Document Detail


Feedback dose alteration significantly affects probability of pathogen eradication in nosocomial pneumonia.
MedLine Citation:
PMID:  19213786     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Nosocomial pneumonia (NP) is associated with considerable morbidity and mortality. Data have shown that inadequate initial antibiotic therapy is a major risk for infection-attributed mortality. The aim of the present study was to measure antibiotic concentration and minimum inhibitory concentration (MIC) in infected hospitalised patients early in therapy, in order to determine whether dose alterations, in those with low drug concentrations, could affect outcomes. Only patients treated with aminoglycosides, fluoroquinolones, and beta-lactams were evaluated. MICs were determined using standard National Committee for Clinical Laboratory Standards procedures. Antibiotics were assayed using validated high-performance liquid chromatographic methods. Pharmacokinetic/pharmacodynamic markers adopted were: aminoglycoside peak/MIC ratio >or=8 mg L(-1); fluoroquinolone peak/MIC >or=10 mg L(-1); beta-lactam peak/MIC >or=4 mg L(-1) and time that plasma levels remain above the MIC >or=70%. 638 patients with NP were included in the study. In 205 patients, both drug concentration and isolate MIC were available, while in other patients, used as controls, one or both parameters were lacking. For clinical outcome, the Acute Physiology and Chronic Health Evaluation II score (p<0.0001), the presence of combination therapy (p = 0.0014) and whether both MIC and drug concentration(s) were measured (p = 0.0002) significantly affected the probability of a good outcome. For microbiological outcome, the MIC for the beta-lactams (<or=2 mg L(-1); p<0.0001) and whether the second drug was a fluoroquinolone or aminoglycoside (fluoroquinolones were better than aminoglycosides; p = 0.0177), as well as whether both MIC and drug concentration(s) were measured (p = 0.02), affected the probability of eradication. Measurement of drug concentrations and determination of pathogen MIC values with subsequent dose alteration significantly improves the probability of good clinical outcome and pathogen eradication in NP.
Authors:
F Scaglione; S Esposito; S Leone; V Lucini; M Pannacci; L Ma; G L Drusano
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-02-12
Journal Detail:
Title:  The European respiratory journal     Volume:  34     ISSN:  1399-3003     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-08-03     Completed Date:  2009-12-14     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  394-400     Citation Subset:  IM    
Affiliation:
Department of Pharmacology, Chemotherapy and Toxicology, Faculty of Medicine, University of Milan, Milan, Italy. francesco.scaglione@unimi.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aminoglycosides / therapeutic use*
Cross Infection / drug therapy*
Female
Fluoroquinolones / therapeutic use*
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Pneumonia / drug therapy*
Time Factors
Treatment Outcome
beta-Lactams / therapeutic use*
Chemical
Reg. No./Substance:
0/Aminoglycosides; 0/Fluoroquinolones; 0/beta-Lactams

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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