Therapeutic drug monitoring-guided continuous infusion of piperacillin/tazobactam significantly improves pharmacokinetic target attainment in critically ill patients: a retrospective analysis of four years of clinical experience

AbstractPurposeStandard dosing and intermittent bolus application (IB) are important risk factors for pharmacokinetic (PK) target non-attainment during empirical treatment with β-lactams in critically ill patients, particularly in those with sepsis and septic shock. We assessed the effect of therapeutic drug monitoring-guided (TDM), continuous infusion (CI) and individual dosing of piperacillin/tazobactam (PIP) on PK-target attainment in critically ill patients.MethodsThis is a retrospective, single-center analysis of a database including 484 patients [933 serum concentrations (SC)] with severe infections, sepsis and septic shock who received TDM-guided CI of PIP in the intensive care unit (ICU) of an academic teaching hospital. The PK-target was defined as a PIP SC between 33 and 64  mg/L [fT  >  2–4 times the epidemiological cutoff value (ECOFF) ofPseudomonas aeruginosa (PSA)].ResultsPK-target attainment with standard dosing (initial dose) was observed in 166 patients (34.3%), whereas only 49 patients (10.1%) demonstrated target non-attainment. The minimum PK-target of  ≥ 33 mg/L was overall realized in 89.9% (n = 435/484) of patients after the first PIP dose including 146 patients (30.2%) with potentially harmful SCs ≥ 100 mg/L. Subsequent TDM-guided dose adjustments significantly enhanced PK-target attainment to 280 patients (62.4%) and significantly reduced the fraction of potentia...
Source: Infection - Category: Infectious Diseases Source Type: research

Related Links:

We report the first US case of a 56-year-old nondiabetic male with ESRD secondary to IgA nephropathy undergoing thrice-weekly maintenance hemodialysis for 3 years, who developed COVID-19 infection. He has hypertension controlled with angiotensin receptor blocker losartan 100 mg/day and coronary artery disease status-post stent placement. During the first 5 days of his febrile disease, he presented to an urgent care, 3 emergency rooms, 1 cardiology clinic, and 2 dialysis centers in California and Utah. During this interval, he reported nausea, vomiting, diarrhea, and low-grade fevers but was not suspected of COVID-19 infect...
Source: American Journal of Nephrology - Category: Urology & Nephrology Authors: Tags: Am J Nephrol Source Type: research
CONCLUSIONS: The incidence of pregnancy-related AKI remains high in the maternal ICU setting. Septic shock, hypovolemic shock, and higher APACHE II and SOFA scores were independently associated dialysis therapy (hemodialysis in all cases). KDIGO stages 2 and 3 were less frequent than KDIGO stage 1 in patients with gestational hypertension. Norepinephrine and hemodialysis therapy were independently associated with maternal mortality in patients with pregnancy-related AKI. KDIGO stage 3 was associated with higher maternal mortality. PMID: 32072506 [PubMed - as supplied by publisher]
Source: Journal of Nephrology - Category: Urology & Nephrology Authors: Tags: J Nephrol Source Type: research
Due to the potential risk of volume overload, physicians are hesitant to aggressively fluid-resuscitate septic patients with end-stage renal disease (ESRD) on hemodialysis (HD). Our study indicates that aggressive fluid resuscitation appears to be safe in ESRD patients.
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
This study seeks to examine the association between the inflammatory background and the need for catecholamine treatment in hemodynamically instable patients having septic shock and acute kidney injury during HCO-CVVHD. There were 38 patients (F/M; 16/22, mean age 63 ± 16 years) included in the study. The initial content of the cytokines IL-4, IL-12, IL-17, and TNFα, C-reactive protein, and the score of the Sequential Organ Failure Assessment (SOFA) were assessed. The receiver operating characteristic (ROC) plot showed that a combination consisting of IL-17 × SOFA ≤22.3 was a ...
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research
We report a case of a 59-year-old female patient with vegetative native mitral valve endocarditis caused by Stenotrophomonas maltophilia (SM). She had hemodialysis-dependent chronic renal failure, but no immunosuppressive disease. Echocardiography showed mobile vegetation on her native mitral valve. Right femoral artery embolectomy and mitral valve replacement were performed simultaneously. She awakened from anesthesia, but she passed away due to septic shock complications. To the best of our knowledge, this was the first case in whom native mitral valve endocarditis caused by SM was observed (despite of absence of any imm...
Source: Revista Brasileira de Cirurgia Cardiovascular - Category: Cardiovascular & Thoracic Surgery Source Type: research
Publication date: Available online 23 October 2019Source: Journal of Critical CareAuthor(s): Kartikeya Rajdev, Lazer Leifer, Gurkirat Sandhu, Benjamin Mann, Sami Pervaiz, Saad Habib, Abdul Hasan Siddiqui, Bino Joseph, Seleshi Demissie, Suzanne El-SayeghAbstractDue to the potential risk of volume overload, physicians are hesitant to aggressively fluid-resuscitate septic patients with end-stage renal disease (ESRD) on hemodialysis (HD). Primary objective: To calculate the percentage of ESRD patients on HD (Case) who received ≥30 mL/Kg fluid resuscitation within the first 6 h compared to non-ESRD patients (Control) tha...
Source: Journal of Critical Care - Category: Gastroenterology Source Type: research
Authors: Barcelos STA, Dall'Oglio VM, de Araújo A, Cerski CTS, Álvares-da-Silva MR Abstract Hepatic sinusoidal obstruction syndrome (HSOS) is a hepatic vascular disease histologically characterized by edema, necrosis, detachment of endothelial cells in small sinusoidal hepatic and interlobular veins and intrahepatic congestion, which leads to portal hypertension and liver dysfunction. In the Western world, most HSOS cases are associated with myeloablative pretreatment in a hematopoietic stem cell transplantation setting. Here we report a case of a 54 years old female patient, otherwise healthy, with n...
Source: Annals of Hepatology - Category: Gastroenterology Tags: Ann Hepatol Source Type: research
Staphylococcal scalded skin syndrome (SSSS) is an exfoliative skin syndrome that occurs as a reaction to an exotoxin released by Staphylococcus aureus, and most commonly occurs in children and adults with renal failure or immunocompromised. Patients can have variation of severity, from localized blisters to generalized skin exfoliation involving all body surfaces. SSSS can be life-threating and should be diagnosed and treated promptly. This is a case of 51 y/o woman with hypertension, type 2 diabetes mellitus, cardiomyopathy, and renal failure for which has been receiving hemodialysis (HD) for the past 4 years that present...
Source: Journal of the American Academy of Dermatology - Category: Dermatology Source Type: research
DISCUSSION: We show that combined cytokine adsorption/continuous veno-venous hemodialysis is effective to control pH, to reduce urea and creatinine, and to improve hemodynamics by reducing norepinephrine doses in patients with septic shock. It can be applied safely with standard settings of regional citrate anticoagulation rendering sufficiently long filter lifetimes for the adsorber and the continuous veno-venous hemodialysis circuit. Further studies are on the way to investigate whether these effects translate into improved outcomes in septic shock patients. PMID: 31379256 [PubMed - as supplied by publisher]
Source: The International Journal of Artificial Organs - Category: Transplant Surgery Authors: Tags: Int J Artif Organs Source Type: research
Abstract An 84-year-old man with chronic renal failure, anemia, and diabetes was admitted for hemodialysis initiation. His vital signs were stable until the eighteenth hospital day, before having an influenza A virus infection. Three days later, he died of septic shock with severe liver impairment. His leukocyte count, prothrombin time (PT-INR), and liver enzymes, such as AST and ALT, were significantly increased. Hypercytokinemia was also observed. Autopsy revealed bilateral diffuse pneumonia with neutrophil infiltration. The liver showed extensive centrilobular hepatocyte necrosis. Immunohistochemistry for influ...
Source: Japanese Journal of Infectious Diseases - Category: Infectious Diseases Authors: Tags: Jpn J Infect Dis Source Type: research
More News: Academia | Databases & Libraries | Dialysis | Epidemiology | Hemodialysis | Infectious Diseases | Intensive Care | Septic Shock | Teaching | Teaching Hospitals | Universities & Medical Training