scholarly journals Prolonged versus intermittent β-lactam antibiotics intravenous infusion strategy in sepsis or septic shock patients: a systematic review with meta-analysis and trial sequential analysis of randomized trials

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Yutaka Kondo ◽  
Kohei Ota ◽  
Haruki Imura ◽  
Naoki Hara ◽  
Nobuaki Shime
Keyword(s):  
Septic Shock ◽  
Plasma Concentration ◽  
Hospital Mortality ◽  
Clinical Cure ◽  
Meta Analysis ◽  
Resistant Bacteria ◽  
Prolonged Infusion ◽  
Antibiotic Resistant ◽  
Target Plasma ◽  
Target Plasma Concentration

Abstract Background The prolonged β-lactam infusion strategy has emerged as the standard treatment for sepsis or septic shock despite its unknown efficacy. This study aimed to assess the efficacy of prolonged versus intermittent β-lactam antibiotics infusion on outcomes in sepsis or septic shock patients by conducting a systematic review and meta-analysis. Methods A thorough search was conducted on MEDLINE, the Cochrane Central Register of Controlled Trials, and the Igaku Chuo Zasshi databases. Randomized controlled trials (RCTs) comparing mortality between prolonged and intermittent infusion in adult patients with sepsis or septic shock were included. The primary outcome was hospital mortality. The secondary outcomes were the attainment of the target plasma concentration, clinical cure, adverse events, and occurrence of antibiotic-resistant bacteria. We performed a subgroup analysis stratified according to the year of publication before or after 2015 and a trial sequential analysis (TSA). The Der Simonian–Laird random-effects models were subsequently used to report the pooled risk ratios (RR) with confidence intervals (CI). Results We identified 2869 studies from the 3 databases, and 13 studies were included in the meta-analysis. Hospital mortality did not decrease (RR 0.69 [95%CI 0.47–1.02]) in the prolonged infusion group. The attainment of the target plasma concentration and clinical cure significantly improved (RR 0.40 [95%CI 0.21–0.75] and RR 0.84 [95%CI 0.73–0.97], respectively) in the prolonged infusion group. There were, however, no significant differences in the adverse events and the occurrence of antibiotic-resistant bacteria between the groups (RR 1.01 (95%CI 0.95–1.06) and RR 0.53 [95%CI 0.10–2.83], respectively). For the subgroup analysis, a significant improvement in hospital mortality or clinical cure was reported in studies published in or after 2015 (RR 0.66 [95%CI 0.44–0.98] and RR 0.67 [95%CI 0.50–0.90], respectively). The results of the TSA indicated an insufficient number of studies for a definitive analysis. Conclusions The prolonged infusion of β-lactam antibiotics significantly improved upon attaining the target plasma concentration and clinical cure without increasing the adverse event or the occurrence of antibiotic-resistant bacteria. Prolonged infusion could not improve hospital mortality although an improvement was shown for studies published in or after 2015. Further studies are warranted as suggested by our TSA results.

The Target Plasma Concentration of Propofol Required to Place Laryngeal Mask Versus Cuffed Oropharyngeal Airway

1999 ◽  
Vol 88 (4) ◽  
pp. 917-920 ◽  
Author(s):  
Andrea Casati ◽  
Guido Fanelli ◽  
Elisabetta Casaletti ◽  
Valeria Cedrati ◽  
Fabrizio Veglia ◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Laryngeal Mask ◽  
Oropharyngeal Airway ◽  
Target Plasma ◽  
Target Plasma Concentration

scholarly journals The Target Plasma Concentration of Propofol Required to Place Laryngeal Mask Versus Cuffed Oropharyngeal Airway

1999 ◽  
Vol 88 (4) ◽  
pp. 917-920 ◽  
Author(s):  
Andrea Casati ◽  
Guido Fanelli ◽  
Elisabetta Casaletti ◽  
Valeria Cedrati ◽  
Fabrizio Veglia ◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Laryngeal Mask ◽  
Oropharyngeal Airway ◽  
Target Plasma ◽  
Target Plasma Concentration

scholarly journals Prevention of Postdental Procedure Bacteremia: A Network Meta-analysis

2019 ◽  
Vol 98 (11) ◽  
pp. 1204-1210 ◽  
Author(s):  
B.S. Zeng ◽  
S.Y. Lin ◽  
Y.K. Tu ◽  
Y.C. Wu ◽  
B. Stubbs ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Resistant Bacteria ◽  
Comparative Efficacy ◽  
Serious Adverse Events ◽  
Antibiotic Resistant ◽  
Randomized Controlled ◽  
Placebo Controls ◽  
Amoxicillin Clavulanate

Postdental procedure bacteremia is common and troublesome. The comparative efficacy of multiple prophylactic interventions is unclear. We compared the efficacy of interventions for the prevention of postdental procedure bacteremia. We conducted a review of ClinicalKey, Cochrane CENTRAL, Embase, ProQuest, PubMed, ScienceDirect, Web of Science, and ClinicalTrials.gov from inception to December 4, 2018. Randomized controlled trials that evaluated prophylactic interventions for the prevention of postdental procedure bacteremia were eligible. The primary outcome was the incidence of postdental procedure bacteremia. A total of 24 trials were included with 2,147 participants. Our network meta-analysis demonstrated that intravenous administration of 1,000/200 mg of amoxicillin/clavulanate provided the least incidence of postdental procedure bacteremia among all the prophylactic interventions (odds ratio = 0.03, 95% CI = 0.00 to 0.63) as compared with the placebo/controls. Oral 3 g of amoxicillin had the least incidence of postdental procedure bacteremia among all oral or topical forms of prophylactic interventions (odds ratio = 0.10, 95% CI = 0.02 to 0.44) as compared with the placebo/controls. No serious adverse events, such as anaphylactic shock, mortality, and the development of antibiotic-resistant bacteria, were reported. None of the included subjects were of high risk of infectious endocarditis. Our network meta-analysis demonstrates that intravenous amoxicillin/clavulanate and oral amoxicillin might be the best prophylactic interventions in preventing postdental procedure bacteremia among all the oral/topical forms of interventions for the overall populations.

Effect of Low-Dose Hydrocortisone Therapy in Adult Patients With Septic Shock: A Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

2018 ◽  
Vol 35 (10) ◽  
pp. 971-983 ◽  
Author(s):  
Qing-Quan Lyu ◽  
Qi-Hong Chen ◽  
Rui-Qiang Zheng ◽  
Jiang-Quan Yu ◽  
Xiao-Hua Gu
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Sequential Analysis ◽  
Low Dose ◽  
Meta Analysis ◽  
Adult Patients ◽  
Trial Sequential Analysis ◽  
Icu Mortality ◽  
Randomized Controlled ◽  
Shock Reversal

Background: The efficacy of low-dose hydrocortisone therapy in the management of septic shock remains controversial in critical care for many years. Hence, we performed this meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA) to evaluate its effect on clinical outcome among adult patients with septic shock. Methods: We identified relevant RCTs published from inception to March 7, 2018 comparing low-dose hydrocortisone with placebo or no intervention in adults admitted to the intensive care unit (ICU) for septic shock. Meta-analyses were performed for the primary and secondary outcomes. The risk of bias was assessed using the Cochrane Collaboration’s instrument. Trial sequential analysis was used to pool the results from the included studies for the primary outcomes. Results: Thirteen studies were retrieved by our literature search strategy. There were no significant differences in 28-day mortality (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.81-1.00; P = .05) and hospital mortality (OR = 0.91, 95% CI = 0.82-1.02; P = .09) between the 2 groups, which were confirmed by TSA. However, there was a significant improvement in shock reversal in the hydrocortisone group (OR = 1.33, 95% CI = 1.02-1.72; P = .03). Furthermore, subgroup analyses revealed that hydrocortisone plus fludrocortisone statistically reduced the rate of 28-day mortality (OR = 0.79, 95% CI = 0.64-0.97; P = .03), ICU mortality (OR = 0.77, 95% CI = 0.63-0.95; P = .02), and hospital mortality (OR = 0.77, 95% CI = 0.63-0.95; P = .01) in comparison with the placebo, the results were also confirmed by TSA. Conclusion: Among adult patients with septic shock, the use of low-dose hydrocortisone compared with control did not confer overall survival benefits, albeit improving shock reversal rate. The benefit of reducing 28-day mortality, ICU mortality, and hospital mortality was observed in combination use of hydrocortisone and fludrocortisone.

scholarly journals Twenty-year trends in antimicrobial resistance from aquaculture and fisheries in Asia

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Daniel Schar ◽  
Cheng Zhao ◽  
Yu Wang ◽  
D. G. Joakim Larsson ◽  
Marius Gilbert ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Foodborne Pathogens ◽  
Meta Analysis ◽  
Animal Health ◽  
Eastern China ◽  
Resistant Bacteria ◽  
Antibiotic Resistant ◽  
China And India ◽  
Aquatic Food ◽  
The Impact

AbstractAntimicrobial resistance (AMR) is a growing threat to human and animal health. However, in aquatic animals—the fastest growing food animal sector globally—AMR trends are seldom documented, particularly in Asia, which contributes two-thirds of global food fish production. Here, we present a systematic review and meta-analysis of 749 point prevalence surveys reporting antibiotic-resistant bacteria from aquatic food animals in Asia, extracted from 343 articles published in 2000–2019. We find concerning levels of resistance to medically important antimicrobials in foodborne pathogens. In aquaculture, the percentage of antimicrobial compounds per survey with resistance exceeding 50% (P50) plateaued at 33% [95% confidence interval (CI) 28 to 37%] between 2000 and 2018. In fisheries, P50 decreased from 52% [95% CI 39 to 65%] to 22% [95% CI 14 to 30%]. We map AMR at 10-kilometer resolution, finding resistance hotspots along Asia’s major river systems and coastal waters of China and India. Regions benefitting most from future surveillance efforts are eastern China and India. Scaling up surveillance to strengthen epidemiological evidence on AMR and inform aquaculture and fisheries interventions is needed to mitigate the impact of AMR globally.

Plasma Antipsychotic Drug Concentrations: Practical Clinical Considerations

1996 ◽  
Vol 9 (2) ◽  
pp. 130-132 ◽  
Author(s):  
John S. Markowitz ◽  
Kennerly S. Patrick
Keyword(s):  
Plasma Concentration ◽  
Clinical Status ◽  
Therapeutic Window ◽  
Drug Induced ◽  
Drug Concentrations ◽  
Therapeutic Outcomes ◽  
Target Plasma ◽  
Target Plasma Concentration ◽  
Clinical Considerations ◽  
Pharmacokinetic Drug

The practical application of plasma antipsychotic moni toring to achieve dose optimization remains problematic. Despite numerous studies attempting to establish antipsychotic dosing guidelines based on target plasma concentration ranges, a therapeutic window for most neuroleptics remains elusive and drug individualiza tion is still most often empirically determined. Drug concentration testing for all antipsychotics is commercially available, but at present, only haloperidol and clozapine appear to provide clinically useful plasma values. Reasons for obtaining levels include suspected noncompliance, pharmacokinetic drug interactions, toxicity, and cases in which difficulty arises in distinguishing between drug-induced toxicity and underlying pathology. Accordingly, antipsychotic plasma concentration monitoring offers potential to improve therapeutic outcomes only when interpreted carefully in conjunction with the patient's overall clinical status. Copyright © 1996 by W.B. Saunders Company

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