[Summary of the GEIPC-SEIMC and GTEI-SEMICYUC recommendations for the treatment of infections caused by gram positive cocci in critical patients]

Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC)

Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.

[Monitoring of intraperitoneal administration of vancomycin in patients on continuous ambulatory peritoneal dialysis]

OBJECTIVE

To validate a pharmacokinetic model of the treatments with intraperitoneal vancomycin applied to patients on continuous ambulatory peritoneal dialysis with bacterial peritonitis.

METHODS

To carry out a prospective study divided in 2 cohorts: the first one including ten patients of 56±14 years and 65±5 kg, and the second one with 10 patients (12 episodes of peritonitis) aged 52±13 years and 64±8 kg. The treatment consists of administering and retaining for 6 h in the peritoneal cavity a solution containing 2 g of vancomycin and 1 g of ceftazidime into 2 l of "dialysis solution". After the antibiotic administration, blood samples were obtained at 4, 6, 8, 10, 24, 48 and 168 h in the first cohort and at 6 and 120 h (C(VAN)(120)) in the second. The pharmacokinetic model was developed from the parameters obtained from the first cohort and was validated by the second cohort, calculating the mean error (ME) and the mean squared prediction error (MSPE) of the C(VAN)(120).

RESULTS

Vancomycin serum concentrations fell from 39.63±7.62 mcg/ml at 4h to 8.55±2.87 mcg/ml at 168 h for the first cohort, and from 37.65±6.84 mcg/ml at 6h to 10.82±2.66 mcg/ml at 120 h (C(VAN)(120)) for the second cohort. The pharmacokinetics parameters were: C1=0.006 1/h/kg and Vd:=0.52 1/kg for the first cohort, and C1=0.006 1/h/kg and Vd:=0.53 1/kg for the second. The predictive ME and MSPE of the C(VAN)(120). were 0.59 mcg/ml ([EM*100/C(VAN)(120)=5.5%) and 10.38 mcg(2)/ml(2) ([MES*100/(C(VAN)(120))(2)]) respectively.

CONCLUSION

The presented model shows an adequate exactitude and precision for the monitoring of intraperitoneal vancomycin in patients submitted to continuous ambulatory peritoneal dialysis with peritonitis.