1
|
Cho H, Lee S, Sheen S, Choi YH. Differences in Vancomycin Clearance between Trauma and Medical Intensive Care Unit Patients. Infect Chemother 2020; 52:48-58. [PMID: 31997602 PMCID: PMC7113446 DOI: 10.3947/ic.2020.52.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/12/2020] [Indexed: 11/24/2022] Open
Abstract
Background To identify the differences in the vancomycin pharmacokinetics between multiple trauma patients and medically ill patients in the intensive care unit (ICU) stratified by the use of continuous renal replacement therapy (CRRT), and the factors affecting vancomycin clearance (CLvan). Materials and Methods All the included patients received at least three consecutive doses of vancomycin, then, therapeutic drug monitoring was conducted. Patients' serum vancomycin trough levels and other clinical variables were identified retrospectively. The vancomycin pharmacokinetics and associated factors were compared and analyzed between trauma ICU (TICU) and medical ICU (MICU) patients. Results In the non-dialyzed group, the CLvan was higher among the TICU patients than the MICU patients. However, in the continuous renal replacement therapy group, there was no significant difference in the CLvan between the multiple trauma and medically ill patients. The only factor associated with CLvan in the non-dialyzed group was creatinine clearance; none of the factors was associated with CLvan in the CRRT group. Conclusion In the case of non-dialyzed patients in the TICU, vancomycin dosages must be adjusted, depending on the patient's actual body weight changes. In the case of patients undergoing CRRT in both ICUs, vancomycin can be infused with fixed doses regardless of the patients' characteristics.
Collapse
Affiliation(s)
- Hundo Cho
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Suna Lee
- Department of Pharmacy, Ajou University Medical Center, Suwon, Korea
| | - Seungsoo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea.
| |
Collapse
|
2
|
Kim JJ, Blevins MW, Brooks DJ, Stehle Jr JR, McLouth CJ, Viviano JP, Holmes IV JH, Bischoff WE. Successful control of a methicillin-resistant Staphylococcus aureus outbreak in a burn intensive care unit by addition of universal decolonization with intranasal mupirocin to basic infection prevention measures. Am J Infect Control 2019; 47:661-665. [PMID: 30616934 DOI: 10.1016/j.ajic.2018.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/15/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is frequently implicated in health care-associated outbreaks in burn intensive care units, incurring substantial morbidity and mortality to these high-risk patients and excess costs to health care systems. METHODS MRSA health care-associated infections (HAIs) were noted before and after the implementation of basic infection prevention measures and the subsequent implementation of universal decolonization with intranasal mupirocin. Pulsed-field gel electrophoresis was used to determine the relatedness of clinical isolates. A case-control study was conducted to characterize the risk factors for MRSA HAIs. RESULTS Basic interventions failed to decrease the rate of MRSA HAIs, although compliance with these interventions was high throughout the study. MRSA HAIs decreased from 8.53 HAIs per 1,000 patient days before the implementation of intranasal mupirocin to 3.61 HAIs per 1,000 patient days after the implementation of intranasal mupirocin (P = .033). Pulsed-field gel electrophoresis disclosed 10 unique clones with no large clusters. The case-control study revealed a significant association between MRSA HAIs and lengths of stay, body surface area burned, intubation, pressor requirement, leukocytosis, lactic acidosis, development of pneumonia, MRSA colonization, and death. CONCLUSIONS Basic environmental and behavioral interventions fell short of controlling a low-count, sporadic, and multiclonal MRSA outbreak in the burn intensive care unit of a tertiary medical center. However, the added implementation of universal decolonization with intranasal mupirocin was effective. Burn victims with greater disease severity were at higher risk for MRSA HAIs.
Collapse
|
3
|
Khan TM, Kok YL, Bukhsh A, Lee LH, Chan KG, Goh BH. Incidence of methicillin resistant Staphylococcus aureus (MRSA) in burn intensive care unit: a systematic review. Germs 2018; 8:113-125. [PMID: 30250830 DOI: 10.18683/germs.2018.1138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 01/08/2023]
Abstract
Background Burn victims admitted in burn intensive care units (ICU) are at a high risk of nosocomial infections generated by methicillin resistant Staphylococcus aureus (MRSA). This systematic review aims to estimate the incidence of MRSA among burn patients admitted to the ICU setting, with an emphasis on the incidence rate and antibiotic resistance profile of the MRSA strains. Methods A systematic literature search was performed in five electronic databases limited to publication dates from 1st January 2000 until 31st August 2017. After screening n=481 articles, n=21 were found to meet the inclusion criteria of this systematic review. Results Results from the meta-analysis revealed that the risk for MRSA isolates in the burn ICU was 55.0% higher (OR 0.55, 95%CI 0.32-0.94). Therefore, timely testing, appropriate hygiene practice and suggested wound care must be practiced while handling such patients. Conclusion Further studies are needed to identify the risk factors of MRSA infections among burn patients and to develop new antimicrobial agents for MRSA infections.
Collapse
Affiliation(s)
- Tahir Mehmood Khan
- Assoc Prof, Dr, School of Pharmacy, Monash University Malaysia, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia, Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia, Institute of Pharmaceutical Sciences (IPS), University of Veterinary & Animal Sciences (UVAS), Outfall road, Lahore, Pakistan
| | - Yee Leng Kok
- Stud, School of Pharmacy, Monash University Malaysia, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Allah Bukhsh
- Research Fellow, Dr, School of Pharmacy, Monash University Malaysia, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia, Institute of Pharmaceutical Sciences (IPS), University of Veterinary & Animal Sciences (UVAS), Outfall road, Lahore, Pakistan
| | - Learn-Han Lee
- Senior Lecturer, Dr, School of Pharmacy, Monash University Malaysia, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia, Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Kok-Gan Chan
- Assoc Prof, Dr, Vice Chancellor Office, Jiangsu University, Zhenjiang 212013, PR China, Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Bey-Hing Goh
- Senior Lecturer, Dr, School of Pharmacy, Monash University Malaysia, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia, Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| |
Collapse
|
4
|
Younan D, Griffin R, Swain T, Pittet JF, Camins B. Trauma patients meeting both Centers for Disease Control and Prevention's definitions for ventilator-associated pneumonia had worse outcomes than those meeting only one. J Surg Res 2017; 216:123-128. [PMID: 28807196 DOI: 10.1016/j.jss.2017.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/23/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) replaced its old definition for ventilator-associated pneumonia (VAP) with the ventilator-associated events algorithm in 2013. We sought to compare the outcome of trauma patients meeting the definitions for VAP in the two modules. METHODS Trauma patients with blunt or penetrating injuries and with at least 2 d of ventilator support were identified from the trauma registry from 2013 to 2014. VAP was determined using two methods: (1) VAP as defined by the "old," clinically based NHSN definition and (2) possible VAP as defined by the updated "new" NHSN definition. Cohen's kappa statistic was determined to compare the two definitions for VAP. To compare demographic and clinical outcomes, the chi-square and Student's t-tests were used for categorical and continuous variables, respectively. RESULTS From 2013 to 2014, there were 1165 trauma patients admitted who had at least 2 d of ventilator support. Seventy-eight patients (6.6%) met the "new" NHSN definition for possible VAP, 361 patients (30.9%) met the "old" definition of VAP, and 68 patients (5.8%) met both definitions. The kappa statistic between VAP as defined by the "new" and "old" definitions was 0.22 (95% confidence interval, 0.17-0.27). There were no differences in age, gender, race, or injury severity score when comparing patients who met the different definitions. Those satisfying both definitions had longer ventilator support days (P = 0.0009), intensive care unit length of stay (LOS; P = 0.0003), and hospital LOS (P = 0.0344) when compared with those meeting only one definition. There was no difference in mortality for those meeting both and those meeting the old definition for VAP; patients meeting both definitions had higher respiratory rate at arrival (P = 0.0178). CONCLUSIONS There was no difference in mortality between patients meeting the "old" and "new" NHSN definitions for VAP; those who met "both" definitions had longer ventilator support days, intensive care unit, and hospital LOS.
Collapse
Affiliation(s)
- Duraid Younan
- Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Russell Griffin
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Thomas Swain
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jean-Francois Pittet
- Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bernard Camins
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|