Improving vancomycin prescription in critical illness through a drug use evaluation process: a weight-based dosing intervention study.
Int J Antimicrob Agents. 2011 Oct 22;
Authors: Li J, Udy AA, Kirkpatrick CM, Lipman J, Robe…

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Implementation and outcomes of a hospital-wide computerised antimicrobial stewardship programme in a large medical centre in Taiwan.
Int J Antimicrob Agents. 2011 Oct 5;
Authors: Chan YY, Lin TY, Huang CT, Deng ST, Wu TL, Leu …

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Antibiotic treatment duration for bloodstream infections in critically ill patients: a national survey of Canadian infectious diseases and critical care specialists.
Int J Antimicrob Agents. 2011 Oct 7;
Authors: Daneman N, Sho…

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Antimicrobial susceptibility of bacterial pathogens associated with community-acquired respiratory tract infections in Asia: report from the Community-Acquired Respiratory Tract Infection Pathogen Surveillance (CARTIPS) study, 2009-2010.
…

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Increased mortality associated with meticillin-resistant Staphylococcus aureus (MRSA) infection in the Intensive Care Unit: results from the EPIC II study.
Int J Antimicrob Agents. 2011 Jul 27;
Authors: Hanberger H, Walther S,…

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Pharmacodynamics of meropenem in critically ill patients with febrile neutropenia and bacteraemia.
Int J Antimicrob Agents. 2011 Jul 2;
Authors: Jaruratanasirikul S, Limapichat T, Jullangkoon M, Aeinlang N, Ingviya N, Wongpoow…

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Non-susceptibility to tigecycline in enterococci from hospitalised patients, food products and community sources.
Int J Antimicrob Agents. 2011 Jun 8;
Authors: Freitas AR, Novais C, Correia R, Monteiro M, Coque TM, Peixe L
…

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Daptomycin: evaluation of a high-dose treatment strategy.
Int J Antimicrob Agents. 2011 May 4;
Authors: Wu G, Abraham T, Rapp J, Vastey F, Saad N, Balmir E
With a decreasing pipeline of novel antibiotics and increasing…

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Candida bloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in Intensive Care Unit (ICU) and non-ICU settings in the SENTRY Antimicrobial Surveillance Program (2008-2009).
…

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Ceftaroline: a comprehensive update.
Int J Antimicrob Agents. 2011 Mar 17;
Authors: Kaushik D, Rathi S, Jain A
Ceftaroline is a novel broad-spectrum cephalosporin antibiotic currently under US Food and Drug Administrat…

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Clinical utility of daptomycin in infective endocarditis caused by Gram-positive cocci.
Int J Antimicrob Agents. 2011 Mar 18;
Authors: Cervera C, Castañeda X, Pericas JM, Del Río A, de la Maria CG, Mestres C, Falces C, Marco…

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Management of serious meticillin-resistant Staphylococcus aureus infections: what are the limits?

Int J Antimicrob Agents. 2011 Feb 5;

Authors: Gould IM, Cauda R, Esposito S, Gudiol F, Mazzei T, Garau J

Severe (life-threatening) meticillin-resistant Staphylococcus aureus (MRSA) infection continues to be treated with vancomycin despite accumulating evidence of poor outcome, increasing resistance and unachievable pharmacokinetic/pharmacodynamic (PK/PD) targets. The minimum inhibitory concentration (MIC) susceptibility breakpoint for vancomycin was recently reduced to 2mg/L. Whilst the great majority of clinical isolates are thus still classified as susceptible, the available clinical evidence argues for a method-dependent breakpoint of 0.5mg/L (broth dilution) or 1.0mg/L (Etest), which would classify many strains as resistant, or at best intermediate. However, automated susceptibility testing systems are not currently capable of performing accurately at this low level, and such low breakpoints are unsatisfactory because the poor reproducibility of tests (plus or minus one doubling dilution) results in a critical non-reproducibility around the modal MIC of 1mg/L described in most published data. Therefore, vancomycin should be used with caution in severe (life-threatening) staphylococcal disease and the MIC should always be reported by method. Daptomycin is generally preferred for bacteraemia/endocarditis and linezolid for pneumonia. Better outcome data for vancomycin, based on achievable PK/PD targets and using robust MIC tests, are urgently required.

PMID: 21300528 [PubMed - as supplied by publisher]

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Clinical implications of ?-lactam-aminoglycoside synergism: systematic review of randomised trials.

Int J Antimicrob Agents. 2011 Feb 1;

Authors: Marcus R, Paul M, Elphick H, Leibovici L

?-Lactam-aminoglycoside combinations are commonly used despite lack of evidence of a clinical benefit. In this study, all randomised controlled trials (RCTs) assessing directly the clinical implications of synergism by comparing a ?-lactam with the same ?-lactam in combination with an aminoglycoside as empirical or definitive therapy for any type of infection and clinical scenario were compiled. A systematic search was undertaken to identify all trials regardless of language, date or publication status. The primary outcomes assessed were all-cause mortality and clinical failure regardless of antibiotic modifications. Risk of bias was evaluated and its effect was assessed through sensitivity analyses. Two reviewers applied inclusion criteria and extracted the data independently. A fixed-effect meta-analysis was performed. Fifty-two RCTs were identified assessing patients with febrile neutropenia, pneumonia, abdominal infections, bacteraemia, endocarditis or cystic fibrosis. Only five trials were double-blinded. All-cause mortality was similar with monotherapy versus combination therapy [risk ratio (RR)=0.96, 95% confidence interval (CI) 0.78-1.18, 28 trials, 3756 episodes]. Clinical failure regardless of antibiotic modifications was not significantly different (RR=0.88, 95% CI 0.74-1.05, 27 trials, 2500 episodes). Treatment failure including antibiotic addition/modification occurred more frequently with monotherapy (RR=1.20, 95% CI 1.12-1.28, 48 trials, 6643 episodes). There were no significant differences with regard to bacterial or fungal superinfections or development of antibiotic-resistant strains. Combination therapy resulted in a significantly higher incidence of adverse events, mainly nephrotoxicity. Overall, no clinical benefit was found for the use of a ?-lactam with an aminoglycoside compared with a ?-lactam alone. Treatment with ?-lactams as monotherapy entailed more antibiotic regimen modifications in open trials.

PMID: 21292449 [PubMed - as supplied by publisher]

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Meticillin-resistant Staphylococcus aureus (MRSA): screening and decolonisation.

Int J Antimicrob Agents. 2010 Dec 14;

Authors: Cookson B, Bonten MJ, Mackenzie FM, Skov RL, Verbrugh HA, Tacconelli E

Meticillin-resistant Staphylococcus aureus (MRSA) infections are of increasing importance to clinicians, public health agencies and governments. Prevention and control strategies must address sources in healthcare settings, the community and livestock. This document presents the conclusions of a European Consensus Conference on the role of screening and decolonisation in the control of MRSA infection. The conference was held in Rome on 5-6 March 2010 and was organised jointly by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC). In an environment where MRSA is endemic, universal or targeted screening of patients to detect colonisation was considered to be an essential pillar of any MRSA control programme, along with the option of decolonising carriers dependent on relative risk of infection, either to self or others, in a specific setting. Staff screening may be useful but is problematic as it needs to distinguish between transient carriage and longer-term colonisation. The consequences of identification of MRSA-positive staff may have important effects on morale and the ability to maintain staffing levels. The role of environmental contamination in MRSA infection is unclear, but screening may be helpful as an audit of hygiene procedures. In all situations, screening procedures and decolonisation carry a significant cost burden, the clinical value of which requires careful evaluation. European initiatives designed to provide further information on the cost/benefit value of particular strategies in the control of infection, including those involving MRSA, are in progress.

PMID: 21163631 [PubMed - as supplied by publisher]

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Does aminoglycoside therapy cause significant acute kidney injury in febrile neutropenia?

Int J Antimicrob Agents. 2011 Jan;37(1):78-81

Authors: Hajkowicz KM, Post JJ

Owing to concern about aminoglycoside-related acute kidney injury (AKI) in therapy for febrile neutropenia, the aim of this study was to ascertain the incidence, severity and persistence of AKI secondary to aminoglycoside use for febrile neutropenia at an adult tertiary referral hospital. All admitted adults with neutropenia in a 27-month period were reviewed. Cases of febrile neutropenia due to chemotherapy who received an aminoglycoside were identified and renal function was assessed up to Day 30 after aminoglycoside administration. Transient renal impairment (TRI) was defined as any temporary rise in serum creatinine of >44?mol/L within 30 days; and persistent, significant renal impairment (PSRI) was defined as an elevation of serum creatinine of >44?mol/L at Day 30, or death from renal failure or need for dialysis. The Acute Kidney Injury Network (AKIN) stage for all episodes was also determined. Amongst 554 episodes of neutropenia, 148 episodes of chemotherapy-related febrile neutropenia with aminoglycoside treatment were identified. PSRI occurred in six episodes [4.1%; 95% confidence interval (CI) 1.9-8.6%] and TRI occurred in seven episodes (4.7%; 95% CI 2.3-9.4%). No PSRI was attributable to aminoglycoside therapy alone (0%; 95% CI 0-3.2%). Severe sepsis was the main cause of PSRI. Aminoglycoside therapy was the main contributing cause of TRI in two episodes (1.4%; 95% CI 0.2-5.3%). In conclusion, PSRI is a rare complication of aminoglycoside therapy for febrile neutropenia at this institution. AKIN stage 1 AKI is a common complication of febrile neutropenia episodes in which aminoglycosides are administered.

PMID: 21163406 [PubMed - in process]

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