Combination of pharmacokinetic and pathogen susceptibility information to optimize meropenem treatment of gram-negative infections in critically ill patients

2021 ◽  
Author(s):  
Uwe Liebchen ◽  
Ferdinand Weinelt ◽  
Christina Scharf ◽  
Ines Schroeder ◽  
Michael Paal ◽  
...  
Keyword(s):  
Renal Function ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Stochastic Simulations ◽  
Care Hospital ◽  
Gram Negative ◽  
Susceptibility Data ◽  
Dosing Algorithm ◽  
Dosing Regimens

Background: Meropenem is one of the most frequently used antibiotics to treat life-threatening infections in critically ill patients. This study aimed to develop a meropenem dosing algorithm for the treatment of gram-negative infections based on intensive care unit (ICU)-specific resistance data. Methods: Antimicrobial susceptibility testing of gram-negative bacteria obtained from critically ill patients was carried out from 2016 to 2020 at a tertiary care hospital. Based on the observed minimal inhibitory concentration (MIC) distribution, stochastic simulations (n=1000) of an evaluated pharmacokinetic meropenem model and a defined pharmacokinetic/pharmacodynamic target (100%T >4xMIC while minimum concentrations <44.5 mg/L), dosing recommendations for patients with varying renal function were derived: Pathogen-specific MIC distributions were used to calculate the cumulative fraction of response (CFR) and the overall MIC distribution was used to calculate the local pathogen-independent mean fraction of response (LPIFR) for the investigated dosing regimens. A CFR/LPIFR >90% was considered adequate. Results: The observed MIC distribution significantly differed from the EUCAST database. Based on the 6520 MIC values included, a three-level dosing algorithm was developed. If the pathogen causing the infection is unknown (level 1), known (level 2), known to be neither Pseudomonas aeruginosa nor Acinetobacter baumannii or classified as susceptible (level 3), a continuous infusion of 1.5 g daily reached sufficient target attainment independent of renal function. In all other cases dosing needs to be adjusted based on renal function. Conclusion: ICU-specific susceptibility data should be assessed regularly and integrated into dosing decisions. The presented workflow may serve as a blueprint for other antimicrobial settings. (250 words)

Pharmacoepidemiology of metaraminol in critically ill patients with shock in a tertiary care hospital

2021 ◽  
Author(s):  
Arwa Abu Sardaneh ◽  
Jonathan Penm ◽  
Matthew Oliver ◽  
David Gattas ◽  
Andrew J. McLachlan ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital

scholarly journals Discomforts in Critically ill Patients: Our Experience in Intensive Care Unit of a Tertiary Care Hospital in India

2021 ◽  
Author(s):  
Reetu Verma ◽  
Sasmita Panda ◽  
Rajeev Kumar Nishad
Keyword(s):  
Intensive Care ◽  
Environmental Factors ◽  
Critically Ill ◽  
Nursing Care ◽  
Critically Ill Patients ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Common Cause

Introduction: Patients admitted in the Intensive Care Units (ICUs) experiences various discomforts which may be recognised or unrecognised. These discomforts may arise from the environment, may be related to the ICU care and discomfort related to the health status of the patient and critical care interventions. Aim: To identify the various discomforts in ICU patients, to classify them with respective causes, identify the most common cause among them and whether ICU sedation helps in reducing discomforts. Materials and Methods: This observational study was conducted from 15th July to 15th October 2018 on 120 mixed ICU patients in a Tertiary Care Hospital in India. Patients who were admitted to ICU for more than 24 hours, aged 18 years and above, those who gave written informed consent were observed and enquired for any discomfort. Discomforts have been identified and recorded by a fulltime intensivist by direct observation, by interacting with the patients and asking the family members and others (indirect approach). Through this study discomforts of critically ill patients were broadly classified into four categories 1. Due to existing illness, 2. Due to ICU interventions, 3. Due to improper nursing care and 4. Due to environmental factors. Results: Out of 120 patients studied, 84 patients (70%) reported some kind of discomfort during their ICU stay. Existing illness was the most common cause of discomfort, 80 patients (66.6%) suffered due to it. ICU interventions was the second most common cause, 71 patients (59.1%) had discomfort due to interventions. Thirty five patients (29.1%) suffered due to improper nursing care and 25 patients (20.8%) suffered due to the environmental factors. In this study, it was observed that sedation reduces all kind of discomforts. conclusion: In this study 70% of patients, who were admitted to ICU due to various illness reported some kind of discomfort. The most common cause of ICU discomforts was existing illness followed by ICU interventions. In this study it was observed that sedation reduces all kind of discomforts. Sedated patients tolerate the endotracheal tube better and they had less environmental and procedure related discomforts. With the present study observation it can be suggested that ICU charts of nurses and doctors can carry a separate column for mentioning discomforts in different duty shifts. However, with the use of appropriate analgesia and sedation discomfort can be reduced.

Monitoring therapeutic colistin concentrations in critically ill patients admitted to a tertiary care hospital

2018 ◽  
Vol 34 (11) ◽  
pp. 534-538
Author(s):  
Sriramulu Manivannan Vithunes ◽  
Sathiyanathan Priyanka ◽  
Johncy Jose ◽  
Nitha Thankam Sajeev ◽  
Ranganathan Hariprasad ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital

scholarly journals Characteristics and Outcomes of Critically Ill Patients with Raised Cardiac Troponins Admitted in the Intensive Care Unit

2021 ◽  
Author(s):  
Sunil K. Nadar ◽  
Muhammad M. Shaikh ◽  
Muhammad A. Khatri ◽  
Wael A. Abdelmottaleb ◽  
Sheeraz Ahmed ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Myocardial Injury ◽  
Tertiary Care ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Coronary Syndrome

Objectives: Critically ill patients have been shown to have raised troponins.  The aim of our study was to assess the incidence of myocardial injury in the intensive care unit (ICU) a tertiary care hospital in Oman and assess their management and prognosis. Methods: This was a retrospective study involving adult patients admitted to the ICU of our institution between 1st January and 31st December 2019 who had a high sensitive cardiac troponin (Hs-CTn) assay performed. We excluded patients who were admitted with a primary diagnosis of myocardial infarction. Results: A total of 264 patients had a Hs-cTn measured during this period. Of these 128 patients (64.3+17.1 years; 58.5% male) had elevated levels giving an incidence of around 48.4%. Those with raised troponin were older and had more co-morbidities. These patients were also more critical with lower blood pressure, higher heart rates, hypotensive episodes. Of the 128 patients, 47 were treated as acute coronary syndrome and 32 underwent coronary angiography. Of these only 3 patients required stenting. Patients with raised troponin had a poor outcome with only 45 (35.1%) surviving to discharge as compared to 73.5% where troponin was normal. They had a shorter hospital length of stay as compared to those with normal troponin (16(8-25) vs 19(13-28) p=0.017). Conclusion: A high proportion of critically ill patients have evidence of myocardial injury without significant coronary artery disease. It is associated with poor prognosis. Further prospective studies are required to ascertain the best mode of treatment in these patients. Keywords: Troponin; Biomarkers; Intensive Care; Myocardial Infarction.

scholarly journals Assessment of prognostic value of FT3, FT4 and TSH among critically ill patients

2021 ◽  
Vol 8 (6) ◽  
pp. 775
Author(s):  
Richa Giri ◽  
Pravin Kumar Yadav ◽  
Saurabh Agarwal ◽  
Lalit Kumar
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Prognostic Value ◽  
Tertiary Care ◽  
Thyroid Stimulating Hormone ◽  
Study Patient ◽  
Care Hospital ◽  
Free Triiodothyronine ◽  
Hormonal Change ◽  
Serum T3

Background: Thyroid dysfunction is found to be associated with increased morbidity and mortality rates in intensive care unit (ICU) admitted patients. Critically ill patients who were admitted to ICU showed free triiodothyronine (FT3) levels to be an independent and important predictor of mortality. Decreased levels of free thyroxine (T4) and thyroid stimulating hormone (TSH) showed an indication of worsening of disease and poor prognosis. The most common thyroid hormonal change reported in critically ill patients is reduced serum T3 level. The aim of this study was assessment and prognostic value of thyroid function values among critically ill patients.Methods: The prospective observational study was conducted at department of medicine, at tertiary care hospital of Kanpur, India on 100 critically ill patients admitted who were more than 18 years of age. Patients with history s/o previous thyroid illness and documented thyroid disease, and clinically evident thyroid enlargement were excluded from the study.Results: 50 (50.0%) of 100 patients were males and 50 (50.0%) were females. A total 44.0% mortality was reported with 57±11.96 years of mean age of non-survivors. Only FT3 of thyroid functions have shown statistically highly significant differences (p<0.01). Conclusions: In our study patient admitted in ICU, FT3 was the strongest predictor of ICU mortality in comparison to all other important parameters included in our study.

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