Antibiotic use in critical illness

Abstract

Objective:To provide a review on the current use of antimicrobials with a discussion on the pharmacokinetic and pharmacodynamic profiles of antimicrobials in critically ill patients, the challenges of drug resistance, the use of diagnostic testing to direct therapy, and the selection of the most likely efficacious antimicrobial protocol. Etiology: Patients in the intensive care unit often possess profound pathophysiologic changes that can complicate antimicrobial therapy. Although many antimicrobials have known pharmacodynamic profiles, critical illness can cause wide variations in their pharmacokinetics. The two principal factors affecting pharmacokinetics are volume of distribution and drug clearance. Understanding the interplay between critical illness, drug pharmacokinetics, and antimicrobial characteristics (ie, time-dependent vs concentration-dependent) may improve antimicrobial efficacy and patient outcome. Diagnosis: Utilizing bacterial culture and susceptibility can aid in identifying drug resistant infections, selecting the most appropriate antimicrobials, and hindering the future development of drug resistance. Therapy: Having a basic knowledge of antimicrobial function and how to use diagnostics to direct therapeutic treatment is paramount in managing this patient population. Diagnostic testing is not always available at the time of initiation of antimicrobial therapy, so empiric selections are often necessary. These empiric choices should be made based on the location of the infection and the most likely infecting bacteria.Prognosis: Studies have demonstrated the importance of moving away from a "one dose fits all" approach to antimicrobial therapy. Instead there has been a move toward an individualized approach that takes into consideration the pharmacokinetic and pharmacodynamic variabilities that can occur in critically ill patients.

Environmental Perturbations during the Rehabilitation of Wild Migratory Birds Induce Gut Microbiome Alteration and Antibiotic Resistance Acquisition

“…Since none of the birds used in the present study was treated with antibiotics during rehabilitation, the increased antibiotic resistance observed is unlikely to have resulted from antibiotic exposure. Antibiotics associated with increased resistance included ciprofloxacin, ampicillin, amoxicillin, and tetracycline, which are the most frequently used drugs in veterinary clinics ( 53 ). In a clinical environment with frequent exposure to these antibiotics, environmental microbes acquire antibiotic resistance and opportunistically infect hosts ( 54 , 55 ).…”

“De-Shrinking” EBEs: The Solution for Bayesian Therapeutic Drug Monitoring

“…far from the mean population values). This is the case for example for patients in the intensive care unit and those with cystic fibrosis or obesity, among others [23][24][25]. Thus, this approach allows us to expect a significant improvement in the estimates of the IPK parameters.…”

Medically managed spontaneous bacterial peritonitis and bacteraemia associated with jugular catheter infection in a dog with tetanus

“…The infecting organism was suspected to be an MDR gram‐negative bacteria, in part due to the rod‐shaped appearance on cytology and was treated as such, with the view of possible de‐escalation after identification of the antimicrobial susceptibility profiles. Considering the high prevalence of MDR isolates in human and veterinary ICUs and their association with increased mortality and prolonged hospitalisation, prompt initiation of appropriate empirical antimicrobial therapy in people and animals with nosocomial infections is critical 54 . It has been shown that delaying antimicrobial treatment is associated with decreased survival in people with sepsis and septic shock 55,56 .…”