scholarly journals Appropriate antibiotic therapy in critically ill patients

2016 ◽  
Vol 10 (4) ◽  
pp. 275
Author(s):  
Filippo Pieralli ◽  
Antonio Mancini ◽  
Andrea Crociani
Keyword(s):  
Antibiotic Therapy ◽  
Critically Ill ◽  
Antimicrobial Therapy ◽  
Critically Ill Patients ◽  
Management Strategies ◽  
Source Control ◽  
Clinical Settings ◽  
Clinical Scenario ◽  
Initial Antimicrobial Therapy ◽  
Sepsis And Septic Shock

Severe sepsis and septic shock are leading causes of morbidity and mortality in critically ill patients in and outside Intensive Care Units. Early hemodynamic and respiratory support, along with prompt appropriate antimicrobial therapy and source control of the infectious process are cornerstone management strategies to improve survival. Antimicrobial therapy should be as much appropriate as possible, since inappropriate initial antimicrobial therapy is associated with poorer outcome in different clinical settings. When prescribing antibiotic therapy, drug’s characteristics, along with dosing, pharmacokinetics, and pharmacodynamic properties related to the drug and to the clinical scenario should be well kept in mind in order to achieve maximal success.

scholarly journals Dosing of antibiotics in patients with sepsis, including those undergoing renal replacement therapy

2019 ◽  
Vol 1 (16) ◽  
pp. 47-57
Author(s):  
A. O. Shalginskikh ◽  
S. V. Yakovlev ◽  
D. N. Protsenko ◽  
I. N. Sychev ◽  
M. P. Suvorova ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Antibiotic Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Antimicrobial Therapy ◽  
Critically Ill Patients ◽  
Antibacterial Drugs ◽  
Dosing Regimens ◽  
Determining Factor ◽  
Selection Of

In critically ill patients the adequacy of starting empirical antimicrobial therapy is a determining factor of the survival of patients with sepsis This article describes the main aspects of the empirical prescription of antibiotics in patients with sepsis who are on renal replacement therapy. Changes in the pharmacokinetic and pharmacodynamic mechanisms that lead to the selection of specific dosing regimens for antibiotics are described. Information on dosing changes for current groups of antibacterial drugs is presented. The purpose of this article is to rationalize antibiotic therapy in a selected group of patients.

scholarly journals Optimizing Antimicrobial Drug Dosing in Critically Ill Patients

2021 ◽  
Vol 9 (7) ◽  
pp. 1401
Author(s):  
Pedro Póvoa ◽  
Patrícia Moniz ◽  
João Gonçalves Pereira ◽  
Luís Coelho
Keyword(s):  
Critically Ill ◽  
Antimicrobial Therapy ◽  
Critically Ill Patients ◽  
Pathogen Resistance ◽  
Volume Of Distribution ◽  
Drug Clearance ◽  
Therapeutic Drug ◽  
Drug Dosing ◽  
Sepsis And Septic Shock ◽  
Drug Pharmacokinetics

A fundamental step in the successful management of sepsis and septic shock is early empiric antimicrobial therapy. However, for this to be effective, several decisions must be addressed simultaneously: (1) antimicrobial choices should be adequate, covering the most probable pathogens; (2) they should be administered in the appropriate dose, (3) by the correct route, and (4) using the correct mode of administration to achieve successful concentration at the infection site. In critically ill patients, antimicrobial dosing is a common challenge and a frequent source of errors, since these patients present deranged pharmacokinetics, namely increased volume of distribution and altered drug clearance, which either increased or decreased. Moreover, the clinical condition of these patients changes markedly over time, either improving or deteriorating. The consequent impact on drug pharmacokinetics further complicates the selection of correct drug schedules and dosing during the course of therapy. In recent years, the knowledge of pharmacokinetics and pharmacodynamics, drug dosing, therapeutic drug monitoring, and antimicrobial resistance in the critically ill patients has greatly improved, fostering strategies to optimize therapeutic efficacy and to reduce toxicity and adverse events. Nonetheless, delivering adequate and appropriate antimicrobial therapy is still a challenge, since pathogen resistance continues to rise, and new therapeutic agents remain scarce. We aim to review the available literature to assess the challenges, impact, and tools to optimize individualization of antimicrobial dosing to maximize exposure and effectiveness in critically ill patients.

scholarly journals Personalized Antibiotic Therapy for the Critically Ill: Implementation Strategies and Effects on Clinical Outcome of Piperacillin Therapeutic Drug Monitoring—A Descriptive Retrospective Analysis

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1452
Author(s):  
Schrader Nikolas ◽  
Riese Thorsten ◽  
Kurlbaum Max ◽  
Meybohm Patrick ◽  
Kredel Markus ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Antibiotic Therapy ◽  
Critically Ill ◽  
Drug Monitoring ◽  
Critically Ill Patients ◽  
Implementation Strategy ◽  
Care Staff ◽  
Therapeutic Drug ◽  
Health Care Staff ◽  
Standard Operating

Therapeutic drug monitoring (TDM) is increasingly relevant for an individualized antibiotic therapy and subsequently a necessary tool to reduce multidrug-resistant pathogens, especially in light of diminishing antimicrobial capabilities. Critical illness is associated with profound pharmacokinetic and pharmacodynamic alterations, which challenge dose finding and the application of particularly hydrophilic drugs such as β-lactam antibiotics. Methods: Implementation strategy, potential benefit, and practicability of the developed standard operating procedures were retrospectively analyzed from January to December 2020. Furthermore, the efficacy of the proposed dosing target of piperacillin in critically ill patients was evaluated. Results: In total, 160 patients received piperacillin/tazobactam therapy and were subsequently included in the study. Of them, 114 patients received piperacillin/tazobactam by continuous infusion and had at least one measurement of piperacillin serum level according to the standard operating procedure. In total, 271 measurements were performed with an average level of 79.0 ± 46.0 mg/L. Seventy-one piperacillin levels exceeded 100 mg/L and six levels were lower than 22.5 mg/L. The high-level and the low-level group differed significantly in infection laboratory parameters (CRP (mg/dL) 20.18 ± 11.71 vs. 5.75 ± 5.33) and renal function [glomerular filtration rate (mL/min/1.75 m2) 40.85 ± 26.74 vs. 120.50 ± 70.48]. Conclusions: Piperacillin levels are unpredictable in critically ill patients. TDM during piperacillin/tazobactam therapy is highly recommended for all patients. Although our implementation strategy was effective, further strategies implemented into the daily clinical workflow might support the health care staff and increase the clinicians’ alertness.

scholarly journals Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers

2020 ◽  
Author(s):  
Isabela Nascimento Borges ◽  
Rafael Carneiro ◽  
Rafael Bergo ◽  
Larissa Martins ◽  
Enrico Colosimo ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Critically Ill ◽  
Antibiotic Treatment ◽  
Median Duration ◽  
Critically Ill Patients ◽  
Treatment Time ◽  
C Reactive Protein ◽  
Daily Monitoring ◽  
Reactive Protein ◽  
To Receive

Abstract Background: The rational use of antibiotics is one of the main strategies to limit the development of bacterial resistance . We therefore sought to evaluate the effectiveness of a C reactive protein-based protocol in reducing antibiotic treatment time in critically ill patients.Methods: A randomized, open-label, controlled clinical trial conducted in two intensive care units of a university hospital in Brazil. Critically ill infected adult patients were randomly allocated to: i) intervention to receive antibiotics guided by daily monitoring of CRP levels, and ii) control to receive antibiotics according to the best practices for rational use of antibiotics.Results : 130 patients were included in the CRP (n=64) and control (n=66) groups. In the intention to treat analysis, the median duration of antibiotic therapy for the index infectious episode was 7.0 (5.0-8.8) days in the CRP and 7.0 (7.0-11.3) days in the control (p = 0.011) groups. A significant difference in the treatment time between the two groups was identified in the curve of cumulative suspension of antibiotics, with less exposure in the CRP group (p = 0.007). In the per protocol analysis, involving 59 patients in each group, the median duration of antibiotic treatment was 6.0 (5.0-8.0) days for the CRP and 7.0 (7.0- 10.0) days for the control (p = 0.011) groups. Conclusions: Daily monitoring of CRP levels may aid in the reduction of antibiotic treatment time of critically ill patients, even in a scenario of judicious use of antimicrobials. Trial Registry : ClinicalTrials.gov Identifier: NCT02987790. Registered 09 December 2016, https://clinicaltrials.gov/ct2/show/NCT02987790 .

scholarly journals Chronically critically ill patients: different behavior in severe sepsis and septic shock?

2015 ◽  
Vol 3 (S1) ◽  
Author(s):  
DH Prevedello ◽  
A Rea-Neto ◽  
HA Teive ◽  
LA Tannous ◽  
RAO Deucher ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Chronically Critically Ill ◽  
Sepsis And Septic Shock

Venous thromboembolism in critically ill patients

2009 ◽  
Vol 101 (01) ◽  
pp. 139-144 ◽  
Author(s):  
Mark Williams ◽  
Andrew Shorr
Keyword(s):  
Severe Sepsis ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Controlled Trial ◽  
Double Blind ◽  
Vte Prophylaxis ◽  
Drotrecogin Alfa Activated ◽  
History Of ◽  
Sepsis And Septic Shock

SummaryVenous thromboembolism (VTE) is a central concern in the intensive care unit (ICU). However, little is known about both current practices for VTE prevention in the ICU and the risk for VTE in persons with severe sepsis and septic shock. XPRESS was a randomized, double-blind, placebo-controlled trial of prophylactic heparin in patients with severe sepsis and higher disease severity who were treated with drotrecogin alfa (activated) (DAA). Subjects were randomized to unfractionated heparin, low-molecular-weight heparin, or placebo during the DAA infusion period. All patients underwent ultrasonography between days 4-6 to screen for VTE. We assessed baseline utilization of VTE prophylaxis along with application of these methods after completion of the DAA infusion. The study included 1,935 subjects and, prior to enrollment approximately half were given no form of prophylaxis. By day 6, 5% of subjects developed a VTE, and the rate of VTE did not vary based on type of heparin administered. The vast majority of VTE detected by day 6 were clinically silent. Of factors analyzed, history of VTE was the only variable independently associated with development of a VTE (odds ratio, 3.66, 95% confidence interval 1.77–7.56, p=0.005). Strikingly, patients who were initially receiving heparin prophylaxis prior to enrollment but who then had this discontinued because of randomization to placebo suffered more VTE that persons continuing on some form of heparin. Despite multiple guidelines, physicians do not uniformly prescribe VTE prophylaxis. Nonetheless, early VTE occurs even in persons given DAA. Most VTE in critically ill patients are clinically silent.

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