tailieunhanh - Báo cáo y học: "Beta-lactam antibiotics in continuous infusion in critically ill patients"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Beta-lactam antibiotics in continuous infusion in critically ill patients. | Jeurissen and Rutsaert Critical Care 2010 14 446 http content 14 5 446 CRITICAL CARE LETTER L_ Beta-lactam antibiotics in continuous infusion in critically ill patients Axel Jeurissen 1 and Robert Rutsaert2 See related research by Taccone etal. http content 14 4 R126 We read with great interest Taccone and colleagues article 1 published in a recent issue of Critical Care on the insufficient p-lactam concentrations in the early phase of severe sepsis and septic shock. While we fully agree with the authors findings we would like to offer some remarks. Only 18 of their 80 patients were infected with Pseudomonas aeruginosa but Taccone and colleagues used the European Committee on Antimicrobial Susceptibility Testing EUCAST minimal inhibitory concentration MIC breakpoints of P aeruginosa to calculate the target pharmacokinetics PK profile in all of the patients. Because Enterobacteriaceae form a substantial part of infectious organisms in intensive care patients it would be interesting to see how many patients would attain the PK profile for these microorganisms 2 . For cefepime for instance if the EUCAST sensitivity thres hold of 1 mg L were used 17 of 19 patients 89 would attain the target PK profile as compared with 3 of 19 patients 16 for P aeruginosa. Of course we agree that in an empirically started antibiotic regimen the organisms let alone the MIC are not known to the clinician. Furthermore the data of Taccone and colleagues should be interpreted in light of local epidemiology and resistance data. In a Belgian multicenter study all P aeruginosa strains isolated from patients hospitalized in the intensive care unit ICU had an MIC90 MIC required to inhibit the growth of 90 of organisms for meropenem of mg L 3 . With this MIC even more than 75 of the patients would have attained the target PK profile. In addition we think that the initial loading dose should be followed immediately by an extended or continuous infusion in .