Abstract:
BACKGROUND:Optimal anti-bacterial activity of meropenem requires maintenance of its plasma concentration (Cp) above the minimum inhibitory concentration (MIC) of the pathogen for at least 40% of the dosing interval (fT > MIC > 40). We aimed to determine whether a 3-h extended infusion (EI) of meropenem achieves fT > MIC > 40 on the first and third days of therapy in patients with severe sepsis or septic shock. We also simulated the performance of the EI with respect to other pharmacokinetic (PK) targets such as fT > 4 × MIC > 40, fT > MIC = 100, and fT > 4 × MIC = 100. METHODS:Arterial blood samples of 25 adults with severe sepsis or septic shock receiving meropenem 1000 mg as a 3-h EI eight hourly (Q8H) were obtained at various intervals during and after the first and seventh doses. Plasma meropenem concentrations were determined using a reverse-phase high-performance liquid chromatography assay, followed by modeling and simulation of PK data. European Committee on Antimicrobial Susceptibility Testing (EUCAST) definitions of MIC breakpoints for sensitive and resistant Gram-negative bacteria were used. RESULTS:A 3-h EI of meropenem 1000 mg Q8H achieved fT > 2 µg/mL > 40 on the first and third days, providing activity against sensitive strains of Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii. However, it failed to achieve fT > 4 µg/mL > 40 to provide activity against strains susceptible to increased exposure in 33.3 and 39.1% patients on the first and the third days, respectively. Modeling and simulation showed that a bolus dose of 500 mg followed by 3-h EI of meropenem 1500 mg Q8H will achieve this target. A bolus of 500 mg followed by an infusion of 2000 mg would be required to achieve fT > 8 µg > 40. Targets of fT > 4 µg/mL = 100 and fT > 8 µg/mL = 100 may be achievable in two-thirds of patients by increasing the frequency of dosing to six hourly (Q6H). CONCLUSIONS:In patients with severe sepsis or septic shock, EI of 1000 mg of meropenem over 3 h administered Q8H is inadequate to provide activity (fT > 4 µg/mL > 40) against strains susceptible to increased exposure, which requires a bolus of 500 mg followed by EI of 1500 mg Q8H. While fT > 8 µg/mL > 40 require escalation of EI dose, fT > 4 µg/mL = 100 and fT > 8 µg/mL = 100 require escalation of both EI dose and frequency.
journal_name
Ann Intensive Carejournal_title
Annals of intensive careauthors
Kothekar AT,Divatia JV,Myatra SN,Patil A,Nookala Krishnamurthy M,Maheshwarappa HM,Siddiqui SS,Gurjar M,Biswas S,Gota Vdoi
10.1186/s13613-019-0622-8subject
Has Abstractpub_date
2020-01-10 00:00:00pages
4issue
1issn
2110-5820pii
10.1186/s13613-019-0622-8journal_volume
10pub_type
杂志文章abstract:BACKGROUND:Intensivists' clinical decision making pursues two main goals for patients: to decrease mortality and to improve quality of life and functional status in survivors. Patient-important outcomes are gaining wide acceptance in most fields of clinical research. We sought to systematically review how well patient-...
journal_title:Annals of intensive care
pub_type: 杂志文章,评审
doi:10.1186/s13613-017-0243-z
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Acute respiratory distress syndrome (ARDS) patients may present impaired in lung function and structure after hospital discharge that may be related to mechanical ventilation strategy. The aim of this study was to evaluate the association between functional and structural lung impairment, N-terminal-peptide ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0469-4
更新日期:2018-12-07 00:00:00
abstract::In the past, the only treatment of acute exacerbations of obstructive diseases with hypercapnic respiratory failure refractory to medical treatment was invasive mechanical ventilation (IMV). Considerable technical improvements transformed extracorporeal techniques for carbon dioxide removal in an attractive option to ...
journal_title:Annals of intensive care
pub_type: 杂志文章,评审
doi:10.1186/s13613-019-0551-6
更新日期:2019-07-02 00:00:00
abstract:BACKGROUND:Red blood cell (RBC) transfusion has been associated with nosocomial infection in the critically ill patients. However, this association may be confounded by length of stay, as prolonged intensive care unit (ICU stay) increases both risk of infection and risk of transfusion. Also, it is not known whether spe...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-016-0173-1
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Among intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS), apart from acute cor pulmonale (ACP), the frequency and prognostic impact of basic critical care echocardiography (BCCE) abnormalities are not well defined. METHODS:Observational study of patients with ARDS, admitted f...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0343-9
更新日期:2017-12-19 00:00:00
abstract:BACKGROUND:High-frequency oscillatory ventilation (HFOV) is a common but unproven management strategy in paediatric critical care. Oscillator settings have been traditionally guided by patient age and/or weight rather than by lung mechanics, thereby potentially negating any beneficial effects. We have adopted an open-l...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-019-0492-0
更新日期:2019-01-18 00:00:00
abstract:BACKGROUND:The impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs). The present study investigated the association between ultrasound guidance (US) during AC insertion and major catheter-related infections (MCRI), catheter-related bloodstream infect...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-020-00705-4
更新日期:2020-07-08 00:00:00
abstract::The 2018 Paris Intensive Care symposium entitled "Update in Neurocritical Care" was organized in Paris, June 21-22, 2018, under the auspices of the French Intensive Care Society. This 2-day post-graduate educational symposium comprised several chapters, aiming first to provide all-board intensivists with current stand...
journal_title:Annals of intensive care
pub_type: 杂志文章,评审
doi:10.1186/s13613-019-0523-x
更新日期:2019-04-16 00:00:00
abstract:BACKGROUND:Continuous glucose monitoring (CGM) has not yet been implemented in the intensive care unit (ICU) setting. The purpose of this study was to evaluate reliability, feasibility, nurse acceptance and accuracy of the Medtronic Sentrino(®) CGM system in critically ill patients. METHODS:Sensors were inserted into ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-016-0167-z
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:The use of novel sepsis biomarkers has increased in recent years. However, their prognostic value with respect to illness severity has not been explored. In this work, we examined the ability of mid-regional proadrenomedullin (MR-proADM) in predicting mortality in sepsis patients with different degrees of or...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0238-9
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Sepsis-associated acute kidney injury (SA-AKI) is an independent risk factor for death in patients with sepsis, but treatment for it is limited. To improve the diagnosis and treatment of SA-AKI, we must first understand its pathogenesis. Recently, interleukin (IL)-17A has been shown to be associated with the...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-016-0157-1
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Hyperglycaemia is commonplace in the adult intensive care unit (ICU), associated with increased morbidity and mortality. Effective glycaemic control (GC) can reduce morbidity and mortality, but has proven difficult. STAR is a proven, effective model-based ICU GC protocol that uniquely maintains normo-glycaem...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0351-9
更新日期:2018-01-10 00:00:00
abstract:BACKGROUND:Extracorporeal cardiopulmonary resuscitation (ECPR) has been considered in selected candidates with potentially reversible causes during a limited period. Candidate selection and the identification of predictable conditions are important factors in determining outcomes during CPR in the emergency department ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0309-y
更新日期:2017-08-30 00:00:00
abstract:BACKGROUND:In randomised controlled trials, procalcitonin (PCT)-guided antibiotic treatment has been proven to significantly reduce length of antibiotic therapy in intensive care unit (ICU) patients. However, concern was raised on low protocol adherence and high rates of overruling, and thus the value of PCT-guided tre...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0415-5
更新日期:2018-06-04 00:00:00
abstract:BACKGROUND:While the process of sepsis-induced immunosuppression is now well described in adults, very little information is available on immune functions in pediatric sepsis. The current study investigated this in children with septic shock by performing immunomonitoring, including both innate (monocyte human leukocyt...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0382-x
更新日期:2018-03-13 00:00:00
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journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-3-4
更新日期:2013-02-15 00:00:00
abstract:BACKGROUND:Despite advances in supportive care, moderate-severe acute respiratory distress syndrome (ARDS) is associated with high mortality rates, and novel therapies to treat this condition are needed. Compelling pre-clinical data from mouse, rat, sheep and ex vivo perfused human lung models support the use of human ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-014-0022-z
更新日期:2014-07-03 00:00:00
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journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0477-4
更新日期:2019-01-03 00:00:00
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journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-016-0128-6
更新日期:2016-12-01 00:00:00
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journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-2-14
更新日期:2012-06-12 00:00:00
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journal_title:Annals of intensive care
pub_type: 已发布勘误
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更新日期:2020-06-02 00:00:00
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journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-2-13
更新日期:2012-05-30 00:00:00
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journal_title:Annals of intensive care
pub_type: 杂志文章
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更新日期:2020-04-22 00:00:00
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journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-015-0073-9
更新日期:2015-12-01 00:00:00
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journal_title:Annals of intensive care
pub_type: 杂志文章,评审
doi:10.1186/2110-5820-4-16
更新日期:2014-06-02 00:00:00
abstract:BACKGROUND:Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whet...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-020-00652-0
更新日期:2020-03-26 00:00:00
abstract:BACKGROUND:Many maneuvers assessing fluid responsiveness (minifluid challenge, lung recruitment maneuver, end-expiratory occlusion test, passive leg raising) are considered as positive when small variations in cardiac index, stroke volume index, stroke volume variation or pulse pressure variation occur. Pulse contour a...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-019-0590-z
更新日期:2019-10-11 00:00:00
abstract:BACKGROUND:Antibiotics are frequently used in intensive care units (ICUs), and their use is associated with the emergence of bacterial resistance to antibiotics. The aim of this study was to investigate the association between the emergence of Pseudomonas aeruginosa resistance and the duration of antibiotic exposure or...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0296-z
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Noninvasive ventilation (NIV) is the first-line treatment of adult patients with exacerbations of cystic fibrosis (CF). High-flow nasal oxygen therapy (HFNT) might benefit patients with hypoxemia and can reduce physiological dead space. We hypothesized that HFNT and NIV would similarly reduce work of breathi...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0432-4
更新日期:2018-09-05 00:00:00
abstract:BACKGROUND:Pneumonia is one of the major complications of drowning, but the optimal empirical antibiotic treatment is not clearly defined. Multidrug-resistant (MDR) bacteria and fungi have been identified in a recent series of freshwater drowning-associated pneumonia. However, microbial data in seawater drowning are sc...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0267-4
更新日期:2017-12-01 00:00:00