Thermal injuries alter pharmacokinetics, complicating the prediction of standard antibiotic dose effectiveness. Therapeutic drug monitoring has been proposed to prevent subtherapeutic dosing of antibiotic therapy, but remains scarcely studied in the burn patient population. A retrospective chart review of burn patients receiving beta-lactam therapeutic drug monitoring from 2016 to 2019 was conducted. Adult patients with thermal injury receiving cefepime, piperacillin/tazobactam, or meropenem for ≥48 hours were included. Between February 2016 and July 2017, we utilized selective therapeutic drug monitoring based on clinical judgement to guide treatment. From October 2018 until July 2019, therapeutic drug monitoring was expanded to all burn patients on beta-lactams. The primary endpoint was achievement of therapeutic concentration, and the secondary endpoints were clinical cure, culture clearance, new resistance, length of stay and mortality. The selective (control) group included 19 patients and the universal (study) group reviewed 23 patients. In both groups, skin and lungs were the most common primary infection sources, with Pseudomonas aeruginosa as the most common species. In the universal cohort, patients were older with higher risk factors, but more frequently achieved the target drug concentration, required less days to start therapeutic drug monitoring (p<0.0001), and had more frequent measurements and beta-lactam dose adjustments. Positive clinical outcome was reported in 77%, and microbial eradication in 82% of all patients. All clinical outcomes were similar between the groups. The implementation of beta-lactam therapeutic drug monitoring protocol shortened the time, increased the probability of appropriate target attainment, and individualized beta-lactam therapy in burn patients.
Patients with a history of ureterosigmoidostomy are at an increased risk
of rectosigmoid adenocarcinoma. The cancer can occur many decades after
the diversion, even if there was conversion to ileal urinary conduit.
These patients may still be considered as high-risk individuals and
screened for colorectal cancer accordingly.
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