Evaluation of intraperitoneal vancomycin in peritoneal dialysis-associated peritonitis

2021 ◽  
pp. 089686082110515
Author(s):  
Wui Ming Chang ◽  
Elaine Cheng ◽  
Karen Shalansky ◽  
Suneet R Singh
Keyword(s):  
Peritoneal Dialysis ◽  
Treatment Options ◽  
Retrospective Chart Review ◽  
Drug Level ◽  
Optimal Dose ◽  
Therapeutic Drug ◽  
Loading Dose ◽  
Eligibility Criteria ◽  
Serum Vancomycin

Background: Intraperitoneal (IP) vancomycin is recommended as one of the treatment options for gram-positive coverage in the management of peritoneal dialysis (PD)-associated peritonitis. There is a lack of literature supporting the optimal dose and approach to vancomycin therapeutic drug-level monitoring. Methods: A retrospective chart review was conducted using the BC Renal Agency PROMIS Database and our hospital records from 1 June 2011 to 1 July 2019. Adult patients with PD-associated peritonitis who received IP vancomycin and had at least one serum vancomycin level drawn were included. All patients received a loading dose of 30 mg/kg, which was repeated every 3–5 days depending on PD modality. Serum vancomycin levels were drawn prior to the second vancomycin dose, then at the discretion of the prescriber. The primary end point was the rate of therapeutic serum vancomycin levels ≥15 mg/L. Results: Twenty-three episodes of PD-associated peritonitis in 20 patients met the eligibility criteria. Only 15/23 serum vancomycin levels were drawn appropriately after the first dose. Sixty per cent of these levels were subtherapeutic at <15 mg/L. All subsequent serum vancomycin levels were above the therapeutic target. Most peritonitis episodes (78%) achieved resolution of infection. Residual kidney function was not significantly correlated with serum vancomycin levels ( p = 0.19). Conclusions: An IP vancomycin regimen of 30 mg/kg every 3–5 days resulted in subtherapeutic serum vancomycin levels in most patients following the loading dose but therapeutic levels thereafter. A large percentage of vancomycin levels were drawn inappropriately due to misalignment of outpatient follow-up visits and timing of blood work.

scholarly journals P511 Association of ustekinumab serum concentrations and clinical outcomes: results from the mUST-DECIDE trial

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S443-S444
Author(s):  
B Bressler ◽  
B Sattin ◽  
M A Williamson ◽  
R Khanna ◽  
C H Seow ◽  
...  
Keyword(s):  
Disease Control ◽  
Clinical Outcomes ◽  
Retrospective Chart Review ◽  
Drug Level ◽  
Clinic Visit ◽  
Therapeutic Drug ◽  
Loss Of Response ◽  
Clinical Scenarios ◽  
Log Linear

Abstract Background Therapeutic drug monitoring is an important adjunct in optimising IBD management in patients treated with anti-TNF therapies. However, it remains unclear whether these principles apply to non-anti-TNF biologic therapies, such as the anti-IL12/23 agent, ustekinumab (UST). A follow-up analysis of the ‘mUST-DECIDE’ study explores the correlation between UST drug level and clinical outcomes. Methods 111 consecutive UST-treated adult CD patients across 11 sites in Canada from April 2017 to January 2018 were evaluated. Clinical decisions were recorded for all subjects at the single study visit and blood was drawn for TDM (Sanquin, radioimmunoassay). A retrospective chart review was completed in patients who had a follow-up visit ≥ 30 days after the baseline visit. Improved disease control (primary outcome) was defined as a composite assessment outcome meeting ≥ 1 disease control criterion (symptomatic, endoscopic/imaging, biochemical) without any of the non-response criteria (inadequate or loss of response, worsening of any disease control criteria, initiation of any CD-related medications and adverse events). Serum [UST] were categorised as therapeutic, subtherapeutic or uninterpretable based on their position in a 2 compartment PK model [subjects on Q8W dosing were assessed as per the log-linear model which projected a therapeutic level of ≥4.5 µg/ml at 4 weeks and ≥1.0 µg/ml at 8 weeks]. Results 53 patients had a clinical follow-up visit and an interpretable serum [UST]. Patients had refractory disease (89% anti-TNF-exposed, median 16.4 years since diagnosis), but clinically well (66% had baseline HBI &lt;5) on treatment with UST for a median [IQR] of 16.5 [10.4–26.8] months. At baseline, the majority had serum [UST] in the therapeutic range (n = 44/53, 83%). After a median [IQR] of 148 [104–193] days, improved disease control was achieved by 51% of patients at next clinic visit. The outcome appeared independent of achieving therapeutic [UST] at baseline (OR[95% CI] = 0.80[0.19–3.38]). Dose-adjustment occurred in eight (15%) patients and improvements were observed in 75% of these patients. Subgroup analyses failed to detect clinical outcomes that were dependent on therapeutic serum [UST] (Table 1). No new safety signal was observed, no patient samples were positive for antibodies to UST. Conclusion The sub-study did not detect any association between routine serum [UST] and short-term clinical outcomes at the next patient visit. These data broadly suggests that the routine measurement of serum UST in CD patients does not aid in disease management, though further studies across different clinical scenarios (e.g. loss of response) are warranted.

Life After Capo

1983 ◽  
Vol 3 (3_suppl) ◽  
pp. 51-53
Author(s):  
Clair C. Williams
Keyword(s):  
Peritoneal Dialysis ◽  
Treatment Options ◽  
Drop Out ◽  
Advanced Age ◽  
Dialysis Modality ◽  
Short History ◽  
Drop Out Rate ◽  
Stage Renal Disease ◽  
End Stage

Of 508 patients trained for CAPD during the first five years, 115 (22.6%) were transferred to an alternative dialysis modality. Of these 87% were transferred to centre dialysis programs, equally divided between hemodialysis and intermittent peritoneal dialysis. Advanced age favoured transfer to intermittent peritoneal dialysis and failure due to peritonitis, transfer to hemodialysis. Three year survival after transfer from CAPD was 38%. The presence of diabetes and advanced age adversely affected survival after transfer. Dialysis modality and peritonitis as the cause of CAPD failure did not affect survival. Other treatment options are available to patients who fail CAPD. A relatively high drop-out is therefore acceptable and preferable to continuing CAPD in patients encountering complications which might ultimately influence their survival. Since its introduction in Toronto in 1977, continuous ambulatory peritoneal dialysis (CAPD) has achieved increasing prominence in the management of end-stage renal disease. Throughout its comparatively short history, one of the major criticisms of this technique has been the relatively high drop-out rate. This report provides a follow-up of patients transferred from CAPD to alternative dialysis modalities.

scholarly journals Therapeutic Challenges for Elderly Patients with Primary Hyperparathyroidism

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Kenneth Sluis ◽  
Hyon Kim ◽  
Yuling He ◽  
Beatrice Wong ◽  
Xiangbing Wang
Keyword(s):  
Primary Hyperparathyroidism ◽  
Chart Review ◽  
Treatment Options ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Long Term Stability ◽  
Feasible Option ◽  
One Year

Primary hyperparathyroidism (PHPT) predominantly affects older adults, and parathyroidectomy can achieve definitive cure in symptomatic PHPT and asymptomatic meeting surgical criteria. As the population continues to age, the treatment of PHPT in octogenarians and nonagenarians presents a clinical conundrum. This case series presents the management of eight patients 85 years of age and older diagnosed with PHPT. A retrospective chart review of patients diagnosed with primary hyperparathyroidism were identified in a single institution. Those patients 85 years of age and older who were followed up for over one year were included in this case series. The literature on treatment options for this age group was also reviewed. Eight cases of PHPT patients aged 88 ± 2.5 years old with a follow-up average of 5.6 ± 4.4 years were reported in our case series. Six PHPT patients were medically managed and two PHPT patients underwent parathyroid resection. Most of the medically managed PHPT patients except for one had long-term stability of disease for over five years. The treatment of PHPT diagnosed in patients over 85 years of age presents a clinical challenge for which there is no clear consensus guideline. Our case series supports that medical therapy is a feasible option for PHPT patients over 85 years old.

scholarly journals LINC-41. TREATMENT OF RECURRENT MEDULLOBLASTOMA IN CHILDREN IN LOW INCOME SETTINGS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii386-iii386
Author(s):  
Roman Kizyma ◽  
Khrystyna Zapotochna ◽  
Bogdan Romanyshyn ◽  
Zoryana Kizyma ◽  
Roman Sobko
Keyword(s):  
Low Income ◽  
Poor Prognosis ◽  
Recurrent Disease ◽  
Treatment Options ◽  
Retrospective Chart Review ◽  
Local Relapse ◽  
Initial Therapy ◽  
Second Line ◽  
Significant Treatment

Abstract INTRODUCTION Children with recurrent medulloblastoma after initial therapy have very poor prognosis due to limited second line treatment options and significant treatment-related morbidity. METHODS A retrospective chart review of 18 children with recurrent or progressive medulloblastoma, treated initially with risk-adapted therapy in Western Ukrainian Specialized Pediatric Medical Centre from 2012 to 2019, was performed. RESULTS All patients received first line multimodal treatment: surgery, distant beam radiotherapy and chemotherapy. Recurrent disease in 11 patients presented with metastatic dissemination and in 7 patients as local relapse. The median time to recurrence was 10 months. The median follow-up after diagnosis of recurrent disease diagnosed was 2 years and 2 months. Second line therapy included re-surgery (5 cases), radiation therapy (10 cases) and various cytostatic agents as monotherapy or combination - carboplatin, cisplatin, cyclophosphamide, etoposide, methotrexate, temozolomide, lomustine. Patients treated with radiotherapy for salvage had prolonged local control compared to those that received chemotherapy only. On follow-up 8 children are currently alive. CONCLUSION Recurrent and progressive medulloblastoma had a poor prognosis with a 2-year overall survival (OS) of 28% on different salvage therapy. The variety in the treatment of all patients experiencing recurrence was observed due to low income country settings. The factors that influenced higher survival after recurrence of medulloblastoma were longer time to relapse, and local pattern of relapse/progression.

A-7 Improving Brain-Behavior Health in Pediatric Survivors of ECMO

2021 ◽  
Vol 36 (6) ◽  
pp. 1029-1029
Author(s):  
Christen Holder ◽  
Rebekah Shappley ◽  
Swati Karmarkar ◽  
Constance Poplos ◽  
Hitesh Sandhu ◽  
...  
Keyword(s):  
Parental Education ◽  
Treatment Options ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Post Discharge ◽  
Medical Needs ◽  
Program Step ◽  
Neuropsychological Evaluations ◽  
Behavior Health

Abstract Objective Extracorporeal Membrane Oxygenation (ECMO) is a lifesaving measure associated with developmental delays and disabilities among survivors. While guidelines recommend follow-up care for ECMO survivors, children miss care due to the lack of standardized follow-up programs and formalized medical homes. We identified deficiencies in follow-up and developed a novel, structured program at a tertiary care children’s hospital called Standardizing Therapies after ECMO program (STEp) for ECMO survivors. Methods An IRB approved program, STEp was implemented in 2017. If consented, a STEp physician formally evaluated the patient’s post ECMO needs, ordered necessary consults, provided parental education and a letter to pediatrician describing patient’s likely long term medical needs and entered patient in a structured post-discharge follow-up program. We conducted a retrospective chart review to collect data prior to and after implementation of the program in 2017. Results There were 33 survivors in the pre-STEp period (2011–16) and 46 survivors in the STEp period (2017–2020). Consent was provided for STEp in 40 patients (87%). The referral rate improved in all necessary specialties (audiology, PT/OT, Neurology). Neuropsychology evaluation referrals improved from 42% to 58% and the timely evaluation improved from 50% to 100%. 35% of the patients evaluated by neuropsychology in the STEp period were diagnosed with a neurodevelopmental/neurocognitive disorder and thus received appropriate therapies. Conclusions Implementation of a standardized follow-up program for ECMO is feasible and can be implemented successfully. STEp demonstrates that with a structured post-ECMO follow-up program, ECMO survivors can receive appropriate neuropsychological evaluations consistently, thereby identifying potential problems and treatment options.

Analysis of Patient Flow into Dialysis: Role of Education in Choice of Dialysis Modality

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 56-59 ◽  
Author(s):  
Belén Marrón ◽  
Juan Carlos Martínez Ocaña ◽  
Mercedes Salgueira ◽  
Guillermina Barril ◽  
José M. Lamas ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Flow ◽  
Treatment Options ◽  
Clinical Status ◽  
Esrd Patient ◽  
Dialysis Modality ◽  
Medical Visits ◽  
Stage Renal Disease ◽  
End Stage

♦ Background Despite advances in predialysis care, morbidity and mortality remain high. ♦ Objectives To analyze end-stage renal disease (ESRD) patient demographics and clinical data on education on dialysis treatment options, type of chronic renal replacement therapy (RRT), and effects of planned versus non-planned dialysis start. ♦ Methods 621 patients, from 24 Spanish hospitals, who started RRT in 2002. Peritoneal or vascular access at dialysis initiation was considered “planned.” ♦ Results 304 (49%) patients were non-planned and half of them had prior nephrology follow-up. Of the patients with ≥3 months nephrology follow-up (76% of all), only half were educated on dialysis modalities. Dialysis education was associated with planned start in 73.4% versus 26% in non-educated patients ( p < 0.05), shorter follow-up (55 vs 65 months, p = 0.033), more medical visits in the prior year (6.5 vs 4.4, * p < 0.001), more patients starting peritoneal dialysis (31% vs 8.3%*), and more specific follow-up by ESRD unit versus general nephrology care (63% vs 26%*). Non-planned start was associated with older age (63 vs 60.6 years, p = 0.06), fewer medical visits (4.6 vs 6.4*), less education about modality options, and greater use of hemodialysis (92% vs 75%*). Planned patients had better biochemical parameters at start of dialysis. ♦ Conclusion Despite nephrology follow-up, half the patients did not have a planned dialysis start. Planned start was associated with better clinical status. More patients chose peritoneal dialysis when educated about dialysis modality options. ESRD-specific units were more likely to provide patient education.

Feasibility of Early Discharge after Open Hypopharyngeal Surgery for Dysphagia

2020 ◽  
Vol 129 (9) ◽  
pp. 894-900
Author(s):  
Jena Patel ◽  
Joseph Spiegel ◽  
Michael C. Topf ◽  
Maurits Boon ◽  
Colin Huntley
Keyword(s):  
Postoperative Complications ◽  
Oral Intake ◽  
Retrospective Chart Review ◽  
Unplanned Readmission ◽  
Esophageal Mucosa ◽  
Eligibility Criteria ◽  
Level Of Evidence ◽  
Early Return ◽  
Increased Risk

Objective: To determine the rate of surgical complications, unplanned readmission, and functional status after open hypopharyngeal surgery for dysphagia with early return to oral diet and hospital discharge. Methods: Retrospective chart review of patients who underwent open hypopharyngeal surgery for management of dysphagia from March 2013 to June 2018 at a single academic institution. A clear liquid diet is restarted the day of surgery and is advanced to a soft diet on postoperative day one. Univariate and multivariate logistic regression was performed to identify risk factors for postoperative complications and unplanned readmission. Results: Ninety patients met eligibility criteria; 62 patients underwent open cricopharyngeal myotomy, 13 underwent Zenker’s diverticulectomy, 15 had a Zenker’s diverticulopexy. Mean inpatient length of stay was 2.0 ± 2.0 days (range 0-11 days); 57 patients (63.3%) were discharged on the same day as surgery or on postoperative day one. Seven patients (7.8%) had postoperative complications; the most common complication was esophageal leak (n = 6). Six patients (6.7%) had unplanned readmissions within 30 days. Mean time to unplanned readmission was 12 days (range 2-19 days). Open diverticulectomy was associated with an increased risk of unplanned readmission with an OR = 7.63 (95% CI 1.29, 45.45, P = .025). At last follow-up, 70% of patients had an increased functional oral intake by at least one scale score (FOIS) after surgery (mean follow-up 0.8 ± 1.1 years, range 0.02-5.1 years). Conclusion: An early diet and discharge may be safe for patients undergoing open surgery without a mechanical or suture closure of their esophageal mucosa, whereas in those undergoing diverticulectomy, NPO status and a radiological check before resuming drinking and eating are advised. Level of Evidence: 4

Practices Associated with Serum Antiepileptic Drug Level Monitoring at a Pediatric Neurology Clinic

2012 ◽  
Vol 26 (3) ◽  
pp. 192-197 ◽  
Author(s):  
Muhannad R. M. Salih ◽  
Mohd. Baidi Bahari ◽  
Mohamed Azmi Ahmad Hassali ◽  
Asrul Akmal Shafie ◽  
Omer Qutaiba B. Al-lela ◽  
...  
Keyword(s):  
Medical Records ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Drug Level ◽  
Therapeutic Drug ◽  
Neurology Clinic ◽  
Metabolic Epilepsy ◽  
Drug Level Monitoring ◽  
Level Monitoring ◽  
Check Level

Objectives: To assess the practices associated with the application of therapeutic drug monitoring (TDM) for antiepileptic drugs (AEDs) in the management of children with structural–metabolic epilepsy. Methods: It was a retrospective chart review and included children aged ≥2 years old with structural–metabolic epilepsy, treated with AEDs, and received TDM. The data were extracted from the medical records. Results: Thirty-two patients were identified with 50 TDM assays. In two thirds of the assays, “check level” and “recheck level” were the reasons behind the requesting of serum level monitoring of AEDs. Knowledge of serum AED levels led to alterations in the management in 60% of the assays. Thirty-two (76%) pediatrician’s actions were consistent with the recommendation of TDM pharmacist. Forty-nine (98%) levels were appropriately indicated. In relation to the appropriateness of sampling time, 9 (18%) levels were not assessed due to missing data. Twenty-seven (54%) levels were appropriately sampled. Conclusions: More studies should be designed to improve the component of the current TDM request form, especially in the reason section. By the same token, the number of pointless assays and the costs to the health care system can be reduced both by enhancing and improving the educational standards of the requesting neurologists

Patient characteristics associated with dose-limiting sunitinib adverse events

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16110-e16110
Author(s):  
B. Atkinson ◽  
J. Hart ◽  
E. Lin ◽  
N. Tannir ◽  
E. Jonasch
Keyword(s):  
Adverse Events ◽  
Tyrosine Kinases ◽  
Univariate Analysis ◽  
Cell Cancer ◽  
Multivariate Logistic Regression Analysis ◽  
Retrospective Chart Review ◽  
Continuation Methods ◽  
Eligibility Criteria ◽  
The Impact

e16110 Background: Sunitinib, an inhibitor of multiple tyrosine kinases, is FDA approved for metastatic renal cell cancer (mRCC). Though better tolerated than historical therapies, sunitinib is associated with adverse events (AEs) that may require dose modifications (DM). We sought to identify 1) baseline patient (pt) characteristics that predispose for DM, 2) the most common AEs requiring DM in a non-protocol setting, and 3) the impact of dose limiting AEs on treatment continuation. Methods: Single-center, retrospective chart review. Pts ≥ 18 years of age with mRCC of clear-cell histology on sunitinib therapy with active follow-up at MDACC were eligible. Univariate and multivariate logistic regression analysis of 66 pt variables (demographics, laboratory analysis, past medical and treatment history, etc) and dose-limiting AEs was completed, with a 6 month endpoint of sunitinib continuation, alternative therapy, or death. Results: From January 1, 2006 through September 30, 2007, 146 pts were identified meeting eligibility criteria. By univariate analysis, increased age (p=0.04; OR 1.04, 1.002–1.081 CI) and elevated BUN (p=0.03; OR 1.06, 1.006 –1.108 CI) were directly associated with increased incidence of dose-limiting AEs. ECOG PS of 2 (p=0.04; OR 0.3, 0.114–0.951 CI) was associated with a decreased incidence of dose limiting AEs. In a multivariate analysis, only BUN remained significant. 57% of patients (n= 83) had dose-limiting AEs. DM were often attributed to multiple AEs (55%), with fatigue, mucositis, hand-foot syndrome and nausea being the most common. At 6 months follow-up, 63% of pts with dose-limiting AEs remained on sunitinib vs. 37% (p=0.18). There was no difference in death rate at 6 months between the two groups. Conclusions: Elevated baseline BUN is associated with an increased rate of DM in patients with RCC receiving sunitinib. Despite the high-incidence of AEs, pts can be maintained on sunitinib with DM and without an adverse impact on outcome. Whether specific AEs are biologic indicators of activity should be evaluated in a larger clinical trial. [Table: see text]

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