Continuous and Prolonged Intravenous β-Lactam Dosing: Implications for the Clinical Laboratory

Grupper, Mordechai; Kuti, Joseph L.; Nicolau, David P.

doi:10.1128/cmr.00022-16

Cited by 53 publications

(50 citation statements)

References 130 publications

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“…Since b-lactam antibiotics exhibit time-dependent killing of bacteria, the length of time for which the free drug concentration is above MIC (%T >MIC) correlates well with the killing of bacteria. Pharmacological studies have clearly shown that with prolonged infusion, and even more so with continuous infusion, the %T >MIC increases in blood and in other compartments [61]. In patients with postoperative intracranial infections, better CSF target level attainment of cefepime has been shown with continuous versus intermittent infusion [62].…”

Section: Prolonged or Continuous Antibiotic Administration And Therapmentioning

confidence: 99%

“…In patients with postoperative intracranial infections, better CSF target level attainment of cefepime has been shown with continuous versus intermittent infusion [62]. Clinical studies have shown inconsistent results for patients with bacteraemia [61]. A systematic review revealed lower mortality for extended or continuous infusion of carbapenems or piperacillin/tazobactam, compared with intermittent infusion, based mostly on observational studies [63].…”

Section: Prolonged or Continuous Antibiotic Administration And Therapmentioning

confidence: 99%

See 1 more Smart Citation

Management of post-neurosurgical meningitis: narrative review

Hussein

Bitterman

Shofty

et al. 2017

Clinical Microbiology and Infection

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Section: Prolonged or Continuous Antibiotic Administration And Therapmentioning

confidence: 99%

Section: Prolonged or Continuous Antibiotic Administration And Therapmentioning

confidence: 99%

Management of post-neurosurgical meningitis: narrative review

Hussein

Bitterman

Shofty

et al. 2017

Clinical Microbiology and Infection

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“…While the reliable detection of Pseudomonas aeruginosa by BC detection systems is a top priority for treatment optimization and effective antimicrobial stewardship (13)(14)(15)(16), no studies have evaluated these BC bottle systems for meropenem, ceftolozane-tazobactam, and ceftazidime-avibactam. These potent broad-spectrum ␤-lactams are frequently administered in high doses and with prolonged infusions to optimize their activity (17); therefore, there is an increased likelihood that the time to detection (TTD) will be delayed or that samples will be sterilized. We aimed to investigate the effect of the in vitro neutralization of clinically achievable concentrations of meropenem, ceftolozanetazobactam, and ceftazidime-avibactam on TTDs and growth curves of P. aeruginosa in two widely used BC bottle systems, the Bactec Plus Aerobic Plus/F, and BacT/Alert FA Plus Aerobic bottles.…”

mentioning

confidence: 99%

Effects of Clinically Meaningful Concentrations of Antipseudomonal β-Lactams on Time to Detection and Organism Growth in Blood Culture Bottles

et al. 2017

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The effectiveness of antimicrobial binding resins present in blood culture (BC) bottles in removing meropenem, ceftolozane-tazobactam, and ceftazidime-avibactam is unknown. We assessed the time to detection (TTD) and growth of 2 isolates in the presence of clinically meaningful concentrations of these antibiotics. Bactec Plus Aerobic/F and BacT/Alert FA Plus BC bottles were inoculated with one of two isolates (1 meropenem susceptible and 1 resistant), followed by fresh whole blood containing the peak, midpoint, or trough plasma concentrations for meropenem, ceftolozane-tazobactam, and ceftazidime-avibactam. Matching bottles were loaded into their respective detection instruments and a standard incubator at 37°C, with TTD and CFU being monitored for up to 72 h. Bacterial growth was observed for 11/48 (22.9%), 22/48 (45.8%), and 47/48 (97.9%) of all BC bottles inoculated with the peak, midpoint, and trough concentrations, respectively ( ≤ 0.001). When was isolated, the TTD was typically<26 h, and no differences between Bactec and BacT/Alert bottles were observed. In both systems, meropenem was removed to a greater degree than were ceftolozane and ceftazidime; however, concentrations for all antibiotics remained above the MIC for the susceptible organisms at 12 h. BC bottles containing antibiotic binding resins may not sufficiently inactivate achievable concentrations of meropenem, ceftolozane-tazobactam, and ceftazidime-avibactam. The consistent identification of both isolates was observed only in the presence of antibiotic trough concentrations. To minimize false-negative BC results for patients already receiving these antibiotics, cultures should be collected just prior to the next dose, when antibiotic concentrations are lowest.

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“…The authors showed that, in order to determine by the bacteriological method the efficacy of antibiotic therapy in patients receiving these antibiotics, it is necessary to take samples for plating right before the administration of the next dose of drugs. Figure 4 shows changes in the concentrations of antibiotics of the beta-lactam group for various methods of administration reviewed by Grupper et al [83]. The review demonstrated the advantage of long-term infusion (3-4 h) of antibiotics compared with short-term administration.…”

Section: Approaches To Assessing Efficacy Of Antibiotic Therapymentioning

confidence: 99%

Monitoring Antibiotics and Inflammatory Markers in Human Blood: Impact in Choice of Antibiotic Therapy and Used Methods

Berlina¹,

Zherdev²,

Dzantiev³

2019

Preprint

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In the modern world, the problem of antibiotic therapy is acute. Despite the diversity of existing antibiotic drugs, their efficacy decreases as new, resistant forms of pathogenic microorganisms emerge. It is extremely difficult to control such processes and even more difficult to treat severe bacterial infections. In such situations, an individual approach to each patient is required and physicians need parameters to estimate the efficacy of antibiotic therapy. This review discusses the significance of monitoring the content of antibiotics in the blood for this purpose, in combination with the content of inflammatory markers, such as C-reactive protein and procalcitonin. The basic principles of antibiotic therapy, and factors in the resistance of microorganisms to antibiotics, are examined. Approaches to assess the efficacy of antibiotic therapy, as well as methods to detect antibiotics and inflammatory markers in the blood of patients, and comparative assessment of their capabilities and limitations, are described.

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Continuous and Prolonged Intravenous β-Lactam Dosing: Implications for the Clinical Laboratory

Cited by 53 publications

References 130 publications

Management of post-neurosurgical meningitis: narrative review

Management of post-neurosurgical meningitis: narrative review

Effects of Clinically Meaningful Concentrations of Antipseudomonal β-Lactams on Time to Detection and Organism Growth in Blood Culture Bottles

Monitoring Antibiotics and Inflammatory Markers in Human Blood: Impact in Choice of Antibiotic Therapy and Used Methods

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