Efficacy and Safety of Once-Daily Amikacin in Combination with Ceftazidime in Critically Ill Adults with Severe Gram-Negative Infections

Background: The optimal timing for the de-escalation of broad-spectrum antibiotics with activity against Pseudomonas aeruginosa and resistant Gram-negative rods (GNRs) in critically ill adults remains unknown. Research Question: We tested the hypothesis that cultures will identify GNRs that ultimately demonstrate resistance to ceftriaxone within 48 hours, potentially allowing safe de-escalation at this time point. Study Design and Methods: We conducted a secondary analysis of data from the Isotonic Solutions and Major Adverse Renal Events Trial: a pragmatic, cluster-randomized, multiple-crossover trial comparing balanced crystalloids versus saline for intravenous fluid administration in 15,802 critically ill adults at 5 intensive care units (ICUs) at Vanderbilt University Medical Center in Nashville, TN, USA. The primary endpoint was the time-to-positivity of respiratory and blood cultures that ultimately demonstrated growth of GNRs resistant to ceftriaxone. Multivariable logistic regression modeling was used to examine risk factors for the growth of cultures after 48 hours. Results: A total of 524 respiratory cultures had growth of GNRs, of which 284 (54.2%) had resistance to ceftriaxone. A total of 376 blood cultures grew GNRs, of which 70 (18.6%) had resistance to ceftriaxone. At 48 hours, 87% of respiratory cultures and 85% of blood cultures that ultimately grew GNRs resistant to ceftriaxone had demonstrated growth. Age, gender, predicted risk of inpatient mortality and prior use of antibiotics did not predict the growth of cultures after 48 hours. Interpretation: Among a cohort of critically ill adults, 13% of respiratory cultures and 15% of blood cultures that ultimately grew GNRs resistant to ceftriaxone did not demonstrate growth until at least 48 hours after collection. Further work is needed to determine the ideal time for critically ill adults to de-escalate from broad-spectrum antibiotics targeting Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing gram-negative pathogens.

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Efficacy and safety of intravenous iron therapy for treating anaemia in critically ill adults: a rapid systematic review with meta-analysis

Transfusion Medicine Reviews ◽

10.1016/j.tmrv.2021.12.002 ◽

2021 ◽

Author(s):

Louise J Geneen ◽

Catherine Kimber ◽

Carolyn Doree ◽

Simon Stanworth ◽

Akshay Shah

Keyword(s):

Systematic Review ◽

Critically Ill ◽

Meta Analysis ◽

Intravenous Iron ◽

Iron Therapy ◽

Efficacy And Safety ◽

Intravenous Iron Therapy ◽

Critically Ill Adults ◽

Ill Adults

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The Efficacy and Safety of Leg Cycle Ergometry in Critically Ill Adults: A Systematic Review and Meta-Analysis

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a4109 ◽

2019 ◽

Author(s):

A. Takaoka ◽

R. Utgikar ◽

B. Rochwerg ◽

D.J. Cook ◽

M. Kho

Keyword(s):

Systematic Review ◽

Critically Ill ◽

Meta Analysis ◽

Cycle Ergometry ◽

Efficacy And Safety ◽

Leg Cycle Ergometry ◽

Critically Ill Adults ◽

Ill Adults

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Estimation of once-daily amikacin dose in critically ill adults

Journal of Chemotherapy ◽

10.1080/1120009x.2017.1376818 ◽

2017 ◽

Vol 30 (1) ◽

pp. 37-43 ◽

Cited By ~ 2

Author(s):

Martin Šíma ◽

Jan Hartinger ◽

Tereza Cikánková ◽

Ondřej Slanař

Keyword(s):

Critically Ill ◽

Once Daily ◽

Critically Ill Adults ◽

Ill Adults

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Co-infection in critically ill patients with COVID-19: An observational cohort study from England

10.1101/2020.10.27.20219097 ◽

2020 ◽

Author(s):

Vadsala Baskaran ◽

Hannah Lawrence ◽

Louise Lansbury ◽

Karmel Webb ◽

Shahideh Safavi ◽

...

Keyword(s):

Cohort Study ◽

Critically Ill ◽

High Rate ◽

Gram Negative ◽

Icu Stay ◽

Observational Cohort ◽

Clinically Significant ◽

Critically Ill Adults ◽

Hospital Acquired ◽

Ill Adults

AbstractObjectiveTo describe the incidence and nature of co-infection in critically ill adults with COVID-19 infection in England.MethodsA retrospective cohort study of adults with COVID-19 admitted to seven intensive care units (ICUs) in England up to 18 May 2020, was performed. Patients with completed ICU stays were included. The proportion and type of organisms were determined at <48 and >48 hours following hospital admission, corresponding to community and hospital-acquired co-infections.ResultsOf 254 patients studied (median age 59 years (IQR 49-69); 64.6% male), 139 clinically significant organisms were identified from 83(32.7%) patients. Bacterial co-infections were identified within 48 hours of admission in 14(5.5%) patients; the commonest pathogens were Staphylococcus aureus (four patients) and Streptococcus pneumoniae (two patients). The proportion of pathogens detected increased with duration of ICU stay, consisting largely of Gram-negative bacteria, particularly Klebsiella pneumoniae and Escherichia coli. The co-infection rate >48 hours after admission was 27/1000 person-days (95% CI 21.3-34.1). Patients with co-infections were more likely to die in ICU (crude OR 1.78,95% CI 1.03-3.08, p=0.04) compared to those without co-infections.ConclusionWe found limited evidence for community-acquired bacterial co-infection in hospitalised adults with COVID-19, but a high rate of Gram-negative infection acquired during ICU stay.

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The efficacy and safety of prokinetics in critically ill adults receiving gastric feeding tubes: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0245317 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245317

Author(s):

Rong Peng ◽

Hailong Li ◽

Lijun Yang ◽

Linan Zeng ◽

Qiusha Yi ◽

...

Keyword(s):

Length Of Stay ◽

Critically Ill ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Efficacy And Safety ◽

Feeding Tubes ◽

Gastric Feeding ◽

Critically Ill Adults ◽

Ill Adults

Background Intolerance to gastric feeding tubes is common among critically ill adults and may increase morbidity. Administration of prokinetics in the ICU is common. However, the efficacy and safety of prokinetics are unclear in critically ill adults with gastric feeding tubes. We conducted a systematic review to determine the efficacy and safety of prokinetics for improving gastric feeding tube tolerance in critically ill adults. Methods Randomized controlled trials (RCTs) were identified by systematically searching the Medline, Cochrane and Embase databases. Two independent reviewers extracted the relevant data and assessed the quality of the studies. We calculated pooled relative risks (RRs) for dichotomous outcomes and the mean differences (MDs) for continuous outcomes with the corresponding 95% confidence intervals (CIs). We assessed the risk of bias using the Cochrane risk-of-bias tool and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to rate the quality of the evidence. Results Fifteen RCTs met the inclusion criteria. A total of 10 RCTs involving 846 participants were eligible for the quantitative analysis. Most studies (10 of 13, 76.92%) showed that prokinetics had beneficial effects on feeding intolerance in critically ill adults. In critically ill adults receiving gastric feeding, prokinetic agents may reduce the ICU length of stay (MD -2.03, 95% CI -3.96, -0.10; P = 0.04; low certainty) and the hospital length of stay (MD -3.21, 95% CI -5.35, -1.06; P = 0.003; low certainty). However, prokinetics failed to improve the outcomes of reported adverse events and all-cause mortality. Conclusion As a class of drugs, prokinetics may improve tolerance to gastric feeding to some extent in critically ill adults. However, the certainty of the evidence suggesting that prokinetics reduce the ICU or hospital length of stay is low. Prokinetics did not significantly decrease the risks of reported adverse events or all-cause mortality among critically ill adults.

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