Introduction: Pseudomonas aeruginosa is one of the main pathogens causing infection in intensive care units (ICUs) and usually presents antimicrobial resistance. Methods: Data were obtained from ICUs between 2010 and 2013. Results: P. aeruginosa had a prevalence of 14.5% of which 48.7% were multidrug resistant. We observed increasing resistance to carbapenems and polymyxin B and growing consumption of aminoglycosides, meropenem, ceftazidime, and polymyxin B. The regression impact between resistance and consumption was significant with respect to amikacin, imipenem, meropenem, and polymyxin B. Conclusions: Monitoring antimicrobial consumption and resistant microorganisms should be reinforced to combat antimicrobial-and multidrug resistance.
Introduction: Monte Carlo simulations have been used for selecting optimal antibiotic regimens for treatment of bacterial infections. The aim of this study was to assess the pharmacokinetic and pharmacodynamic target attainment of intravenous β-lactam regimens commonly used to treat bloodstream infections (BSIs) caused by Gram-negative rod-shaped organisms in a Brazilian teaching hospital. Methods: In total, 5,000 patients were included in the Monte Carlo simulations of distinct antimicrobial regimens to estimate the likelihood of achieving free drug concentrations above the minimum inhibitory concentration (MIC; fT > MIC) for the requisite periods to clear distinct target organisms. Microbiological data were obtained from blood culture isolates harvested in our hospital from 2008 to 2010. Results: In total, 614 bacterial isolates, including Escherichia coli, Enterobacter spp., Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa, were analyzed. Piperacillin/tazobactam failed to achieve a cumulative fraction of response (CFR) > 90% for any of the isolates. While standard dosing (short infusion) of β-lactams achieved target attainment for BSIs caused by E. coli and Enterobacter spp., pharmacodynamic target attainment against K. pneumoniae isolates was only achieved with ceftazidime and meropenem (prolonged infusion). Lastly, only prolonged infusion of high-dose meropenem approached an ideal CFR against P. aeruginosa; however, no antimicrobial regimen achieved an ideal CFR against A. baumannii. Conclusions: These data reinforce the use of prolonged infusions of high-dose β-lactam antimicrobials as a reasonable strategy for the treatment of BSIs caused by multidrug resistant Gram-negative bacteria in Brazil.
Inappropriate use of antimicrobial drugs is responsible for therapeutic failures, increased mortality rates, and the emergence of resistance. Antimicrobial activity is determined by intrinsic pharmacokinetics/pharmacodynamics concepts. In critically ill patients, an inappropriate dosing regimen can be caused by the inability of an antimicrobial drug to reach adequate concentrations at the infection site owing to alterations in the drug's pharmacokinetics caused by pathophysiological changes. Understanding these concepts and changes in PK-PD parameters that occur in intensive care unit patients is crucial for the optimization of antimicrobial therapy in these patients.
Background Multiple factors have defined the success of treatment with oral antineoplastic, especially adherence to the therapeutic regimen. The aim of this study was to describe the profile of individuals in treatment with oral antineoplastic according to the sociodemographic and clinical epidemiology factors as well as to estimate the association with those to Non-adherence to the treatment with oral antineoplastic. Methods A cross-sectional observational study was performed in the chemotherapy outpatient’s department from December 2015 to March 2016 at a teaching hospital. The outcome Non-adherence was evaluated according to Morisky Green test. The variables which have reached statistical significance in the bivariate analysis were tested in the multivariate model to evaluate if they remained associated to “Non-adherence” according to the Poisson logistic regression and corrected by robust variance. Results In total, 233 patients were analyzed and 60.9% were found in Non-adherence to the treatment with oral antineoplastic according Morisky Green test (MMAS8), in which forgetfulness were often and had driven to non-adherence outcome. Multivariate analysis found three final predictors for Non-adherence which were own income, carer, unease and had needed urgency services in the last year. Conclusion This study reveals several factors associated with nonadherence. Those outcomes show that the patient's journey during antineoplastic treatment must be discussed and addressed in a broad way together with measures in public health policies.
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