Prolonged Infusion Antibiotics for Suspected Gram-Negative Infections in the ICU: A Before-After Study

Arnold, Heather; Hollands, James M.; Skrupky, Lee P.; Smith, Jennifer; Juang, Paul; Hampton, Nicholas; McCormick, Sandra; Reichley, Richard M.; Hoban, Alex; Hoffmann, Justin; Micek, Scott T.; Kollef, Marin H.

doi:10.1345/aph.1r523

Cited by 46 publications

(53 citation statements)

References 33 publications

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Contrasting

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“…Contrasting findings were recently reported from a single-centre before and after study, in which extended infusions of beta-lactams offered no advantage over intermittent dosing (187).…”

Section: Implications Of Arc For Dosing Beta-lactams In the Criticallcontrasting

confidence: 99%

Augmented renal clearance in the critically ill: Prevalence, risk factors, and implications for beta-lactam therapy

Udy¹

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“…Contrasting findings were recently reported from a single-centre before and after study, in which extended infusions of beta-lactams offered no advantage over intermittent dosing (187).…”

Section: Implications Of Arc For Dosing Beta-lactams In the Criticallcontrasting

confidence: 99%

Augmented renal clearance in the critically ill: Prevalence, risk factors, and implications for beta-lactam therapy

Udy¹

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“…A few studies have failed to find any benefit of EI over SI dosing schemes among critically-ill patients [3,16]. In one example, Arnold et al conducted a retrospective cohort study of ICU patients receiving various beta-lactams including piperacillin-tazobactam [16].…”

Section: Discussionmentioning

confidence: 99%

“…In one example, Arnold et al conducted a retrospective cohort study of ICU patients receiving various beta-lactams including piperacillin-tazobactam [16]. Piperacillin-tazobactam was the primary beta-lactam administered for 41 (16.9%) patients receiving SI dosing and 54 (20.7%) patients receiving EI dosing.…”

Section: Discussionmentioning

confidence: 99%

Microbiologic clearance following transition from standard infusion piperacillin-tazobactam to extended-infusion for persistent Gram-negative bacteremia and possible endocarditis: A case report and review of the literature

D’Agostino

Rhodes

Skoglund

et al. 2015

Journal of Infection and Chemotherapy

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“…Conversely, in patients with renal dysfunction, acute or chronic, β-lactams may have an increased half-life and thus not only a potential for higher T > MIC but also a higher risk for toxic effects. Results of a recent retrospective before-after study 34 also challenge the benefits of extended infusion. Critically ill patients received 3-hour extended infusions of cefepime, meropenem, or piperacillin/tazobactam.…”

Section: Pharmacokinetics and Pharmacodynamicsmentioning

confidence: 99%

Application of Antibiotic Pharmacodynamics and Dosing Principles in Patients With Sepsis

Fleet

Mueller

2016

Critical Care Nurse

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Sepsis is associated with marked mortality, which may be reduced by prompt initiation of adequate, appropriate doses of antibiotic. Critically ill patients often have physiological changes that reduce blood and tissue concentrations of antibiotic and high rates of multidrug-resistant pathogens, which may affect patients' outcomes. All critical care professionals, including critical care nurses, should understand antibiotic pharmacokinetics and pharmacodynamics to ensure sound antibiotic dosing and administration strategies for optimal microbial killing and patients' outcomes. Effective pathogen eradication occurs when the dose of antibiotic reaches or maintains optimal concentrations relative to the minimum inhibitory concentration for the pathogen. Time-dependent antibiotics, such as β-lactams, can be given as extended or continuous infusions. Concentration-dependent antibiotics such as aminoglycosides are optimized by using high, once-daily dosing strategies with serum concentration monitoring. Vancomycin and fl uoroquinolones are dependent on both time and concentration above the minimum inhibitory concentration. (Critical Care Nurse. 2016;36[2]:22-32) S epsis is a major cause of morbidity and mortality in the United States, affecting more than 650 000 patients per year. The spectrum of sepsis to septic shock is associated with crude mortality rates of 20% to 70%. [1][2][3][4] From the onset of hypotension, the probability of survival is reduced by 12% for each hour of delay before administration of adequate empiric antibiotics. 5Hence, current guidelines advocate early administration of adequate, broad-spectrum, local antibiogram-based antibiotic therapy in appropriate doses to penetrate the suspected site of infection (eg, lungs, cerebral spinal fl uid, intra-abdominal fl uid).1 Physiological changes associated with sepsis can complicate antibiotic dosing, effectiveness, and safety.

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Prolonged Infusion Antibiotics for Suspected Gram-Negative Infections in the ICU: A Before-After Study

Cited by 46 publications

References 33 publications

Augmented renal clearance in the critically ill: Prevalence, risk factors, and implications for beta-lactam therapy

Augmented renal clearance in the critically ill: Prevalence, risk factors, and implications for beta-lactam therapy

Microbiologic clearance following transition from standard infusion piperacillin-tazobactam to extended-infusion for persistent Gram-negative bacteremia and possible endocarditis: A case report and review of the literature

Application of Antibiotic Pharmacodynamics and Dosing Principles in Patients With Sepsis

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