimethate sodium administered via nebulization in critically ill surgical patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). Patients and methods Formed colistin plasma concentrations were measured in critically ill surgical patients with pneumonia treated with two different doses of nebulized colistimethate sodium (3 MIU/8 h versus 5 MIU/8 h). Adverse events possibly related to nebulized colistimethate sodium were recorded. Results Twenty-seven patients (15 in the 3 MIU/8 h group and 12 in the 5 MIU/8 h group) were included. Colistin plasma concentrations were unquantifiable (<0.1 mg/L) in eight (53.3%) patients in the 3 MIU/8 h group and in seven patients (58.3%) in the 5 MIU/8 h group. Median (IQR) quantifiable colistin plasma concentrations before nebulization and at 1, 4 and 8 h were 0.17 (0.12–0.33), 0.20 (0.11–0.24), 0.17 (0.12–0.23) and 0.17 (0.11–0.32) mg/L, respectively, in the 3 MIU/8 h group and 0.20 (0.11–0.35), 0.24 (0.12–0.44), 0.24 (0.10–0.49) and 0.23 (0.11–0.44) mg/L, respectively, in the 5 MIU/8 h group, with no differences between the two groups at any time. Renal impairment during nebulized treatment was observed in three patients in each group, but was unlikely to be related to colistimethate sodium treatment. Nebulized colistimethate sodium therapy was well tolerated and no bronchospasms or neurotoxicity events were observed. Conclusions In this limited observational case series of critically ill patients with HAP or VAP treated with high doses of nebulized colistimethate sodium, systemic exposure was minimal and the treatment was well tolerated.

Vitamin D Status Is Associated With Development of Hospital-Acquired Pressure Injuries in Critically Ill Surgical Patients

2018 ◽  
Vol 34 (1) ◽  
pp. 142-147 ◽  
Author(s):  
Tiffany M. N. Otero ◽  
Cecilia Canales ◽  
D. Dante Yeh ◽  
Ali Elsayes ◽  
Donna M. Belcher ◽  
...  
Keyword(s):  
Vitamin D ◽  
Critically Ill ◽  
Surgical Patients ◽  
Vitamin D Status ◽  
Hospital Acquired ◽  
Critically Ill Surgical Patients

scholarly journals The association between culture positivity and long-term mortality in critically ill surgical patients

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Yu-Cheng Wu ◽  
Li-Ting Wong ◽  
Chieh-Liang Wu ◽  
Wen-Cheng Chao
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Culture ◽  
Surgical Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Culture Positivity ◽  
Critically Ill Surgical Patients ◽  
Long Term Mortality

Abstract Background The long-term outcome is an essential issue in critically ill patients, and the identification of early determinant is needed for risk stratification of the long-term outcome. In the present study, we investigate the association between culture positivity during admission and long-term outcome in critically ill surgical patients. Methods We linked the 2015–2019 critical care database at Taichung Veterans General Hospital with the nationwide death registration files in Taiwan. We described the long-term mortality and proportion of culture positivity among enrolled subjects. We used a log-rank test to estimate survival curves between patients with and without positive cultures and a multivariable Cox proportional hazards regression model to determine hazard ratio (HR) and 95% confidence interval (CI). Results A total of 6748 critically ill patients were enrolled, and 32.5% (2196/6749) of them died during the follow-up period, with the overall follow-up duration was 1.8 ± 1.4 years. We found that 31.4% (2122/6748) of critically ill patients had at least one positive culture during the index admission, and the number of patients with positive culture in the blood, respiratory tract, urinary tract, skin and soft tissue and abdomen were 417, 1702, 554, 194 and 139, respectively. We found that a positive culture from any sites was independently associated with high long-term mortality (aHR 1.579, 95% CI 1.422–1.754) after adjusting relevant covariates, including age, sex, body-mass index, comorbidities, severity score, shock, early fluid overload, receiving mechanical ventilation and the need of renal replacement therapy for critical illness. Conclusions We linked two databases to identify that a positive culture during admission was independently correlated with increased long-term mortality in critically ill surgical patients. Our findings highlight the need for vigilance among patients with a positive culture during admission, and more studies are warranted to validate our findings and to clarify underlying mechanisms.

scholarly journals Liver function, quantified by the LiMAx test, as a predictor for the clinical outcome of critically ill patients treated with linezolid

2021 ◽  
pp. 1-13
Author(s):  
Rawan Alraish ◽  
Sebastian G. Wicha ◽  
Otto R. Frey ◽  
Anka C. Roehr ◽  
Johann Pratschke ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Liver Function ◽  
Clinical Outcome ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Independent Predictor ◽  
Surgical Patients ◽  
Clinical Failure ◽  
Linezolid Therapy ◽  
Critically Ill Surgical Patients

BACKGROUND: Critically ill patients commonly suffer from infections that require antimicrobial therapy. In previous studies, liver dysfunction was shown to have an essential impact on the dose selection in these patients. This pilot study aims to assess the influence of liver dysfunction, measured by the novel LiMAx test, on clinical outcomes in critically ill patients treated with linezolid. METHODS: Twenty-nine critically ill patients were included and treated with linezolid. Indications for linezolid therapy were secondary or tertiary peritonitis (46.7%), bloodstream infection (6.7%) and 46.7% were other infections with gram-positive bacteria. Linezolid Cmin, maximal liver function capacity (LiMAx test) and plasma samples were collected while linezolid therapy was in a steady-state condition. Furthermore, potential factors for the clinical outcome were investigated using logistic regression analysis. Clinical cure was defined as the resolution or significant improvement of clinical symptoms without using additional antibiotic therapy or intervention. RESULTS: Cured patients presented lower median linezolid Cmin yet a significantly higher mean LiMAx-value compared to the clinical failure group (1.9 mg/L vs. 5.1 mg/L) (349 μg/kg/h vs. 131 μg/kg/h). In the logistic regression model, LiMAx < 178 μg/kg/h was the only independent predictor of clinical failure with a sensitivity of 77% and specificity of 93%. CONCLUSIONS: The LiMAx test predicts clinical failure more precisely than linezolid trough levels in critically ill surgical patients. Therefore liver failure may have a stronger impact on the outcome of critically ill surgical patients than low linezolid Cmin. While linezolid Cmin failed to predict patient’s outcome, LiMAx results were the only independent predictor of clinical failure.

Minimizing diagnostic blood loss in critically ill patients

1992 ◽  
Vol 1 (1) ◽  
pp. 85-90 ◽  
Author(s):  
E Gleason ◽  
S Grossman ◽  
C Campbell
Keyword(s):  
Blood Loss ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Diagnostic Procedures ◽  
Open Group ◽  
Surgical Patients ◽  
Comparison Study ◽  
Initial Sample ◽  
Open Method ◽  
Critically Ill Surgical Patients

BACKGROUND: Blood loss from diagnostic procedures in critically ill patients needs to be minimized. Traditionally, when drawing blood from arterial lines, the initial sample used to clear the line has been discarded (open method). Use of a temporary reservoir enables this discard sample to be returned to the patient (closed method). METHODS: Critically ill surgical patients were prospectively randomized to the open or closed method of drawing blood from arterial lines. Blood loss to diagnostic sampling was measured in both groups. RESULTS: A comparison study (n = 1657) of these two methods revealed that blood loss to the patient was significantly decreased (P &lt;&lt; .01) using the closed method. Mean blood loss per patient per day was 69 mL in the open group (n = 873) vs 35 mL in the closed group (n = 784). CONCLUSIONS: Use of the closed method when drawing blood from arterial lines results in a significant decrease in blood lost to diagnostic procedures.

Pharmacokinetic/Pharmacodynamics-Optimized Antimicrobial Therapy in Patients with Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia

2017 ◽  
Vol 38 (03) ◽  
pp. 271-286 ◽  
Author(s):  
Helmi Sulaiman ◽  
Mohd Abdul-Aziz ◽  
Jason Roberts
Keyword(s):  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Drug ◽  
Ventilator Associated Pneumonia ◽  
Physiological Changes ◽  
Significant Morbidity ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

AbstractHospital-acquired pneumonia and ventilator-associated pneumonia continue to cause significant morbidity and mortality. With increasing rates of antimicrobial resistance, the importance of optimizing antibiotic treatment is key to maximize treatment outcomes. This is especially important in critically ill patients in intensive care units, in whom the infection is usually caused by less susceptible organisms. In addition, the marked physiological changes that can occur in these patients can cause serious changes in antibiotic pharmacokinetics which in turn alter the attainment of therapeutic drug exposures. This article reviews the various aspects of the pharmacokinetic changes that can occur in the critically ill patients, the barriers to achieving therapeutic drug exposures in pneumonia for systemically delivered antibiotics, the optimization for commonly used antibiotics in hospital- and ventilator-associated pneumonia, the agents that should be avoided in the treatment regimen, as well as the use of adjunctive therapy in the form of nebulized antibiotics.

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