Continuous Infusion of Beta-Lactam Antibiotics in Severe Sepsis: A Multicenter Double-Blind, Randomized Controlled Trial

Dulhunty, Joel M.; Roberts, Jason A.; Davis, Joshua S.; Webb, Steven A R; Bellomo, Rinaldo; Gomersall, Charles D.; Shirwadkar, Charudatt; Eastwood, Glenn M; Myburgh, John; Paterson, David L.; Lipman, Jeffrey

doi:10.1093/cid/cis856

Cited by 319 publications

(273 citation statements)

References 33 publications

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“…We referred to 4 RCT reports 72, 90, 91, 92. Among these studies, no significant differences were observed between the respective study groups with respect to 90‐day mortality rate (odds ratio: 0.94; 95% confidence interval [CI]: 0.69–1.28, P = 0.68), ICU mortality rate (odds ratio: 0.79; 95% CI: 0.59–1.06, P = 0.11), in‐hospital mortality rate (odds ratio: 0.78; 95% CI: 0.59–1.03, P = 0.08), or target serum drug concentration achievement rate (odds ratio: 1.88; 95% CI: 0.89–3.98, P = 0.10).…”

Section: Cq5 Antimicrobial Therapymentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Cq5 Antimicrobial Therapymentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

View full text Add to dashboard Cite

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“…Some of these networks are well established and have been highly productive, completing a number of high-impact studies. [4][5][6][7][8][9] Others are nascent, like our own, and may seek to replicate our methodology.…”

Section: Discussionmentioning

confidence: 99%

“…3 The NHMRC has already demonstrated a willingness to fund clinician-initiated RCTs, as shown by the success of networks such as the Australian and New Zealand Intensive Care Society Clinical Trials Group. [4][5][6][7] The impact of their successfully completed trials on practice change, co st savings and improved patient outcomes has not been formally measured but is likely to be significant.…”

mentioning

confidence: 99%

Determining research priorities for clinician‐initiated trials in infectious diseases

Paterson

2013

Medical Journal of Australia

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Objectives: To determine research priorities of infectious diseases physicians for clinician‐initiated randomised controlled trials (RCTs). Design, setting and participants: Online survey of infectious diseases physicians in Australia and New Zealand. Main outcome measures: Research priorities for, and perceived barriers to, clinician‐initiated RCTs. Results: 122/550 infectious diseases physicians (22%) responded to the survey. The five highest ranked proposals for clinician‐initiated RCTs were in the areas of prosthetic joint infections, septic arthritis and osteomyelitis of native joints, Staphylococcus aureus bloodstream infections, diabetic foot infections and the treatment of serious multiresistant, gram‐negative bacterial infections. Lack of funding was the most important perceived barrier to participation in clinician‐initiated RCTs. Conclusions: The research focus of infectious diseases physicians — optimal treatment of commonly encountered serious infections — highlights a lack of well conducted RCTs in this area.

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“…Continuous infusion (CI) could also be used as alternative administration for b-lactams in lung infections. [24][25][26]40,41 In patients with moderate to severe renal failure, a reduction in drug clearance may help in the achievement of PK/PD targets with usual dosing regimens. 24 …”

Section: B-lactammentioning

confidence: 99%

Defining Antibiotic Dosing in Lung Infections

Jamal

Abdul‐Aziz

Lipman

et al. 2013

Clinical Pulmonary Medicine

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Defining optimal antibiotic dosing for treatment of lung infections is challenging because of the interrelationship between patient characteristics (eg, pathophysiological changes of lung during an infection, albumin level, renal function), antibiotic characteristics (eg, physicochemical properties, protein binding), and bacterial pathogen susceptibility. Measurement of antibiotic concentration in the lung compartments, such as epithelial lining fluid (ELF), is important to describe the drug exposure at site of infection. This article reviews published data on antibiotic penetration described by the ELF to plasma (ELF:plasma) ratios and the probability of pharmacokinetic/ pharmacodynamics (PK/PD) attainment at the target site with current dosing regimens to outline dosing strategies that could optimize the PK/PD indices. Antibiotic physicochemical properties could be used to predict the extent of penetration into the lung tissues. Lipophilic antibiotics penetrate well into the lung compartments; however, standard dosing regimens generally seem to be insufficient to achieve optimal PK/PD indices in the ELF, particularly during severe infections. Aggressive dosing regimens are required for antibiotics that poorly or moderately penetrate the lung tissues, whereas nebulization could be the alternative method to enhance antibiotic concentration at the target site. Special populations such as the critically ill, patients on renal replacement therapy, and those with renal impairment need dosing to be individualized, as these populations have high PK variability. Dosing based on free drug concentrations should be considered preferred, as these concentrations frequently reflect the antibiotic concentration at the target site. Therefore, the use of therapeutic drug monitoring should be considered necessary, whenever possible, to guide dosing in lung infection.

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Continuous Infusion of Beta-Lactam Antibiotics in Severe Sepsis: A Multicenter Double-Blind, Randomized Controlled Trial

Cited by 319 publications

References 33 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

Determining research priorities for clinician‐initiated trials in infectious diseases

Defining Antibiotic Dosing in Lung Infections

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