A pharmacodynamic analysis of resistance trends in pathogens from patients with infection in intensive care units in the United States between 1993 and 2004

Cost analysis of real-time polymerase chain reaction microbiological diagnosis in patients with septic shock

Antibiotic treatment for septic shock is generally prescribed on an empirical basis using broad-spectrum antibiotics. Molecular diagnostic techniques can detect the presence of microbial DNA in blood within a few hours and facilitate early, targeted treatment. The aim of this study was to evaluate the economic impact of a real-time polymerase chain reaction technique, LightCycler SeptiFast (LSC), in patients with sepsis. A cost-minimisation study was carried out in patients admitted with a diagnosis of severe sepsis or septic shock to the intensive care unit of a university hospital. The stay in the intensive care unit, hospital admission, 28-day and six-month mortality, and the economic cost of the clinical process were also evaluated. The study involved 48 patients in the LSC group and 54 patients in the control group. The total cost was €42,198 in the control group versus €32,228 in the LCS group with statistically significant differences (P <0.05), giving rise to an average net saving of €9970 per patient. The mortality rate was similar in both groups. The main finding of this study was the significant economic saving afforded by the use of the LCS technique, due to the shortening of intensive care unit stay and the use of fewer antibiotics.

Studies on New Delhi Metallo-Beta-Lactamse-1 producing Acinetobacter baumannii isolated from donor swab in a tertiary eye care centre, India and structural analysis of its antibiotic binding interactions

Gram-negative bacilli, Enterobacteriaceae and Non-fermentors with resistance to carbapenems and metallo beta-lactams are the major cause of concern in clinical problems in current human healthcare. The most highly emerging dreadful Metallo Beta-lactamses is New Delhi metallo-beta-lactamase (blaNDM-1) which confers resistance to carbapenems; susceptible only to colistin and, less consistently to tigecycline, leading to no therapeutic options. In the present study, we demonstrate the effects of cephalosporins and carbepenems on biofilm producing A. baumanii clinical isolate and also to infer the probable inhibitory binding mode through molecular docking studies. The result of MIC on Biofilm producing A. baumanii and the docking analysis results were found to be concordant. Moreover, we also found cephalosporins and carbepenem groups to interact with 162-166 region of blaNDM-1, which is unique for NDM-1 and also documented to be a potential drug targeting region.

Comparison of 2002–2006 OPTAMA Programs for US Hospitals: Focus on Gram-Negative Resistance

Background:

Resistance among gram-negative bacteria is increasing within the US.

Objective:

To determine pharmacodynamic target attainment rates for 10 antimicrobials against selected gram-negative bacilli and compare these results with previous Optimizing Pharmacodynamic Target Attainment Using the MYSTIC Antibiogram (OPTAMA) assessments.

Methods:

A 5000-patient Monte Carlo simulation using data from population pharmacokinetic studies was employed to estimate the pharmacokinetic profiles for standard and/or prolonged infusion (PI) regimens of cefepime, ceftazidime, ceftriaxone, ciprofloxacin, ertapenem, imipenem, levofloxacin, meropenem, piperacillin–tazobactam, and tigecycline. Minimum inhibitory concentration data were obtained from intensive care units of 15 US hospitals participating in the 2006 MYSTIC (Meropenem Yearly Susceptibility Test Information Collection) study for 640 Escherichia coli, 618 Klebsiella spp., and 606 Pseudomonas aeruginosa isolates. Cumulative fraction of response (CFR) was calculated using pharmacodynamic targets for each antibiotic and compared with results from the 2002 and 2004 OPTAMA studies.

Results:

Against E. coli, CFRs greater than 92% were maintained for all regimens except the fluoroquinolones (CFR range 69.4–72%), which showed a 7% decrease compared with 2004. The presence of Klebsiella spp. producing KPC-type carbapenemases with associated multidrug resistance resulted in a 7% or greater drop in CFR of standard regimens relative to 2004. Despite these resistant phenotypes, high-dose PI regimens (2 g every 8 hours as 3-hour PI) of cefepime and meropenem achieved CFRs of 97% and 95.8%, respectively. Excluding 3 KPC-harboring hospitals resulted in CFR increases to greater than 98% for carbapenems and cefepime and greater than 88% for all other agents tested, except tigecycline. Against P. aeruginosa, the fluoroquinolones had the lowest CFR (55.8–63.9%), followed by imipenem (74.6-80.4%). The most predictable activity was seen with cefepime 2 g every 12 hours or higher (>90%), ceftazidime 2 g every 8 hours (97.9%), and meropenem 1-2 g every 8 hours (86.7–92.6%). Use of PI for piperacillin-tazobactam and meropenem increased CFRs by 6% and 4%, respectively, over standard infusions.

Conclusions:

Relative to previous years, an increase in resistance was noted among gram-negative bacilli to common antibiotics, resulting in disproportionate decreases in pharmacodynamic target attainment. The use of PI for β-lactams may help to overcome these decreases.

Cefepime: a reappraisal in an era of increasing antimicrobial resistance

Cefepime is a 'fourth-generation' cephalosporin with an in vitro extended-spectrum of activity against Gram-negative and Gram-positive pathogens. Cefepime is approved for the treatment of moderate-to-severe infections, such as pneumonia, uncomplicated and complicated urinary tract infections, skin and soft-tissue infections, intra-abdominal infections and febrile neutropenia. In this article, we provide a critical review of pharmacodynamics, clinical management, pharmacokinetics, metabolism, pharmacodynamic target analyses, clinical efficacy, safety and tolerability of cefepime after more than a decade of clinical use.