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Assefa GM, Roberts JA, Mohammed SA, Sime FB. What are the optimal pharmacokinetic/pharmacodynamic targets for β-lactamase inhibitors? A systematic review. J Antimicrob Chemother 2024; 79:946-958. [PMID: 38459763 PMCID: PMC11062945 DOI: 10.1093/jac/dkae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/20/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Pharmacokinetic/pharmacodynamic (PK/PD) indices are widely used for the selection of optimum antibiotic doses. For β-lactam antibiotics, fT>MIC, best relates antibiotic exposure to efficacy and is widely used to guide the dosing of β-lactam/β-lactamase inhibitor (BLI) combinations, often without considering any PK/PD exposure requirements for BLIs. OBJECTIVES This systematic review aimed to describe the PK/PD exposure requirements of BLIs for optimal microbiological efficacy when used in combination with β-lactam antibiotics. METHODS Literature was searched online through PubMed, Embase, Web of Science, Scopus and Cochrane Library databases up to 5 June 2023. Studies that report the PK/PD index and threshold concentration of BLIs approved for clinical use were included. Narrative data synthesis was carried out to assimilate the available evidence. RESULTS Twenty-three studies were included. The PK/PD index that described the efficacy of BLIs was fT>CT for tazobactam, avibactam and clavulanic acid and fAUC0-24/MIC for relebactam and vaborbactam. The optimal magnitude of the PK/PD index is variable for each BLI based on the companion β-lactam antibiotics, type of bacteria and β-lactamase enzyme gene transcription levels. CONCLUSIONS The PK/PD index that describes the efficacy of BLIs and the exposure measure required for their efficacy is variable among inhibitors; as a result, it is difficult to make clear inference on what the optimum index is. Further PK/PD profiling of BLI, using preclinical infection models that simulate the anticipated mode(s) of clinical use, is warranted to streamline the exposure targets for use in the optimization of dosing regimens.
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Affiliation(s)
- Getnet M Assefa
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Jason A Roberts
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Herston Infectious Disease Institute (HeIDI), Metro North Health, Brisbane, QLD, Australia
- Division of Anaesthesiology Critical Care Emerging and Pain Medicine, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Solomon A Mohammed
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fekade B Sime
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Chai MG, Tu Q, Cotta MO, Bauer MJ, Balch R, Okafor C, Comans T, Kruger P, Meyer J, Shekar K, Brady K, Fourie C, Sharp N, Vlad L, Whiley D, Ungerer JPJ, Mcwhinney BC, Farkas A, Paterson DL, Clark JE, Hajkowicz K, Raman S, Bialasiewicz S, Lipman J, Forde BM, Harris PNA, Schlapbach LJ, Coin L, Roberts JA, Irwin AD. Correction: Achievement of therapeutic antibiotic exposures using Bayesian dosing software in critically unwell children and adults with sepsis. Intensive Care Med 2024:10.1007/s00134-024-07393-9. [PMID: 38563901 DOI: 10.1007/s00134-024-07393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Ming G Chai
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Quyen Tu
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Menino O Cotta
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
| | - Michelle J Bauer
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Ross Balch
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Charles Okafor
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jason Meyer
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kiran Shekar
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Kara Brady
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Cheryl Fourie
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Natalie Sharp
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Luminita Vlad
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - David Whiley
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Jacobus P J Ungerer
- Department of Chemical Pathology, Pathology Queensland, Brisbane, QLD, Australia
- Faculty of Biomedical Science, University of Queensland, Brisbane, QLD, Australia
| | - Brett C Mcwhinney
- Department of Chemical Pathology, Pathology Queensland, Brisbane, QLD, Australia
| | - Andras Farkas
- Optimum Dosing Strategies, Bloomingdale, NJ, 07403, USA
- Department of Pharmacy, Saint Clare's Health, Denville, NJ, 07834, USA
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Julia E Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Sainath Raman
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Seweryn Bialasiewicz
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- ICU and Jameson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Nimes University Hospital, University of Montpellier, Nimes, France
| | - Brian M Forde
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Patrick N A Harris
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lachlan Coin
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
| | - Adam D Irwin
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia.
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Ramachandra SS, Sime FB, Naicker S, Han P, Lee RS, C Wallis S, Roberts JA, Ivanovski S. An in vitro dynamic bioreactor model for evaluating antimicrobial effectiveness on periodontal polymicrobial biofilms: a proof-of-concept study. J Periodontol 2024; 95:384-396. [PMID: 37724702 DOI: 10.1002/jper.23-0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/12/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The aim of this study was to investigate an in vitro dynamic bioreactor model by evaluating the antimicrobial effect of clinically relevant amoxicillin doses on polymicrobial microcosm biofilms derived from subgingival plaque. METHODS Biofilms from pooled subgingival plaque were grown for 108 hours in control and experimental dynamic biofilm reactors. Amoxicillin was subsequently infused into the experimental reactor to simulate the pharmacokinetic profile of a standard 500 mg thrice-daily dosing regimen over 5 days and biofilms were assessed by live/dead staining, scanning electron microscopy, and quantitative polymerase chain reaction. RESULTS Following establishment of the oral microcosm biofilms, confocal imaging analysis showed a significant increase in dead bacteria at 8 hours (p = 0.0095), 48 hours (p = 0.0070), 96 hours (p = 0.0140), and 120 hours (p < 0.0001) in the amoxicillin-treated biofilms compared to the control biofilms. Nevertheless, viable bacteria remained in the center of the biofilm at all timepoints. Significant reductions/elimination in Campylobacter rectus, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, and Peptostreptococcus anaerobius was observed among the amoxicillin-treated biofilms at the 96 and 120 hour timepoints. CONCLUSION A novel in vitro dynamic model of oral microcosm biofilms was effective in modeling the antimicrobial effect of a pharmacokinetically simulated clinically relevant dose of amoxicillin.
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Affiliation(s)
- Srinivas Sulugodu Ramachandra
- School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Preventive Dental Sciences, College of Dentistry, Gulf Medical University, Ajman, United Arab Emirates
| | - Fekade Bruck Sime
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Saiyuri Naicker
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Pingping Han
- School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Center for Orofacial Regeneration, Rehabilitation and Reconstruction (COR3), School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Ryan Sb Lee
- School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Center for Orofacial Regeneration, Rehabilitation and Reconstruction (COR3), School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Steven C Wallis
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology, Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Sašo Ivanovski
- School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Center for Orofacial Regeneration, Rehabilitation and Reconstruction (COR3), School of Dentistry, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Naicker S, Roberts JA, Won H, Wallis SC, Unwin S, Jamieson C, Hills T, Gilchrist M, Santillo M, Seaton RA, Drummond F, Sime FB. Evaluation of the stability of ceftazidime/avibactam in elastomeric infusion devices used for outpatient parenteral antimicrobial therapy utilizing a national stability protocol framework. JAC Antimicrob Resist 2024; 6:dlae056. [PMID: 38585225 PMCID: PMC10995722 DOI: 10.1093/jacamr/dlae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
Objectives To evaluate the stability of ceftazidime/avibactam in elastomeric infusers, utilizing the UK's Yellow Cover Document (YCD) stability testing framework, in conditions representative of OPAT practice. Methods Ceftazidime/avibactam was reconstituted with sodium chloride 0.9% (w/v) in two elastomeric infusers at concentrations (dose) levels of 1500/375, 3000/750 and 6000 mg/1500 mg in 240 mL. The infusers were exposed to a fridge storage (2°C-8°C) for 14 days followed by 24 h in-use temperature (32°C). Results After 14 days of fridge storage and subsequent 24 h exposure to 32°C, mean ± SD of ceftazidime percent remaining was 75.5% ± 1.8%, 79.9% ± 1.1%, 82.4% ± 0.6%, for Easypump, and 81.7% ± 1.2%, 82.5% ± 0.5%, 85.4% ± 1.1% for Dosi-Fuser devices at the high, intermediate and low doses tested, respectively. For avibactam, mean ± SD percent remaining was 83.2% ± 1.8%, 87.4% ± 2.0%, 93.1% ± 0.9% for Easypump, and 85.1% ± 2.0%, 86.7% ± 0.1%, 92.5% ± 0.1% for Dosi-Fuser devices. The cumulative amount of pyridine generated in the devices ranged from 10.4 mg at low dose to 76.9 mg at high dose. Regression-based simulation showed that the degradation of both ceftazidime and avibactam was <10% for at least 12 h of the running phase, if stored in a fridge for not more than 72 h prior to in-use temperature exposure. Conclusions Whilst not meeting the strict UK YCD criteria for ≤5% degradation, ceftazidime/avibactam may be acceptable to administer as a continuous 12 hourly infusion in those territories where degradation of ≤10% is deemed acceptable.
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Affiliation(s)
- Saiyuri Naicker
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Jason A Roberts
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Hayoung Won
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Steven C Wallis
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Sean Unwin
- Infection Management Services, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Conor Jamieson
- Medical Directorate, NHS England (Midlands), Birmingham, UK
| | - Tim Hills
- Pharmacy Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mark Gilchrist
- Department of Pharmacy/Infection, Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Mark Santillo
- Pharmacy Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
- Pharmacy Department, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - R Andrew Seaton
- Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Fekade B Sime
- The University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia
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5
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Bellapart J, Laupland KB, Malacova E, Roberts JA, Paratz J. Nimodipine prophylaxis in aneurysmal subarachnoid hemorrhage, a question of tradition or evidence: A scoping review. J Clin Neurosci 2024; 123:91-99. [PMID: 38564967 DOI: 10.1016/j.jocn.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/14/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The prophylactic use of nimodipine following subarachnoid hemorrhage is a practice established four decades ago when clinical management differed from current and the concept of Delayed Cerebral Ischemia (DCI) was not established. The applicability of the original studies is limited by the fact of not reflecting current practice; by utilising a dichotomised outcome measure such as good neurological outcome versus death and vegetative state; by applying variable dosing regimens and including all causes of poor neurological outcome different than DCI. This study aims to review the available evidence to discuss the ongoing role of nimodipine in contemporaneous clinical practice. METHODS PRISMA guidelines based review, evaluated the evidence on the prophylactic use of nimodipine. The following search engines: Medline, Embase, Cochrane, Web of Science and PubMed, identified Randomized Control Trials (RCTs) with neurological benefit as outcome measure and the impact of fixed versus weight-based nimodipine dosing regimens. RESULTS Eight RCT were selected. Three of those trials with a total of 349 patients, showed a reduction on death and vegetative state (pooled RR: 0.62; 95 % confidence interval-CI: 0.45, 0.86) related to DCI. Amongst all studies, all cause death (pooled RR = 0.73, [95 % CI: 0.56, 0.97]) favoured a fixed-dose regimen (pooled RR: 0.60; [95 % CI: 0.43, 0.85]). CONCLUSION Available evidence demonstrates that nimodipine only reduces the risk for DCI-related death or vegetative state and that fixed-dose regimens favour all cause infarct and death independent of DCI. Contemporaneous studies assessing the benefit of nimodipine beyond death or vegetative states and applying individualized dosing are warranted.
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Affiliation(s)
- Judith Bellapart
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; Burns Trauma and Critical Care Research Centre, the University of Queensland, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, 4029, Brisbane, Australia.
| | - Kevin B Laupland
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; Queensland University of Technology (QUT), Brisbane, Australia.
| | - Eva Malacova
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD, 4006, Australia.
| | - Jason A Roberts
- University of Queensland Centre of Clinical Research (UQCCR), the University of Queensland, Herston, Brisbane, Australia; Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Jennifer Paratz
- School of Allied Health Sciences, Griffith University, Brisbane, Australia; Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia.
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6
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Chai MG, Tu Q, Cotta MO, Bauer MJ, Balch R, Okafor C, Comans T, Kruger P, Meyer J, Shekar K, Brady K, Fourie C, Sharp N, Vlad L, Whiley D, Ungerer JPJ, Mcwhinney BC, Farkas A, Paterson DL, Clark JE, Hajkowicz K, Raman S, Bialasiewicz S, Lipman J, Forde BM, Harris PNA, Schlapbach LJ, Coin L, Roberts JA, Irwin AD. Achievement of therapeutic antibiotic exposures using Bayesian dosing software in critically unwell children and adults with sepsis. Intensive Care Med 2024; 50:539-547. [PMID: 38478027 PMCID: PMC11018654 DOI: 10.1007/s00134-024-07353-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/11/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Early recognition and effective treatment of sepsis improves outcomes in critically ill patients. However, antibiotic exposures are frequently suboptimal in the intensive care unit (ICU) setting. We describe the feasibility of the Bayesian dosing software Individually Designed Optimum Dosing Strategies (ID-ODS™), to reduce time to effective antibiotic exposure in children and adults with sepsis in ICU. METHODS A multi-centre prospective, non-randomised interventional trial in three adult ICUs and one paediatric ICU. In a pre-intervention Phase 1, we measured the time to target antibiotic exposure in participants. In Phase 2, antibiotic dosing recommendations were made using ID-ODS™, and time to target antibiotic concentrations were compared to patients in Phase 1 (a pre-post-design). RESULTS 175 antibiotic courses (Phase 1 = 123, Phase 2 = 52) were analysed from 156 participants. Across all patients, there was no difference in the time to achieve target exposures (8.7 h vs 14.3 h in Phase 1 and Phase 2, respectively, p = 0.45). Sixty-one courses in 54 participants failed to achieve target exposures within 24 h of antibiotic commencement (n = 36 in Phase 1, n = 18 in Phase 2). In these participants, ID-ODS™ was associated with a reduction in time to target antibiotic exposure (96 vs 36.4 h in Phase 1 and Phase 2, respectively, p < 0.01). These patients were less likely to exhibit subtherapeutic antibiotic exposures at 96 h (hazard ratio (HR) 0.02, 95% confidence interval (CI) 0.01-0.05, p < 0.01). There was no difference observed in in-hospital mortality. CONCLUSIONS Dosing software may reduce the time to achieve target antibiotic exposures. It should be evaluated further in trials to establish its impact on clinical outcomes.
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Affiliation(s)
- Ming G Chai
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Quyen Tu
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Menino O Cotta
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
| | - Michelle J Bauer
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Ross Balch
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Charles Okafor
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jason Meyer
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kiran Shekar
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Kara Brady
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Cheryl Fourie
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Natalie Sharp
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Luminita Vlad
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - David Whiley
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Jacobus P J Ungerer
- Department of Chemical Pathology, Pathology Queensland, Brisbane, QLD, Australia
- Faculty of Biomedical Science, University of Queensland, Brisbane, QLD, Australia
| | - Brett C Mcwhinney
- Department of Chemical Pathology, Pathology Queensland, Brisbane, QLD, Australia
| | - Andras Farkas
- Optimum Dosing Strategies, Bloomingdale, NJ, 07403, USA
- Department of Pharmacy, Saint Clare's Health, Denville, NJ, 07834, USA
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Julia E Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Sainath Raman
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Seweryn Bialasiewicz
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- ICU and Jameson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Nimes University Hospital, University of Montpellier, Nimes, France
| | - Brian M Forde
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Patrick N A Harris
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lachlan Coin
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Herston Infectious Disease Institute, Metro North, QLD Health, Herston, QLD, Australia
| | - Adam D Irwin
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia.
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7
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Novy E, Liu X, Hernandez-Mitre MP, Belveyre T, Scala-Bertola J, A Roberts J, L Parker S. Population pharmacokinetics of prophylactic cefoxitin in elective bariatric surgery patients: A prospective monocentric study. Anaesth Crit Care Pain Med 2024:101376. [PMID: 38494157 DOI: 10.1016/j.accpm.2024.101376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/19/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND This study describes the population pharmacokinetics of cefoxitin in obese patients undergoing elective bariatric surgery and evaluates different dosing regimens for achievement of pre-defined target exposures. METHODS Serial blood samples were collected during surgery with relevant clinical data. Total serum cefoxitin concentrations were measured by chromatographic assay and analysed using a population PK approach with Pmetrics®. The cefoxitin unbound fraction (fu) was estimated. Dosing simulations were performed to ascertain the probability of target attainment (PTA) to achieve cefoxitin fu above minimum inhibitory concentrations (MIC) from surgical incision to wound closure. Fractional target attainment (FTA) was calculated against MIC distributions of common pathogens. RESULTS A total of 123 obese patients (median BMI 44.3 kg/m2) were included with 381 cefoxitin concentration values. Cefoxitin was best described by a one-compartment model, with a mean clearance and volume of distribution of 10.9 ± 6.1 L/h and 23.4 ± 10.5 L, respectively. In surgery <2 h, a 2 and a 4 g doses were sufficient for an MIC up to 4 and 8 mg/L (fu 50%), respectively. In prolonged surgery (2 to 4 h), only continuous infusion enabled optimal PTA for an MIC up to 16 mg/L. Optimal FTAs were obtained against Staphylococcus aureus and Escherichia Coli only when simulating with 50% cefoxitin protein binding (intermittent regimen) and regardless of the protein binding for the continuous infusion. CONCLUSION Intermittent dosing regimens resulted in optimal FTAs against susceptible MIC distributions of S. aureus and E. coli when simulating with 50% cefoxitin protein binding. Continuous infusion of cefoxitin may improve FTA regardless of protein binding. STUDY REGISTRATION Registration on ClinicalTrials.gov, NCT03306290.
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Affiliation(s)
- Emmanuel Novy
- Department of Anaesthesiology Critical Care and perioperative medicine, Nancy University Hospital, University of Lorraine, Vandoeuvre-Lès-Nancy, 54500, France; UR 7300, SIMPA, Université de Lorraine, 54000, Nancy, France; UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia.
| | - Xin Liu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia
| | | | - Thibaut Belveyre
- Department of Anaesthesiology Critical Care and perioperative medicine, Nancy University Hospital, University of Lorraine, Vandoeuvre-Lès-Nancy, 54500, France
| | - Julien Scala-Bertola
- Department of Clinical Pharmacology and Toxicology, Nancy University Hospital, Vandoeuvre-Lès-Nancy, 54500, France; CNRS, IMoPA, Université de Lorraine, 54000, Nancy, France
| | - Jason A Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia; Division of Anaesthesiology Critical Care Emergency & Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, 30029, France; Herston Infectious Disease Institute (HeiDI), Metro North Health, Brisbane, Australia
| | - Suzanne L Parker
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia
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Selby PR, Heffernan AJ, Yeung D, Warner MS, Peake SL, Hahn U, Westley I, Shakib S, Roberts JA. Population pharmacokinetics of posaconazole in allogeneic haematopoietic stem cell transplant patients. J Antimicrob Chemother 2024; 79:567-577. [PMID: 38217845 DOI: 10.1093/jac/dkae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Invasive fungal disease (IFD) in the early post-allogeneic HSCT (alloHCT) period is associated with increased likelihood of catastrophic outcomes. The utility of oral modified release (MR) posaconazole tablets is limited by reduced drug absorption from gastrointestinal toxicity induced by cytotoxic chemotherapy, necessitating a switch to the IV posaconazole formulation. OBJECTIVES To describe the population pharmacokinetics of posaconazole for oral MR and IV formulations in alloHCT patients and determine dosing regimens likely to achieve therapeutic exposures. METHODS We performed a prospective observational pharmacokinetic study in adult patients in the early post-alloHCT period requiring a change in posaconazole formulation (oral to IV). Samples were analysed using a validated LC-MS/MS method. Population pharmacokinetic analysis and Monte Carlo simulations (n = 1000) were performed using Pmetrics for R. RESULTS Twenty patients aged between 21 and 70 years were included in the study. A two-compartment model, incorporating mucositis/diarrhoea to modify the bioavailability for oral administration best described the data. To achieve ≥90% PTA, simulations showed that higher than currently recommended doses of oral MR posaconazole were required for prophylaxis Cmin targets (≥0.5 and ≥0.7 mg/L), while increased doses of both formulations were required for IFD treatment PK/PD targets, with patients experiencing oral mucositis/diarrhoea unlikely to achieve these. CONCLUSIONS Increased doses of posaconazole should be considered for both prophylaxis and treatment of IFD to increase the proportion of alloHCT patients achieving therapeutic exposures, particularly the oral formulation in patients with mucositis and/or diarrhoea. Posaconazole therapeutic drug monitoring should be considered for all formulations in this setting.
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Affiliation(s)
- Philip R Selby
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- Pharmacy Department, Royal Adelaide Hospital, Port Road, Adelaide, Australia
| | - Aaron J Heffernan
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - David Yeung
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Haematology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Morgyn S Warner
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Sandra L Peake
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Uwe Hahn
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Haematology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Ian Westley
- SA Pathology, Adelaide, Australia
- School of Pharmacy and Biomedical Sciences, University of South Australia, Adelaide, Australia
| | - Sepehr Shakib
- School of Medicine, Discipline of Pharmacology, University of Adelaide, Adelaide, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Dhanani J, Roberts JA, Monsel A, Torres A, Kollef M, Rouby JJ. Understanding the nebulisation of antibiotics: the key role of lung microdialysis studies. Crit Care 2024; 28:49. [PMID: 38373973 PMCID: PMC10875779 DOI: 10.1186/s13054-024-04828-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Nebulisation of antibiotics is a promising treatment for ventilator-associated pneumonia (VAP) caused by multidrug-resistant organisms. Ensuring effective antibiotic concentrations at the site of infection in the interstitial space fluid is crucial for clinical outcomes. Current assessment methods, such as epithelial lining fluid and tissue homogenates, have limitations in providing longitudinal pharmacokinetic data. MAIN BODY Lung microdialysis, an invasive research technique predominantly used in animals, involves inserting probes into lung parenchyma to measure antibiotic concentrations in interstitial space fluid. Lung microdialysis offers unique advantages, such as continuous sampling, regional assessment of antibiotic lung concentrations and avoidance of bronchial contamination. However, it also has inherent limitations including the cost of probes and assay development, the need for probe calibration and limited applicability to certain antibiotics. As a research tool in VAP, lung microdialysis necessitates specialist techniques and resource-intensive experimental designs involving large animals undergoing prolonged mechanical ventilation. However, its potential impact on advancing our understanding of nebulised antibiotics for VAP is substantial. The technique may enable the investigation of various factors influencing antibiotic lung pharmacokinetics, including drug types, delivery devices, ventilator settings, interfaces and disease conditions. Combining in vivo pharmacokinetics with in vitro pharmacodynamic simulations can become feasible, providing insights to inform nebulised antibiotic dose optimisation regimens. Specifically, it may aid in understanding and optimising the nebulisation of polymyxins, effective against multidrug-resistant Gram-negative bacteria. Furthermore, lung microdialysis holds promise in exploring novel nebulisation therapies, including repurposed antibiotic formulations, bacteriophages and immunomodulators. The technique's potential to monitor dynamic biochemical changes in pneumonia, such as cytokines, metabolites and inflammation/infection markers, opens avenues for developing theranostic tools tailored to critically ill patients with VAP. CONCLUSION In summary, lung microdialysis can be a potential transformative tool, offering real-time insights into nebulised antibiotic pharmacokinetics. Its potential to inform optimal dosing regimen development based on precise target site concentrations and contribute to development of theranostic tools positions it as key player in advancing treatment strategies for VAP caused by multidrug-resistant organisms. The establishment of international research networks, exemplified by LUMINA (lung microdialysis applied to nebulised antibiotics), signifies a proactive step towards addressing complexities and promoting multicentre experimental studies in the future.
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Affiliation(s)
- Jayesh Dhanani
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Australia.
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Antoine Monsel
- Unité Mixte de Recherche (UMR)-S 959, Immunology-Immunopathology-Immunotherapy, Paris, Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne University, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), DMU DREAM, Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Antoni Torres
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), University of Barcelona, Barcelona, Spain
| | - Marin Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jean-Jacques Rouby
- Sorbonne University, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), DMU DREAM, Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
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Harris PNA, Bauer MJ, Lüftinger L, Beisken S, Forde BM, Balch R, Cotta M, Schlapbach L, Raman S, Shekar K, Kruger P, Lipman J, Bialasiewicz S, Coin L, Roberts JA, Paterson DL, Irwin AD. Rapid nanopore sequencing and predictive susceptibility testing of positive blood cultures from intensive care patients with sepsis. Microbiol Spectr 2024; 12:e0306523. [PMID: 38193658 PMCID: PMC10846127 DOI: 10.1128/spectrum.03065-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
We aimed to evaluate the performance of Oxford Nanopore Technologies (ONT) sequencing from positive blood culture (BC) broths for bacterial identification and antimicrobial susceptibility prediction. Patients with suspected sepsis in four intensive care units were prospectively enrolled. Human-depleted DNA was extracted from positive BC broths and sequenced using ONT (MinION). Species abundance was estimated using Kraken2, and a cloud-based system (AREScloud) provided in silico predictive antimicrobial susceptibility testing (AST) from assembled contigs. Results were compared to conventional identification and phenotypic AST. Species-level agreement between conventional methods and AST predicted from sequencing was 94.2% (49/52), increasing to 100% in monomicrobial infections. In 262 high-quality AREScloud AST predictions across 24 samples, categorical agreement (CA) was 89.3%, with major error (ME) and very major error (VME) rates of 10.5% and 12.1%, respectively. Over 90% CA was achieved for some taxa (e.g., Staphylococcus aureus) but was suboptimal for Pseudomonas aeruginosa. In 470 AST predictions across 42 samples, with both high quality and exploratory-only predictions, overall CA, ME, and VME rates were 87.7%, 8.3%, and 28.4%. VME rates were inflated by false susceptibility calls in a small number of species/antibiotic combinations with few representative resistant isolates. Time to reporting from sequencing could be achieved within 8-16 h from BC positivity. Direct sequencing from positive BC broths is feasible and can provide accurate predictive AST for some species. ONT-based approaches may be faster but significant improvements in accuracy are required before it can be considered for clinical use.IMPORTANCESepsis and bloodstream infections carry a high risk of morbidity and mortality. Rapid identification and susceptibility prediction of causative pathogens, using Nanopore sequencing direct from blood cultures, may offer clinical benefit. We assessed this approach in comparison to conventional phenotypic methods and determined the accuracy of species identification and susceptibility prediction from genomic data. While this workflow holds promise, and performed well for some common bacterial species, improvements in sequencing accuracy and more robust predictive algorithms across a diverse range of organisms are required before this can be considered for clinical use. However, results could be achieved in timeframes that are faster than conventional phenotypic methods.
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Affiliation(s)
- Patrick N. A. Harris
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Herston Infectious Disease Institute, Royal Brisbane and Women’s Hospital Campus, Brisbane, Australia
| | - Michelle J. Bauer
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | | | - Brian M. Forde
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Ross Balch
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Menino Cotta
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Luregn Schlapbach
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sainath Raman
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, South Brisbane, Australia
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Anaesthesiology and Critical Care, The University of Queensland, St Lucia, Queensland, Australia
| | - Jeff Lipman
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Intensive Care Unit, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
- Jamieson Trauma Institute, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Seweryn Bialasiewicz
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, Faculty of Science, University of Queensland, Brisbane, Australia
| | - Lachlan Coin
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason A. Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Herston Infectious Disease Institute, Royal Brisbane and Women’s Hospital Campus, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - David L. Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- ADVANCE-ID, Saw Swee School of Public Health, National University of Singapore, Singapore, Singapore
| | - Adam D. Irwin
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Infection Management and Prevention Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
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Hernández-Mitre MP, Morpeth SC, Venkatesh B, Hills TE, Davis J, Mahar RK, McPhee G, Jones M, Totterdell J, Tong SYC, Roberts JA. TMPRSS2 inhibitors for the treatment of COVID-19 in adults: a systematic review and meta-analysis of randomized clinical trials of nafamostat and camostat mesylate. Clin Microbiol Infect 2024:S1198-743X(24)00055-7. [PMID: 38331253 DOI: 10.1016/j.cmi.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Synthetic serine protease inhibitors block the cellular enzyme transmembrane protease serine 2, thus preventing SARS-CoV-2 cell entry. There are two relevant drugs in this class, namely, nafamostat (intravenous formulation) and camostat (oral formulation). OBJECTIVE To determine whether transmembrane protease serine 2 inhibition with nafamostat or camostat is associated with a reduced risk of 30-day all-cause mortality in adults with COVID-19. DATA SOURCES Scientific databases and clinical trial registry platforms. STUDY ELIGIBILITY CRITERIA, INTERVENTIONS, AND PARTICIPANTS Preprints or published randomized clinical trials (RCTs) of nafamostat or camostat vs. usual care or placebo in adults requiring treatment for COVID-19. METHODS OF DATA SYNTHESIS AND RISK-OF-BIAS ASSESSMENT The primary outcome of the meta-analysis was 30-day all-cause mortality. Secondary outcomes included time to recovery, adverse events, and serious adverse events. Risk of bias (RoB) was assessed using the revised Cochrane RoB 2 tool for individually randomized trials. Meta-analysis was conducted in the R package meta (v7.0-0) using inverse variance and random effects. Protocol registration number was INPLASY202320120. RESULTS Twelve RCTs were included. Overall, the number of available patients was small (nafamostat = 387; camostat = 1061), the number of enrolled patients meeting the primary outcome was low (nafamostat = 12; camostat = 13), and heterogeneity was high. In hospitalized adults, we did not identify differences in 30-day all-cause mortality (risk ratio [95% CI]: 0.58 [0.19, 1.80], p 0.34; I2 = 0%; n = 6) and time to recovery (mean difference [95% CI]: 0.08 days [-0.74, 0.89], p 0.86; n = 2) between nafamostat vs. usual care; and for 30-day all-cause mortality (risk ratio [95% CI]: 0.99 [0.31, 3.18], p 0.99; n = 2) between camostat vs. placebo. CONCLUSION The RCT evidence is inconclusive to determine whether there is a mortality reduction and safety with either nafamostat or camostat for the treatment of adults with COVID-19. There were high RoB, small sample size, and high heterogeneity between RCTs.
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Affiliation(s)
| | - Susan C Morpeth
- Departments of Microbiology and Infectious Diseases, Middlemore Hospital, Te Whatu Ora Counties Manukau, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Balasubramanian Venkatesh
- Intensive Care, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia; Intensive Care, Wesley Hospital, Brisbane, Queensland, Australia; The George Institute for Global Health, UNSW Sydney, New South Wales, Australia
| | - Thomas E Hills
- Departments of Immunology and Infectious Diseases, Auckland District Health Board, Auckland, New Zealand; Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Joshua Davis
- Infection Research Program, Hunter Medical Research Institute, Univerity of Newcastle, Newcastle, New South Wales, Australia
| | - Robert K Mahar
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Grace McPhee
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Mark Jones
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - James Totterdell
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; Departments of Intensive Care Medicine and Pharmacy, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France; Herston Infectious Diseases Institute (HeIDI), Metro North Health, Herston, Queensland, Australia.
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12
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Li Y, Roberts JA, Walker MM, Aslan AT, Harris PNA, Sime FB. The global epidemiology of ventilator-associated pneumonia caused by multi-drug resistant Pseudomonas aeruginosa: A systematic review and meta-analysis. Int J Infect Dis 2024; 139:78-85. [PMID: 38013153 DOI: 10.1016/j.ijid.2023.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/08/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES The objective of this systematic review and meta-analysis was to estimate the global prevalence of multi-drug resistant (MDR) Pseudomonas aeruginosa causing ventilator-associated pneumonia (VAP). METHODS The systematic search was conducted in four databases. Original studies describing MDR P. aeruginosa VAP prevalence in adults from 2012- 2022 were included. A meta-analysis, using the random effects model, was conducted for overall, subgroups (country, published year, study duration, and study design), and European data, respectively. Univariate meta-regression based on pooled estimates was also conducted. Systematic review registered in International Prospective Register of Systematic Review (CRD42022384035). RESULTS In total of 31 studies, containing a total of 7951 cases from 16 countries, were included. The overall pooled prevalence of MDR among P. aeruginosa causing VAP was 33% (95% confidence interval [CI] 27.7-38.3%). The highest prevalence was for Iran at 87.5% (95% CI 69-95.7%), and the lowest was for the USA at 19.7% (95% CI 18.6-20.7%). The European prevalence was 29.9% (95% CI 23.2-36.7%). CONCLUSIONS This review indicates that the prevalence of MDR P. aeruginosa in patients with VAP is generally high and varies significantly between countries; however, data are insufficient for many countries. The data in this study can provide a reference for VAP management and drug customisation strategies.
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Affiliation(s)
- Yixuan Li
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia; Departments of Phaemacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Australia; Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Mikaela M Walker
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia
| | - Abdullah Tarik Aslan
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia; Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Patrick N A Harris
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia; Pathology Queensland, Health Support Queensland, Herston, Australia
| | - Fekade B Sime
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Herston, Australia.
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Hong LT, Downes KJ, FakhriRavari A, Abdul-Mutakabbir JC, Kuti JL, Jorgensen S, Young DC, Alshaer MH, Bassetti M, Bonomo RA, Gilchrist M, Jang SM, Lodise T, Roberts JA, Tängdén T, Zuppa A, Scheetz MH. Response to comment on "International consensus recommendations for the use of prolonged-infusion β-lactams endorsed by the American College of Clinical Pharmacy (ACCP), the British Society for Antimicrobial Chemotherapy (BSAC), the Cystic Fibrosis Foundation (CFF), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the Infectious Diseases Society of American (IDSA), the Society of Critical Care Medicine (SCCM), and the Society of Infectious Diseases Pharmacists". Pharmacotherapy 2024; 44:208-209. [PMID: 38362632 DOI: 10.1002/phar.2907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/15/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Lisa T Hong
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Kevin J Downes
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Jacinda C Abdul-Mutakabbir
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
- Divisions of Clinical Pharmacy and Black Diaspora and African American Studies, University of California San Diego, La Jolla, California, USA
| | - Joseph L Kuti
- Center for Anti-Infective Research and Development, Hartford Hospital, Gainesville, Florida, USA
| | | | - David C Young
- University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | | | | | - Robert A Bonomo
- Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA
- Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Case Western Reserve University, Cleveland, Ohio, USA
| | - Mark Gilchrist
- Imperial College Healthcare National Health Services Trust, London, UK
| | - Soo Min Jang
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Thomas Lodise
- Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Center for Clinical Research, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Thomas Tängdén
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Athena Zuppa
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marc H Scheetz
- College of Pharmacy, Pharmacometric Center of Excellence, Midwestern University, Downers Grove, Illinois, USA
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA
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Legg A, Roberts JA, Roberts MA, Cass A, Davies J, Tong SYC, Davis JS. Avoiding misclassification of acute kidney injury: Timing is everything. Nephrology (Carlton) 2024; 29:100-104. [PMID: 37820650 PMCID: PMC10952645 DOI: 10.1111/nep.14246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
Accurate detection of acute kidney injury (AKI) in clinical trials is important. Using a 'baseline' creatinine from trial enrolment may not be ideal for understanding a participant's true baseline kidney function. We aimed to determine if a 'pre-trial baseline creatinine' resulted in comparable creatinine concentrations to a 'trial baseline creatinine', and how the timing of baseline creatinine affected the incidence of AKI in the Combination Antibiotic therapy for MEthicillin Resistant Staphylococcus aureus (CAMERA2) randomised trial. Study sites retrospectively collected a pre-trial baseline creatinine from up to 1 year before CAMERA2 trial enrolment ideally when the patient was medically stable. Baseline creatinine from CAMERA2 (the 'trial baseline creatinine'), was the highest creatinine measurement in the 24 h preceding trial randomisation. We used Wilcoxon sign rank test to compare pre-trial and trial baseline creatinine concentrations. We included 217 patients. The median pre-trial baseline creatinine was significantly lower than the median trial baseline creatinine (82 μmol/L [IQR 65-104 μmol/L] versus 86 μmol/L [IQR 66-152 μmol/L] p = <0.001). Using pre-trial baseline creatinine, 48 of 217 patients (22%) met criteria for an AKI at CAMERA2 enrolment and only 5 of these patients met criteria for an AKI using the CAMERA2 study protocol (using baseline creatinine from trial entry). Using a baseline creatinine from the time of trial enrolment failed to detect many patients with AKI. Trial protocols should consider the optimal timing of baseline creatinine and the limitations of using a baseline creatinine during an acute illness.
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Affiliation(s)
- Amy Legg
- Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia
- Herston Infectious Diseases Institute, Metro North HealthBrisbaneQueenslandAustralia
| | - Jason A. Roberts
- Herston Infectious Diseases Institute, Metro North HealthBrisbaneQueenslandAustralia
- Faculty of MedicineUniversity of Queensland Centre for Clinical Research (UQCCR)BrisbaneQueenslandAustralia
- Departments of Intensive Care Medicine and PharmacyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Nîmes University Hospital, Division of Anaesthesiology Critical Care Emergency and Pain MedicineUniversity of MontpellierNîmesFrance
| | - Matthew A. Roberts
- Eastern Health Clinical SchoolMonash UniversityBox HillVictoriaAustralia
| | - Alan Cass
- Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia
| | - Jane Davies
- Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia
- Department of Infectious DiseasesRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
| | - Steven Y. C. Tong
- Victorian Infectious Diseases Service, The Royal Melbourne HospitalPeter Doherty Institute for Infection and ImmunityMelbourneVictoriaAustralia
- Department of Infectious DiseasesThe University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Joshua S. Davis
- Menzies School of Health ResearchCharles Darwin UniversityDarwinNorthern TerritoryAustralia
- School of Medicine and Public HealthThe University of NewcastleNewcastleNew South WalesAustralia
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Ngougni Pokem P, Liu X, Parker SL, Verroken A, Collienne C, Finet P, Wijnant GJ, Laterre PF, Roberts JA, Van Bambeke F, Wittebole X. Population pharmacokinetics and dosing simulations of total and unbound temocillin in the plasma and CSF of neurocritically ill patients with external ventricular drain-related cerebral ventriculitis. J Antimicrob Chemother 2024; 79:429-442. [PMID: 38153240 DOI: 10.1093/jac/dkad398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Cerebral ventriculitis might be caused by Gram-negative bacteria, including ESBL producers. Temocillin may be a useful treatment option in this scenario; however, no consistent data are available regarding its penetration into the CSF. OBJECTIVES To describe the population pharmacokinetics of temocillin in plasma and CSF and to determine the probability for different simulated dosing regimens to achieve pharmacokinetic/pharmacodynamic (PK/PD) targets in the CSF. METHODS Ten post-neurosurgical critically ill adult patients requiring continuous drainage of CSF were included in this monocentric, prospective, open-label, non-randomized study. They received 2 g loading dose temocillin over 30 min IV infusion, followed by a 6 g continuous infusion over 24 h. Total and unbound concentrations were measured in plasma (n = 88 and 86) and CSF (n = 88 and 88) samples and used to build a population PK model. Monte Carlo simulations were performed to estimate the PTA at 100% Css>MIC (steady state concentration above the MIC) in CSF. RESULTS All patients were infected with Enterobacterales with temocillin MICs ≤8 mg/L. The median (min-max) temocillin penetration in CSF was 12.1% (4.3-25.5) at steady state. Temocillin unbound plasma pharmacokinetics were best described by a one-compartment model. PTA for the applied dosing regimen was >90% for bacteria with MIC ≤ 4 mg/L. CONCLUSIONS The currently approved dose of 6 g by continuous infusion may be adequate for the treatment of ventriculitis by Enterobacterales with MIC ≤ 4 mg/L if considering 100% Css>MIC as the PK/PD target to reach. Higher maintenance doses could help covering higher MICs, but their safety would need to be assessed.
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Affiliation(s)
- Perrin Ngougni Pokem
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Avenue E. Mounier 73/B1.73.05, B-1200, Brussels, Belgium
| | - Xin Liu
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Suzanne L Parker
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Alexia Verroken
- Clinical Microbiology Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Christine Collienne
- Department of Critical Care Medicine, Cliniques universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
| | - Patrice Finet
- Department of Neurosurgery, Cliniques universitaires St Luc, Université catholique de Louvain, Brussels, Belgium
| | - Gert-Jan Wijnant
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Avenue E. Mounier 73/B1.73.05, B-1200, Brussels, Belgium
| | - Pierre-François Laterre
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Avenue E. Mounier 73/B1.73.05, B-1200, Brussels, Belgium
| | - Xavier Wittebole
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Hernández-Mitre MP, Wallis SC, Morgan EE, Dudley MN, Loutit JS, Griffith DC, Roberts JA. A phase I, randomized, double-blind, placebo-controlled, ascending single- and multiple-dose study of the pharmacokinetics, safety, and tolerability of oral ceftibuten in healthy adult subjects. Antimicrob Agents Chemother 2024; 68:e0109923. [PMID: 38059635 PMCID: PMC10777847 DOI: 10.1128/aac.01099-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/30/2023] [Indexed: 12/08/2023] Open
Abstract
This was a phase I, randomized, double-blind, placebo-controlled, ascending single- and multiple-dose study of oral ceftibuten to describe the pharmacokinetics (PK) of cis-ceftibuten (administered form) and trans-ceftibuten (metabolite), and to describe safety and tolerability at higher than licensed doses. Subjects received single 400, 600, or 800 mg doses of ceftibuten on Days 1 and 4, followed by 7 days of twice-daily dosing from Days 4 to 10. Non-compartmental methods were used to describe parent drug and metabolite PK in plasma and urine. Dose proportionality was examined using C max, AUC0-12, and AUC0-INF. Accumulation was calculated as the ratio of AUC0-12 on Days 4 and 10. Adverse events (AEs) were monitored throughout the study. Following single ascending doses, mean cis- and trans-ceftibuten C max were 17.6, 24.1, and 28.1 mg/L, and 1.1, 1.5, and 2.2 mg/L, respectively; cis-ceftibuten urinary recovery accounted for 64.3%-86.9% of the administered dose over 48 h. Following multiple ascending doses, mean cis- and trans-ceftibuten C max were 21.7, 28.1, and 38.8 mg/L, and 1.4, 1.9, and 2.8 mg/L, respectively; cis-ceftibuten urinary recovery accounted for 72.2%-96.4% of the administered dose at steady state. The exposure of cis- and trans-ceftibuten increased proportionally with increasing doses. Cis- and trans-ceftibuten accumulation factor was 1.14-1.19 and 1.28-1.32. The most common gastrointestinal treatment emergent AEs were mild and resolved without intervention. Ceftibuten was well tolerated. Dose proportionality and accumulation of cis- and trans-ceftibuten were observed. These results support the ongoing development of ceftibuten at doses up to 800 mg twice-daily. (The study was registered at ClinicalTrials.gov under the identifier NCT03939429.).
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Affiliation(s)
| | - Steven C. Wallis
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | | | | | | | - Jason A. Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
- Departments of Intensive Care Medicine and Pharmacy, Royal Brisbane & Women’s Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Novy E, Abdul-Aziz MH, Cheng V, Burrows F, Buscher H, Corley A, Diehl A, Gilder E, Levkovich BJ, McGuinness S, Ordonez J, Parke R, Parker S, Pellegrino V, Reynolds C, Rudham S, Wallis SC, Welch SA, Fraser JF, Shekar K, Roberts JA. Population pharmacokinetics of fluconazole in critically ill patients receiving extracorporeal membrane oxygenation and continuous renal replacement therapy: an ASAP ECMO study. Antimicrob Agents Chemother 2024; 68:e0120123. [PMID: 38063399 PMCID: PMC10777822 DOI: 10.1128/aac.01201-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/07/2023] [Indexed: 01/11/2024] Open
Abstract
This multicenter study describes the population pharmacokinetics (PK) of fluconazole in critically ill patients receiving concomitant extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) and includes an evaluation of different fluconazole dosing regimens for achievement of target exposure associated with maximal efficacy. Serial blood samples were obtained from critically ill patients on ECMO and CRRT receiving fluconazole. Total fluconazole concentrations were measured in plasma using a validated chromatographic assay. A population PK model was developed and Monte Carlo dosing simulations were performed using Pmetrics in R. The probability of target attainment (PTA) of various dosing regimens to achieve fluconazole area under the curve to minimal inhibitory concentration ratio (AUC0-24/MIC) >100 was estimated. Eight critically ill patients receiving concomitant ECMO and CRRT were included. A two-compartment model including total body weight as a covariate on clearance adequately described the data. The mean (±standard deviation, SD) clearance and volume of distribution were 2.87 ± 0.63 L/h and 15.90 ± 13.29 L, respectively. Dosing simulations showed that current guidelines (initial loading dose of 12 mg/kg then 6 mg/kg q24h) achieved >90% of PTA for a MIC up to 1 mg/L. None of the tested dosing regimens achieved 90% of PTA for MIC above 2 mg/L. Current fluconazole dosing regimen guidelines achieved >90% PTA only for Candida species with MIC <1 mg/L and thus should be only used for Candida-documented infections in critically ill patients receiving concomitant ECMO and CRRT. Total body weight should be considered for fluconazole dose.
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Affiliation(s)
- Emmanuel Novy
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
- Université de Lorraine, SIMPA, Nancy, France
- Departement of anesthesiology, Critical care and peri-operative medicine, University hospital of Nancy, Nancy, France
| | - Mohd H. Abdul-Aziz
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
| | - Vesa Cheng
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
| | - Fay Burrows
- Department of Pharmacy, St. Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Hergen Buscher
- Department of Intensive Care Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia
- University of New South Wales, St Vincent’s Centre for Applied Medical Research, Sydney, New South Wales, Australia
| | - Amanda Corley
- The Prince Charles Hospital, Critical Care Research Group and Adult Intensive Care Services, Brisbane, Queensland, Australia
| | - Arne Diehl
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eileen Gilder
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - Bianca J. Levkovich
- Experiential Development and Graduate Education and Centre for Medicines Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shay McGuinness
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - Jenny Ordonez
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- The University of Auckland, School of Nursing, Auckland, New Zealand
| | - Suzanne Parker
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
| | - Vincent Pellegrino
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Claire Reynolds
- Department of Intensive Care Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Sam Rudham
- Department of Intensive Care Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Steven C. Wallis
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
| | - Susan A. Welch
- Department of Pharmacy, St. Vincent’s Hospital, Sydney, New South Wales, Australia
| | - John F. Fraser
- The Prince Charles Hospital, Critical Care Research Group and Adult Intensive Care Services, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Kiran Shekar
- The Prince Charles Hospital, Critical Care Research Group and Adult Intensive Care Services, Brisbane, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jason A. Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine and Pharmacy, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Chai MG, Roberts JA, Kelly CF, Ungerer JPJ, McWhinney BC, Lipman J, Farkas A, Cotta MO. Efficiency of dosing software using Bayesian forecasting in achieving target antibiotic exposures in critically ill patients, a prospective cohort study. Anaesth Crit Care Pain Med 2023; 42:101296. [PMID: 37579945 DOI: 10.1016/j.accpm.2023.101296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/28/2023] [Accepted: 08/06/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Broad-spectrum antibiotics such as beta-lactams and vancomycin are frequently used to treat critically ill patients, however, a significant number do not achieve target exposures. Therapeutic drug monitoring (TDM) combined with Bayesian forecasting dosing software may improve target attainment in these patients. This study aims to describe the efficiency of dosing software for achieving target exposures of selected beta-lactam antibiotics and vancomycin in critically ill patients. METHODS A prospective cohort study was undertaken in an adult intensive care unit (ICU). Patients prescribed vancomycin, piperacillin-tazobactam and meropenem were included if they exhibited a subtherapeutic or supratherapeutic exposure informed by TDM. The dosing software, ID-ODS™, was used to generate dosing recommendations which could be either accepted or rejected by the treating team. Repeat antibiotic TDM were requested to determine if target exposures were achieved. RESULTS Between March 2020 and December 2021, 70 were included in the analysis. Software recommendations were accepted for 56 patients (80%) with 50 having repeated antibiotic measurements. Forty-three of the 50 patients (86%) achieved target exposures after one software recommendation, with 3 of the remaining 7 patients achieving target exposures after 2. Forty-seven patients out of the 50 patients (94%) achieved the secondary outcome of clinical cure. There were no antibiotic exposure-related adverse events reported. CONCLUSION The use of TDM combined with Bayesian forecasting dosing software increases the efficiency for achieving target antibiotic exposures in the ICU. Clinical trials comparing this approach with other dosing strategies are required to further validate these findings.
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Affiliation(s)
- Ming G Chai
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
| | - Jason A Roberts
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nimes University Hospital, University of Montpellier, Nimes, France; Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
| | - Christina F Kelly
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Jacobus P J Ungerer
- Pathology Queensland, Brisbane, Australia; Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | | | - Jeffrey Lipman
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, Australia
| | - Andras Farkas
- Optimum Dosing Strategies, Bloomingdale, NJ, United States
| | - Menino O Cotta
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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19
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Fresán D, Luque S, Benítez-Cano A, Sorlí L, Montero MM, De-Antonio M, Vega V, Roberts JA, Horcajada JP, Grau S. Real-world experience of therapeutic drug monitoring and PK/PD achievement of ceftaroline administered by different infusion regimens in patients with confirmed infections caused by Gram-positive bacteria. J Antimicrob Chemother 2023; 78:2810-2815. [PMID: 37823445 DOI: 10.1093/jac/dkad296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Ceftaroline is a novel cephalosporin active against MDR Gram-positive (GP) bacteria. For β-lactam antibiotics, such as ceftaroline, prolonged infusions and therapeutic drug monitoring (TDM) are used for dosage optimization based on their pharmacokinetics/pharmacodynamics (PK/PD). OBJECTIVES To describe our experience with TDM and PK/PD target attainment of ceftaroline administered by intermittent and prolonged infusion in a cohort of patients with MDR-GP bacterial infections. METHODS Patients treated with ceftaroline administered by continuous (24 h), extended (3 h/6 h) and intermittent infusion (1 h) and undergoing TDM of plasma concentrations were included. A 100%fT>4×MIC was the pre-specified PK/PD target and 100%fT>10×MIC was considered overexposure. Dose recommendations were made based on TDM results and each patient's clinical condition. RESULTS Twelve patients [83.3% male, median age of 73 (38-83) years] were included. Nine patients (75%) achieved 100%fT>4×MIC, all under prolonged infusions. In one patient, the 100%fT was >10×MIC but no toxicity was observed. Based on TDM results, initial doses were recommended to be maintained in eight patients, decreased in three and increased in one. CONCLUSIONS The administration of ceftaroline by prolonged infusion together with TDM may be a useful strategy for achieving the desired PK/PD target in these patients. However, more studies evaluating the relationship between PK/PD attainment and clinical outcomes are needed.
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Affiliation(s)
- Daniel Fresán
- Pharmacy Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Sonia Luque
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, Madrid 28029, Spain
| | - Adela Benítez-Cano
- Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Luisa Sorlí
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, Madrid 28029, Spain
- Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - María Milagro Montero
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, Madrid 28029, Spain
- Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta De-Antonio
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Victoria Vega
- Analytical Department, Laboratori de Referència de Catalunya, Barcelona, Spain
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Juan P Horcajada
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, Madrid 28029, Spain
- Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Santiago Grau
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Av. de Monforte de Lemos, 5, Madrid 28029, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
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Novy E, Roger C, Roberts JA, Cotta MO. Pharmacokinetic and pharmacodynamic considerations for antifungal therapy optimisation in the treatment of intra-abdominal candidiasis. Crit Care 2023; 27:449. [PMID: 37981676 PMCID: PMC10659066 DOI: 10.1186/s13054-023-04742-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
Intra-abdominal candidiasis (IAC) is one of the most common of invasive candidiasis observed in critically ill patients. It is associated with high mortality, with up to 50% of deaths attributable to delays in source control and/or the introduction of antifungal therapy. Currently, there is no comprehensive guidance on optimising antifungal dosing in the treatment of IAC among the critically ill. However, this form of abdominal sepsis presents specific pharmacokinetic (PK) alterations and pharmacodynamic (PD) challenges that risk suboptimal antifungal exposure at the site of infection in critically ill patients. This review aims to describe the peculiarities of IAC from both PK and PD perspectives, advocating an individualized approach to antifungal dosing. Additionally, all current PK/PD studies relating to IAC are reviewed in terms of strength and limitations, so that core elements for the basis of future research can be provided.
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Affiliation(s)
- Emmanuel Novy
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital Campus Herston, Brisbane, QLD, 4029, Australia
- Department of Anaesthesiology, Critical Care and Peri-Operative Medicine, University Hospital of Nancy, Nancy, France
- Université de Lorraine, SIMPA, 54500, Nancy, France
| | - Claire Roger
- Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nimes University Hospital, Place du Professeur Robert Debré, 30029, Nîmes Cedex 9, France
- UR UM103 IMAGINE, Univ Montpellier, Montpellier, France
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital Campus Herston, Brisbane, QLD, 4029, Australia.
- Department of Anesthesiology, Critical Care, Pain and Emergency Medicine, Nimes University Hospital, Place du Professeur Robert Debré, 30029, Nîmes Cedex 9, France.
- Department of Intensive Care Medicine and Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia.
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital Campus Herston, Brisbane, QLD, 4029, Australia
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21
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Williams P, Cotta MO, Abdul‐Aziz MH, Wilks K, Farkas A, Roberts JA. In silico evaluation of a beta-lactam dosing guideline among adults with serious infections. Pharmacotherapy 2023; 43:1121-1130. [PMID: 36567467 PMCID: PMC10946580 DOI: 10.1002/phar.2753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to compare the achievement of therapeutic pharmacokinetic-pharmacodynamic (PK-PD) exposure targets for beta-lactam antibiotics using product information dosing or guideline-based dosing for the treatment of serious infections. DESIGN In silico study. DATA SOURCE ID-ODSTM (Individually Designed Optimum Dosing Strategies). PATIENTS AND INTERVENTION None. MEASUREMENTS AND MAIN RESULTS In silico product information and guideline-based dosing simulations for cefepime, ceftazidime, flucloxacillin, meropenem, and piperacillin/tazobactam were performed using pharmacokinetic models from seriously ill patient populations. The median simulated concentration at 48 and 96 h was used to measure the probability of target attainment (PTA) to achieve predefined therapeutic and toxicity PK-PD targets. A multiple linear regression model was constructed to identify the effect of guideline-based dosing covariates on achieving pre-defined therapeutic targets. In total, 480 dosing simulations were performed. The PTA percentage with guideline-based dosing at 48 and 96 h was 80% and 68%, respectively, yielding significantly higher results when compared to product information dosing (48.45% and 49%, respectively), p < 0.001 at both time points. At 48 h, predefined toxicity thresholds were exceeded in 4.7% and 0% of simulations for guideline-based and product information-based dosing, respectively (p = 0.002). eGFR was significantly associated with the % PTA by guideline-based dosing, with eGFR values of 20 and 50 ml/min both statistically significant in leading to an increase in PTA. CONCLUSIONS Our study demonstrated that achievement of PK-PD exposures associated with an increased likelihood of effectiveness was more likely to occur with guideline-based dosing; especially at 48 h.
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Affiliation(s)
- Paul Williams
- University of Queensland Centre for Clinical Research (UQCCR), The University of QueenslandBrisbaneQueenslandAustralia
- Pharmacy DepartmentSunshine Coast University HospitalBirtinyaQueenslandAustralia
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research (UQCCR), The University of QueenslandBrisbaneQueenslandAustralia
| | - Mohd H. Abdul‐Aziz
- University of Queensland Centre for Clinical Research (UQCCR), The University of QueenslandBrisbaneQueenslandAustralia
| | - Kathryn Wilks
- Infectious Diseases DepartmentSunshine Coast University HospitalBirtinyaQueenslandAustralia
- School of Public HealthThe University of QueenslandBrisbaneQueenslandAustralia
| | - Andras Farkas
- Department of PharmacyMount Sinai WestNew YorkNew YorkUSA
- Optimum Dosing StrategiesBloomingdaleNew JerseyUSA
| | - Jason A. Roberts
- University of Queensland Centre for Clinical Research (UQCCR), The University of QueenslandBrisbaneQueenslandAustralia
- Department of Intensive Care MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Pharmacy DepartmentRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Division of Anaesthesiology Critical Care Emergency and Pain MedicineNîmes University Hospital, University of MontpellierNîmesFrance
- Herston Infectious Diseases Institute (HeIDI)BrisbaneQueenslandAustralia
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22
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Barletta JF, Roberts JA. Precision medicine in the ICU: One size fits one patient. Pharmacotherapy 2023; 43:1100-1101. [PMID: 37840471 DOI: 10.1002/phar.2886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Jeffrey F Barletta
- Department of Pharmacy Practice, College of Pharmacy-GlendaleCampus, Midwestern University, Glendale, Arizona, USA
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Morpeth SC, Venkatesh B, Totterdell JA, McPhee GM, Mahar RK, Jones M, Bandara M, Barina LA, Basnet BK, Bowen AC, Burke AJ, Cochrane B, Denholm JT, Dhungana A, Dore GJ, Dotel R, Duffy E, Dummer J, Foo H, Gilbey TL, Hammond NE, Hudson BJ, Jha V, Jevaji PR, John O, Joshi R, Kang G, Kaur B, Kim S, Das SK, Lau JSY, Littleford R, Marsh JA, Marschner IC, Matthews G, Maze MJ, McArthur CJ, McFadyen JD, McMahon JH, McQuilten ZK, Molton J, Mora JM, Mudaliar V, Nguyen V, O'Sullivan MVN, Pant S, Park JE, Paterson DL, Price DJ, Raymond N, Rees MA, Robinson JO, Rogers BA, Ryu WS, Sasadeusz J, Shum O, Snelling TL, Sommerville C, Trask N, Lewin SR, Hills TE, Davis JS, Roberts JA, Tong SYC. A Randomized Trial of Nafamostat for Covid-19. NEJM Evid 2023; 2:EVIDoa2300132. [PMID: 38320527 DOI: 10.1056/evidoa2300132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
A Randomized Trial of Nafamostat for Covid-19Nafamostat mesylate is a potent in vitro antiviral that inhibits the host transmembrane protease serine 2 enzyme used by SARS-CoV-2 for cell entry. Morpeth et al report the results of an open-label randomized clinical trial of nafamostat for noncritically ill patients with Covid-19.
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Affiliation(s)
- Susan C Morpeth
- Department of Microbiology and Infectious Diseases, Middlemore Hospital, Te Whatu Ora Counties Makukau, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Balasubramanian Venkatesh
- Department of Intensive Care Medicine, The University of Queensland at Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Department of Intensive Care Medicine, The University of Queensland at The Wesley Hospital, Toowong, QLD, Australia
- The George Institute for Global Health, Newtown, NSW, Australia
| | - James A Totterdell
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney
| | - Grace M McPhee
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Robert K Mahar
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mark Jones
- Department of Health and Clinical Analytics, The University of Sydney School of Public Health, Sydney
| | - Methma Bandara
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Lauren A Barina
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Bhupendra K Basnet
- Department of Medicine, Bir Hospital, Kathmandu, Nepal
- Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
| | - Andrew J Burke
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Department of Infectious Diseases, Prince Charles Hospital, Merthyr Tydfil, United Kingdom
| | - Belinda Cochrane
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Campbelltown, NSW, Australia
- Western Sydney University School of Medicine, Campbelltown, NSW, Australia
| | - Justin T Denholm
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ashesh Dhungana
- Department of Medicine, National Academy of Medical Sciences at Bir Hospital, Kathmandu, Nepal
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, University of New South Wales, Kensington, NSW, Australia
- Department of Infectious Diseases, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Ravindra Dotel
- Department of Infectious Diseases, Blacktown Hospital, Blacktown, NSW, Australia
| | - Eamon Duffy
- Department of Infectious Diseases, Te Whatu Ora Health New Zealand at Auckland City Hospital, Auckland, New Zealand
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jack Dummer
- Department of Medicine, University of Otago, Dunedin, New Zealand
- Respiratory Services, Dunedin Hospital, Dunedin, New Zealand
| | - Hong Foo
- Department of Microbiology and Infectious Diseases, NSW Health Pathology Liverpool, Liverpool, NSW, Australia
| | - Timothy L Gilbey
- Department of Medicine and Infectious Diseases, Wagga Wagga Base Hospital, Wagga Wagga, Australia
| | - Naomi E Hammond
- Critical Care Program, The George Institute for Global Health, New Town, NSW, Australia
- Critical Care Program, The University of New South Wales, Sydney
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Bernard J Hudson
- Department of Microbiology and Infectious Diseases, NSW Health Pathology, St. Leonards, St. Leonards, NSW, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, Newtown, NSW, Australia
| | - Purnima R Jevaji
- Department of Research, The George Institute for Global Health, Pune, Maharashta, India
| | - Oommen John
- Department of Research, The George Institute for Global Health, Vellore, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Karnataka, India
| | - Rajesh Joshi
- Department of Research, The George Institute for Global Health, Pune, Maharashta, India
| | - Gagandeep Kang
- Wellcome Trust Research Laboratory, Chartered Accountants Australia and New Zealand, Sydney
| | - Baldeep Kaur
- Critical Care Program, The George Institute for Global Health, New Town, NSW, Australia
| | - Seungtaek Kim
- Zoonotic Virus Laboratory, Institut Pasteur Korea, Bundang-gu, Gyeonggi-do, Republic of Korea
| | - Santa Kumar Das
- Department of Internal Medicine, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Jillian S Y Lau
- Department of Infectious Diseases, Eastern Health, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Roberta Littleford
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, QLD, Australia
| | - Julie A Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Centre for Child Health Research, University of Western Australia Medical School, Nedlands, WA, Australia
| | - Ian C Marschner
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney
| | - Gail Matthews
- Department of Infectious Diseases, St. Vincent's Hospital Sydney, Sydney
- Therapeutic and Vaccine Research Program, The Kirby Institute at The University of New South Wales, Kensington, NSW, Australia
| | - Michael J Maze
- Department of Medicine, University of Otago Christchurch, Christchurch, New England
| | - Colin J McArthur
- Department of Critical Care Medicine, Te Whatu Ora - Health New Zealand, Wellington, New Zealand
| | - James D McFadyen
- Department of Clinical Haematology, Alfred Hospital, Melbourne, VIC, Australia
- Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - James H McMahon
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Zoe K McQuilten
- Department of Haematology, Monash Health, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - James Molton
- Department of Infectious Diseases, Western Health, Footscray, VIC, Australia
| | - Jocelyn M Mora
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Vijaybabu Mudaliar
- Department of Research, The George Institute for Global Health, Pune, Maharashta, India
| | - Vi Nguyen
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Matthew V N O'Sullivan
- Department of Microbiology and Infectious Diseases, NSW Health Pathology Westmead Hospital, Newcastle, NSW, Australia
- Faculty of Medicine and Health, University of Sydney Westmead Clinical School, Sydney
| | - Suman Pant
- Department of Internal Medicine, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Nepal
| | - Jaha E Park
- Business Development Team, Chong Kun Dang Pharmaceutical Corp., Dongbaekjukjeon-daero, Giheung-gu Yongin, Kyeonggi-do, Republic of Korea
| | - David L Paterson
- Saw Swee Hock School of Public Health, National Institute of Singapore, Singapore
| | - David J Price
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nigel Raymond
- Department of Medicine, Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
- Department of Medicine, Wellington School of Medicine, University of Otago, Wellington, New Zealand
| | - Megan A Rees
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - James O Robinson
- Department of Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Nedlands, WA, Australia
| | - Benjamin A Rogers
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
- Department of Infectious Diseases, Monash Health, Clayton, VIC, Australia
| | - Wang-Shick Ryu
- Virology, Institute Pasteur Korea, Bundang-gu, Gyeonggi-do, Republic of Korea
| | - Joe Sasadeusz
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Omar Shum
- Department of Infectious Diseases, Wollongong Hospital, Kingoonya, NSW, Australia
- Graduate School of Medicine, University of Wollongong, Wollonngong, NSW, Australia
| | - Thomas L Snelling
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
| | - Christine Sommerville
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Nanette Trask
- Chartered Accountants Australia and New Zealand, Sydney
| | - Sharon R Lewin
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Thomas E Hills
- Department of Clinical Research, Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Infectious Diseases, Auckland City Hospital, Auckland, New Zealand
| | - Joshua S Davis
- School of Medicine and Public Health, The University of Newcastle, New Castle, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Jason A Roberts
- Faculty of Medicine, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia
- Metro North Health, Herston Infectious Diseases Institute, Herston, QLD, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Division of Anaesthesiology, Critical Care Emergency and Pain Medicine, Nîmes University Hospital at The University of Montpellier, Nîmes, France
| | - Steven Y C Tong
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
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Cucci MD, Gerlach AT, Mangira C, Murphy CV, Roberts JA, Udy AA, Dowling TC, Mullen CL. Performance of different body weights in the Cockcroft-Gault equation in critically ill patients with and without augmented renal clearance: A multicenter cohort. Pharmacotherapy 2023; 43:1131-1138. [PMID: 36373197 PMCID: PMC10947228 DOI: 10.1002/phar.2743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/29/2022] [Accepted: 09/14/2022] [Indexed: 11/18/2023]
Abstract
STUDY OBJECTIVE The primary objective was to evaluate the performance of the Cockcroft-Gault (CG) equation with different body weights (BWs) compared to a measured creatinine clearance (mCrCl) in an intensive care unit (ICU) population with and without augmented renal clearance (ARC). DESIGN Multicenter, retrospective cohort. SETTING Two ICUs in the United States and four ICUs from a previous international observational analysis. PATIENTS Adult ICU patients admitted from January 1, 2010 to July 30, 2020 with at least one mCrCl collected within the initial 10 days of hospitalization were eligible for inclusion. MEASUREMENTS AND MAIN RESULTS The primary outcome was the performance of the CG equation in ARC (mCrCl≥130 ml/min/1.73 m2 ) and non-ARC (mCrCl<130 ml/min/1.73 m2 ) patients. Correlation was analyzed by Pearson's correlation coefficient, bias by mean difference, and accuracy by the percentage of patients within 30% of the mCrCl. A total of 383 patients were included, which provided 1708 mCrCl values. The majority were male (n = 239, 62%), median age of 55 years [IQR 40-65] with a surgical diagnosis (n = 239, 77%). ARC was identified in 229 (60%) patients. The ARC group had lower Scr values (0.6 [0.5-0.7] vs. 0.7 [0.6-0.9] mg/dl, p < 0.001) and higher mCrCl (172.8 (SD 39.1) vs. 89.9 mL/min/1.73 m2 (SD 25.4), p < 0.001) compared with the non-ARC group, respectively. Among non-ARC patients there was a moderate correlation (r = 0.33-0.39), moderate accuracy (range 48-58%), and low bias (range of -12.9 to 17.1) among the different BW estimations with the adjusted BW having the better performance. Among ARC patients there was low correlation (r = 0.24-0.28), low to moderate accuracy (range 38-70%), and high bias (range of -58.5 to -21.6). CONCLUSIONS The CG-adjusted BW had the best performance in the non-ARC patients, while CG performed poorly with any BW in ARC patients. Although the CG equation remains the standard equation for estimating CrCl in the ICU setting, a new, validated equation is needed for patients with ARC.
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Affiliation(s)
| | - Anthony T. Gerlach
- Critical CareThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | | | - Claire V. Murphy
- Critical CareThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | | | - Andrew A. Udy
- Department of Intensive Care & Hyperbaric MedicineAlfred HealthMelbourneVictoriaAustralia
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Legg A, Davis JS, Roberts JA. Optimal drug therapy for Staphylococcus aureus bacteraemia in adults. Curr Opin Crit Care 2023; 29:446-456. [PMID: 37641503 DOI: 10.1097/mcc.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW Staphylococcus aureus is a significant human pathogen, causing a variety of infections, from skin and soft tissue infections to endocarditis, bone and joint infections and deep tissue abscesses. Mortality from S. aureus bacteraemia remains high, without major therapeutic advances in recent decades. RECENT FINDINGS In recent years, optimized dosing of antibiotics is increasingly being recognized as a cornerstone of management for severe infections including S. aureus bacteraemia. This comprehensive review details the pharmacokinetics/pharmacodynamics (PK/PD) targets for commonly used antistaphylococcal antibiotics and the doses predicted to achieve them in clinical practice. Recent advances in dosing of teicoplanin and use of cefazolin in CNS infections and findings from combination therapy studies are discussed. Drug exposure relationships related to toxicity are also detailed. SUMMARY This review details the different PK/PD targets for drugs used to treat S. aureus bacteraemia and how to apply them in various scenarios. The drug doses that achieve them, and the risks of toxicity are also provided.
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Affiliation(s)
- Amy Legg
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland
| | - Joshua S Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales
| | - Jason A Roberts
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes France
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Burke A, Carter R, Tolson C, Congdon J, Duplancic C, Bursle E, Bell SC, Roberts JA, Thomson R. In vitro susceptibility testing of imipenem-relebactam and tedizolid against 102 Mycobacterium abscessus isolates. Int J Antimicrob Agents 2023; 62:106938. [PMID: 37517624 DOI: 10.1016/j.ijantimicag.2023.106938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/15/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES Mycobacterium abscessus is an emerging infection in people living with lung diseases, including cystic fibrosis (CF) and bronchiectasis, and it has limited treatment options and low cure rates. The off-label use of novel antibiotics developed for other bacterial pathogens offers potential new therapeutic options. We aimed to describe the in vitro activity of imipenem, imipenem-relebactam and tedizolid against comparator antibiotics in M. abscessus isolates from Australian patients with and without CF. METHODS We performed susceptibility testing for imipenem-relebactam, tedizolid and comparator antibiotics by Clinical and Laboratory Standards Institute (CLSI) criteria against 102 clinical M. abscessus isolates, including 46 from people with CF. RESULTS In this study, the minimum inhibitory concentration (MICs) of imipenem-relebactam was one-fold dilution less than of imipenem alone. The MIC50 and MIC90 of imipenem-relebactam were 8 and 16 mg/L, respectively, whereas for imipenem they were 16 and 32 mg/L. Tedizolid had an MIC50 and MIC90 of 2 and 4 mg/L, respectively. Forty non-CF isolates had linezolid susceptibility performed, with MIC50 and MIC90 values of 16 and 32 mg/L, respectively, measured. CONCLUSIONS This study shows lower MICs for imipenem-relebactam and tedizolid compared to other more commonly used antibiotics and supports their consideration in clinical trials for M. abscessus treatment.
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Affiliation(s)
- Andrew Burke
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; The Prince Charles Hospital, Brisbane, Australia.
| | - Robyn Carter
- Faculty of Medicine, The University of Queensland School of Medicine School of Medicine, Australia; Gallipoli Medical Research Institute, Brisbane, Australia
| | - Carla Tolson
- Gallipoli Medical Research Institute, Brisbane, Australia
| | - Jacob Congdon
- Gallipoli Medical Research Institute, Brisbane, Australia
| | - Christine Duplancic
- Faculty of Medicine, The University of Queensland School of Medicine School of Medicine, Australia
| | - Evan Bursle
- Faculty of Medicine, The University of Queensland School of Medicine School of Medicine, Australia; Sullivan and Nicolaides Pathology, Brisbane, Australia
| | - Scott C Bell
- The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland School of Medicine School of Medicine, Australia; Translational Research Institute, Brisbane, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Rachel Thomson
- The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland School of Medicine School of Medicine, Australia; Gallipoli Medical Research Institute, Brisbane, Australia
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Brasier N, Ates HC, Sempionatto JR, Cotta MO, Widmer AF, Eckstein J, Goldhahn J, Roberts JA, Gao W, Dincer C. A three-level model for therapeutic drug monitoring of antimicrobials at the site of infection. Lancet Infect Dis 2023; 23:e445-e453. [PMID: 37348517 DOI: 10.1016/s1473-3099(23)00215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 06/24/2023]
Abstract
The silent pandemic of bacterial antimicrobial resistance is a leading cause of death worldwide, prolonging hospital stays and raising health-care costs. Poor incentives to develop novel pharmacological compounds and the misuse of antibiotics contribute to the bacterial antimicrobial resistance crisis. Therapeutic drug monitoring (TDM) based on blood analysis can help alleviate the emergence of bacterial antimicrobial resistance and effectively decreases the risk of toxic drug concentrations in patients' blood. Antibiotic tissue penetration can vary in patients who are critically or chronically ill and can potentially lead to treatment failure. Antibiotics such as β-lactams and glycopeptides are detectable in non-invasively collectable biofluids, such as sweat and exhaled breath. The emergence of wearable sensors enables easy access to these non-invasive biofluids, and thus a laboratory-independent analysis of various disease-associated biomarkers and drugs. In this Personal View, we introduce a three-level model for TDM of antibiotics to describe concentrations at the site of infection (SOI) by use of wearable sensors. Our model links blood-based drug measurement with the analysis of drug concentrations in non-invasively collectable biofluids stemming from the SOI to characterise drug concentrations at the SOI. Finally, we outline the necessary clinical and technical steps for the development of wearable sensing platforms for SOI applications.
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Affiliation(s)
- Noé Brasier
- Institute for Translational Medicine, ETH Zurich, Zurich, Switzerland; Department of Digitalization & ICT, University Hospital Basel, Basel, Switzerland.
| | - H Ceren Ates
- FIT Freiburg Centre for Interactive Materials and Bioinspired Technology, University of Freiburg, Freiburg, Germany; Department of Microsystems Engineering, IMTEK, University of Freiburg, Freiburg, Germany
| | - Juliane R Sempionatto
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Menino O Cotta
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Andreas F Widmer
- Department of Infectious Disease and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Jens Eckstein
- Department of Digitalization & ICT, University Hospital Basel, Basel, Switzerland; Division for Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Jörg Goldhahn
- Institute for Translational Medicine, ETH Zurich, Zurich, Switzerland
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia; Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, QLD, Australia; Department of Pharmacy and Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Division of Anaesthesiology, Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Wei Gao
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Can Dincer
- FIT Freiburg Centre for Interactive Materials and Bioinspired Technology, University of Freiburg, Freiburg, Germany; Department of Microsystems Engineering, IMTEK, University of Freiburg, Freiburg, Germany.
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Williams P, Cotta MO, Abdul-Aziz MH, Wilks K, Farkas A, Roberts JA. In silico Evaluation of a Vancomycin Dosing Guideline Among Adults with Serious Infections. Ther Drug Monit 2023; 45:631-636. [PMID: 37199397 DOI: 10.1097/ftd.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/14/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND This study aimed to compare the achievement of pharmacokinetic-pharmacodynamic (PK-PD) exposure targets for vancomycin using a newly developed dosing guideline with product-information-based dosing in the treatment of adult patients with serious infections. METHODS In silico product-information- and guideline-based dosing simulations for vancomycin were performed across a range of doses and patient characteristics, including body weight, age, and renal function at 36-48 and 96 hours, using a pharmacokinetic model derived from a seriously ill patient population. The median simulated concentration and area under the 24-hour concentration-time curve (AUC 0-24 ) were used to measure predefined therapeutic, subtherapeutic, and toxicity PK-PD targets. RESULTS Ninety-six dosing simulations were performed. The pooled median trough concentration target with guideline-based dosing at 36 and 96 hours was achieved in 27.1% (13/48) and 8.3% (7/48) of simulations, respectively. The pooled median AUC 0-24 /minimum inhibitory concentration ratio with guideline-based dosing at 48 and 96 hours was attained in 39.6% (19/48) and 27.1% (13/48) of simulations, respectively. Guideline-based dosing simulations yielded improved trough target attainment compared with product-information-based dosing at 36 hours and significantly less subtherapeutic drug exposure. The toxicity threshold was exceeded in 52.1% (25/48) and 0% (0/48) for guideline- and product-information-information-based dosing, respectively ( P < 0.001). CONCLUSIONS A Critical care vancomycin dosing guideline appeared slightly more effective than standard dosing, as per product information, in achieving PK-PD exposure associated with an increased likelihood of effectiveness. In addition, this guideline significantly reduced the risk of subtherapeutic exposure. The risk of exceeding toxicity thresholds, however, was greater with the guideline, and further investigation is suggested to improve dosing accuracy and sensitivity.
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Affiliation(s)
- Paul Williams
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Pharmacy Department, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
| | - Mohd H Abdul-Aziz
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
| | - Kathryn Wilks
- Infectious Diseases Department, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Andras Farkas
- Department of Pharmacy, Mount Sinai West, New York, New York
- Optimum Dosing Strategies, Bloomingdale, New Jersey
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; and
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes France
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Alli A, Paruk F, Roger C, Lipman J, Calleemalay D, Wallis SC, Scribante J, Richards GA, Roberts JA. Peri-operative pharmacokinetics of cefazolin prophylaxis during valve replacement surgery. PLoS One 2023; 18:e0291425. [PMID: 37729151 PMCID: PMC10511078 DOI: 10.1371/journal.pone.0291425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/17/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE There is little prospective data to guide effective dosing for antibiotic prophylaxis during surgery requiring cardiopulmonary bypass (CPB). We aim to describe the effects of CPB on the population pharmacokinetics (PK) of total and unbound concentrations of cefazolin and to recommend optimised dosing regimens. METHODS Patients undergoing CPB for elective cardiac valve replacement were included using convenience sampling. Intravenous cefazolin (2g) was administered pre-incision and re-dosed at 4 hours. Serial blood and urine samples were collected and analysed using validated chromatography. Population PK modelling and Monte-Carlo simulations were performed using Pmetrics® to determine the fractional target attainment (FTA) of achieving unbound concentrations exceeding pre-defined exposures against organisms known to cause surgical site infections for 100% of surgery (100% fT>MIC). RESULTS From the 16 included patients, 195 total and 64 unbound concentrations of cefazolin were obtained. A three-compartment linear population PK model best described the data. We observed that cefazolin 2g 4-hourly was insufficient to achieve the FTA of 100% fT>MIC for Staphylococcus aureus and Escherichia coli at serum creatinine concentrations ≤ 50 μmol/L and for Staphylococcus epidermidis at any of our simulated doses and serum creatinine concentrations. A dose of cefazolin 3g 4-hourly demonstrated >93% FTA for S. aureus and E. coli. CONCLUSIONS We found that cefazolin 2g 4-hourly was not able to maintain concentrations above the MIC for relevant pathogens in patients with low serum creatinine concentrations undergoing cardiac surgery with CPB. The simulations showed that optimised dosing is more likely with an increased dose and/or dosing frequency.
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Affiliation(s)
- Ahmad Alli
- Department of Anesthesiology and Pain Medicine, St Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Fathima Paruk
- Faculty of Health Sciences, Department of Critical Care, University of Pretoria, Pretoria, South Africa
| | - Claire Roger
- Department of Anesthesiology, Critical Care Pain, and Emergency Medicine, Nimes University Hospital, Nimes, France
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jeffrey Lipman
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Daren Calleemalay
- Faculty of Health Sciences, Department of Anesthesiology, University of Witwatersrand, Johannesburg, South Africa
| | - Steven C. Wallis
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Juan Scribante
- Surgeons for Little Lives and Department of Paediatric Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy A. Richards
- Faculty of Health Sciences, Division of Critical Care, University of Witwatersrand, Johannesburg, South Africa
| | - Jason A. Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
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Hong LT, Downes KJ, FakhriRavari A, Abdul-Mutakabbir JC, Kuti JL, Jorgensen S, Young DC, Alshaer MH, Bassetti M, Bonomo RA, Gilchrist M, Jang SM, Lodise T, Roberts JA, Tängdén T, Zuppa A, Scheetz MH. International consensus recommendations for the use of prolonged-infusion beta-lactam antibiotics: Endorsed by the American College of Clinical Pharmacy, British Society for Antimicrobial Chemotherapy, Cystic Fibrosis Foundation, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Critical Care Medicine, and Society of Infectious Diseases Pharmacists. Pharmacotherapy 2023; 43:740-777. [PMID: 37615245 DOI: 10.1002/phar.2842] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/15/2022] [Accepted: 12/26/2022] [Indexed: 08/25/2023]
Abstract
Intravenous β-lactam antibiotics remain a cornerstone in the management of bacterial infections due to their broad spectrum of activity and excellent tolerability. β-lactams are well established to display time-dependent bactericidal activity, where reductions in bacterial burden are directly associated with the time that free drug concentrations remain above the minimum inhibitory concentration (MIC) of the pathogen during the dosing interval. In an effort to take advantage of these bactericidal characteristics, prolonged (extended and continuous) infusions (PIs) can be applied during the administration of intravenous β-lactams to increase time above the MIC. PI dosing regimens have been implemented worldwide, but implementation is inconsistent. We report consensus therapeutic recommendations for the use of PI β-lactams developed by an expert international panel with representation from clinical pharmacy and medicine. This consensus guideline provides recommendations regarding pharmacokinetic and pharmacodynamic targets, therapeutic drug-monitoring considerations, and the use of PI β-lactam therapy in the following patient populations: severely ill and nonseverely ill adult patients, pediatric patients, and obese patients. These recommendations provide the first consensus guidance for the use of β-lactam therapy administered as PIs and have been reviewed and endorsed by the American College of Clinical Pharmacy (ACCP), the British Society for Antimicrobial Chemotherapy (BSAC), the Cystic Fibrosis Foundation (CFF), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the Infectious Diseases Society of America (IDSA), the Society of Critical Care Medicine (SCCM), and the Society of Infectious Diseases Pharmacists (SIDP).
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Affiliation(s)
- Lisa T Hong
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Kevin J Downes
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Jacinda C Abdul-Mutakabbir
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
- Divisions of Clinical Pharmacy and Black Diaspora and African American Studies, University of California San Diego, La Jolla, California, USA
| | - Joseph L Kuti
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | | | - David C Young
- University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | | | | | - Robert A Bonomo
- Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA
- Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Case Western Reserve University, Cleveland, Ohio, USA
| | - Mark Gilchrist
- Imperial College Healthcare National Health Services Trust, London, UK
| | - Soo Min Jang
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Thomas Lodise
- Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Center for Clinical Research, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Thomas Tängdén
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Athena Zuppa
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marc H Scheetz
- College of Pharmacy, Pharmacometric Center of Excellence, Midwestern University, Downers Grove, Illinois, USA
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA
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31
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Hong LT, Downes KJ, FakhriRavari A, Abdul-Mutakabbir JC, Kuti JL, Jorgensen S, Young DC, Alshaer MH, Bassetti M, Bonomo RA, Gilchrist M, Jang SM, Lodise T, Roberts JA, Tängdén T, Zuppa A, Scheetz MH. International consensus recommendations for the use of prolonged-infusion beta-lactam antibiotics: Endorsed by the American College of Clinical Pharmacy, British Society for Antimicrobial Chemotherapy, Cystic Fibrosis Foundation, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Critical Care Medicine, and Society of Infectious Diseases Pharmacists: An executive summary. Pharmacotherapy 2023; 43:736-739. [PMID: 37615244 DOI: 10.1002/phar.2844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 08/25/2023]
Abstract
Intravenous β-lactam antibiotics remain a cornerstone in the management of bacterial infections due to their broad spectrum of activity and excellent tolerability. β-lactams are well established to display time-dependent bactericidal activity, where reductions in bacterial burden are directly associated with the time that free drug concentrations remain above the minimum inhibitory concentration (MIC) of the pathogen during the dosing interval. In an effort to take advantage of these bactericidal characteristics, prolonged (extended and continuous) infusions (PI) can be applied during the administration of intravenous β-lactams to increase time above the MIC. PI dosing regimens have been implemented worldwide, but implementation is inconsistent. We report consensus therapeutic recommendations for the use of β-lactam PI developed by an expert international panel with representation from clinical pharmacy and medicine. This consensus guideline provides recommendations regarding pharmacokinetic and pharmacodynamic targets, therapeutic drug monitoring considerations, and the use of PI β-lactam therapy in the following patient populations: severely ill and nonseverely ill adult patients, pediatric patients, and obese patients. These recommendations provide the first consensus guidance for the use of β-lactam therapy administered as PIs and have been reviewed and endorsed by the American College of Clinical Pharmacy (ACCP), the British Society for Antimicrobial Chemotherapy (BSAC), the Cystic Fibrosis Foundation (CFF), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the Infectious Diseases Society of America (IDSA), the Society of Critical Care Medicine (SCCM), and the Society of Infectious Diseases Pharmacists (SIDP).
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Affiliation(s)
- Lisa T Hong
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Kevin J Downes
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Jacinda C Abdul-Mutakabbir
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
- Divisions of Clinical Pharmacy and the Black Diaspora and African American Studies, University of California San Diego, La Jolla, California, USA
| | - Joseph L Kuti
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | | | - David C Young
- University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | | | | | - Robert A Bonomo
- Cleveland Veteran Affairs Medical Center, Cleveland, Ohio, USA
- Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Case Western Reserve University, Cleveland, Ohio, USA
| | - Mark Gilchrist
- Imperial College Healthcare National Health Services Trust, London, UK
| | - Soo Min Jang
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Thomas Lodise
- Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Center for Clinical Research, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Thomas Tängdén
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Athena Zuppa
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marc H Scheetz
- Departments of Pharmacy Practice and Pharmacology, Pharmacometric Center of Excellence, Midwestern University- Downers Grove Campus, Downers Grove, Illinois, USA
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA
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Cotta MO, Roberts JA, Reade MC. Comment: Is off-label medication use in the ICU a problem? Crit Care 2023; 27:288. [PMID: 37454194 PMCID: PMC10349488 DOI: 10.1186/s13054-023-04546-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Menino O Cotta
- University of Queensland Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Brisbane, QLD, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Brisbane, QLD, Australia
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nimes University Hospital, University of Montpellier, Nîmes, France
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
| | - Michael C Reade
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia.
- Medical School, University of Queensland, Herston, Brisbane, QLD, Australia.
- Joint Health Command, Australian Defence Force, Canberra, Australian Capital Territory, Australia.
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33
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Legg A, Roberts MA, Davies J, Cass A, Meagher N, Sud A, Daitch V, Dishon Benattar Y, Yahav D, Paul M, Xinxin C, Ping YH, Lye D, Lee R, Robinson JO, Foo H, Tramontana AR, Bak N, Grenfell A, Rogers B, Li Y, Joshi N, O’Sullivan M, McKew G, Ghosh N, Schneider K, Holmes NE, Dotel R, Chia T, Archuleta S, Smith S, Warner MS, Titin C, Kalimuddin S, Roberts JA, Tong SYC, Davis JS. Longer-term Mortality and Kidney Outcomes of Participants in the Combination Antibiotics for Methicillin-Resistant Staphylococcus aureus (CAMERA2) Trial: A Post Hoc Analysis. Open Forum Infect Dis 2023; 10:ofad337. [PMID: 37496601 PMCID: PMC10368200 DOI: 10.1093/ofid/ofad337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023] Open
Abstract
Background The Combination Antibiotic Therapy for Methicillin-Resistant Staphylococcus aureus (CAMERA2) trial ceased recruitment in July 2018, noting that a higher proportion of patients in the intervention arm (combination therapy) developed acute kidney injury (AKI) compared to the standard therapy (monotherapy) arm. We analyzed the long-term outcomes of participants in CAMERA2 to understand the impact of combination antibiotic therapy and AKI. Methods Trial sites obtained additional follow-up data. The primary outcome was all-cause mortality, censored at death or the date of last known follow-up. Secondary outcomes included kidney failure or a reduction in kidney function (a 40% reduction in estimated glomerular filtration rate to <60 mL/minute/1.73 m2). To determine independent predictors of mortality in this cohort, adjusted hazard ratios were calculated using a Cox proportional hazards regression model. Results This post hoc analysis included extended follow-up data for 260 patients. Overall, 123 of 260 (47%) of participants died, with a median population survival estimate of 3.4 years (235 deaths per 1000 person-years). Fifty-five patients died within 90 days after CAMERA2 trial randomization; another 68 deaths occurred after day 90. Using univariable Cox proportional hazards regression, mortality was not associated with either the assigned treatment arm in CAMERA2 (hazard ratio [HR], 0.84 [95% confidence interval [CI], .59-1.19]; P = .33) or experiencing an AKI (HR at 1 year, 1.04 [95% CI, .64-1.68]; P = .88). Conclusions In this cohort of patients hospitalized with methicillin-resistant S aureus bacteremia, we found no association between either treatment arm of the CAMERA2 trial or AKI (using CAMERA2 trial definition) and longer-term mortality.
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Affiliation(s)
- Amy Legg
- Correspondence: Amy Legg, Bpharm, GradDipClinPharm, Herston Infectious Diseases Institute, Royal Brisbane and Women’s Hospital, Level 8, UQCCR Building, Herston, QLD 4029 Brisbane, Australia (); Joshua S. Davis, MBBS (Hons), DTM&H, FRACP, Grad CertPopHealth, PhD, Infectious Diseases Dept., John Hunter Hospital, Lookout Road, New Lambton, Newcastle, NSW, 2305 ()
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Jane Davies
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Niamh Meagher
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Archana Sud
- Department of Infectious Diseases, Nepean Hospital and Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Vered Daitch
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | | | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Centre, Ramat-Gan, Israel
| | - Mical Paul
- Infectious Diseases Unit, Sheba Medical Centre, Ramat-Gan, Israel
- Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Chen Xinxin
- National Centre for Infectious Diseases, Singapore
| | - Yeo He Ping
- National Centre for Infectious Diseases, Singapore
| | - David Lye
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Russel Lee
- National Centre for Infectious Diseases, Singapore
| | - J Owen Robinson
- Infectious Disease Department, Royal Perth Hospital and Fiona Stanley Hospital, PathWest Laboratory Medicine,Perth, Western Australia, Australia
- College of Science, Health, Engineering and Education, Discipline of Health, Murdoch University, Perth, Western Australia, Australia
| | - Hong Foo
- Department of Microbiology and Infectious Diseases, NSW Health Pathology, Liverpool, New South Wales, Australia
| | - Adrian R Tramontana
- Infectious Diseases Department, Western Health, Footscray, Victoria, Australia
- Western Clinical School, University of Melbourne, St Albans, Victoria, Australia
| | - Narin Bak
- Infectious Diseases Department, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Benjamin Rogers
- Monash Infectious Diseases, Monash Health, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Ying Li
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Neela Joshi
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Matthew O’Sullivan
- Department of Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia
- New South Wales Health Pathology, Department of Microbiology, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Genevieve McKew
- Department of Microbiology and Infectious Diseases, Concord Repatriation and General Hospital, New South Wales Health Pathology, Sydney, NSW, Australia
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Niladri Ghosh
- Department of Infectious Diseases, Wollongong Public Hospital, Wollongong, New South Wales, Australia
| | - Kellie Schneider
- Immunology and Infectious Diseases Unit, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Ravindra Dotel
- Department of Infectious Diseases, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Timothy Chia
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Sophia Archuleta
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Morgyn S Warner
- Microbiology and Infectious Diseases Directorate, South Australia Pathology, Infectious Diseases Unit, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Christina Titin
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- Duke–National University of Singapore Medical School, Programme in Emerging Infectious Diseases, Singapore
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
- Departments of Intensive Care Medicine and Pharmacy, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology, Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Joshua S Davis
- Correspondence: Amy Legg, Bpharm, GradDipClinPharm, Herston Infectious Diseases Institute, Royal Brisbane and Women’s Hospital, Level 8, UQCCR Building, Herston, QLD 4029 Brisbane, Australia (); Joshua S. Davis, MBBS (Hons), DTM&H, FRACP, Grad CertPopHealth, PhD, Infectious Diseases Dept., John Hunter Hospital, Lookout Road, New Lambton, Newcastle, NSW, 2305 ()
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Lyster H, Shekar K, Watt K, Reed A, Roberts JA, Abdul-Aziz MH. Antifungal Dosing in Critically Ill Patients on Extracorporeal Membrane Oxygenation. Clin Pharmacokinet 2023; 62:931-942. [PMID: 37300631 PMCID: PMC10338597 DOI: 10.1007/s40262-023-01264-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/12/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is an established advanced life support system, providing temporary cardiac and/or respiratory support in critically ill patients. Fungal infections are associated with increased mortality in patients on ECMO. Antifungal drug dosing for critically ill patients is highly challenging because of altered pharmacokinetics (PK). PK changes during critical illness; in particular, the drug volume of distribution (Vd) and clearance can be exacerbated by ECMO. This article discusses the available literature to inform adequate dosing of antifungals in this patient population. The number of antifungal PK studies in critically ill patients on ECMO is growing; currently available literature consists of case reports and studies with small sample sizes providing inconsistent findings, with scant or no data for some antifungals. Current data are insufficient to provide definitive empirical drug dosing guidance and use of dosing strategies derived from critically patients not on ECMO is reasonable. However, due to high PK variability, therapeutic drug monitoring should be considered where available in critically ill patients receiving ECMO to prevent subtherapeutic or toxic antifungal exposures.
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Affiliation(s)
- Haifa Lyster
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
- University of Portsmouth, Portsmouth, UK
| | - Kiran Shekar
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Kevin Watt
- School of Pharmacy, University of Waterloo, 10 Victoria St S. Kitchener, Waterloo, ON, N2G 1C5, Canada
- Department of Paediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Anna Reed
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
- Imperial College London, London, SW3 6NP, UK
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
- Herston Infectious Diseases (HeIDI), Metro North Health, Brisbane, QLD, Australia.
- Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France.
| | - Mohd-Hafiz Abdul-Aziz
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia
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Tsai D, Zam BB, Tongs C, Chiong F, Sajiv C, Pawar B, Ashok A, Cooper BP, Tong SYC, Janson S, Wallis SC, Roberts JA, Parker SL. Validating a novel three-times-weekly post-hemodialysis ceftriaxone regimen in infected Indigenous Australian patients-a population pharmacokinetic study. J Antimicrob Chemother 2023:dkad190. [PMID: 37367723 PMCID: PMC10393936 DOI: 10.1093/jac/dkad190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVES To describe the total and unbound population pharmacokinetics of a 2 g three-times-weekly post-dialysis ceftriaxone regimen in Indigenous Australian patients requiring hemodialysis. METHODS A pharmacokinetic study was carried out in the dialysis unit of a remote Australian hospital. Adult Indigenous patients on intermittent hemodialysis (using a high-flux dialyzer) and treated with a 2 g three-times-weekly ceftriaxone regimen were recruited. Plasma samples were serially collected over two dosing intervals and assayed using validated methodology. Population pharmacokinetic analysis and Monte Carlo simulations were performed using Pmetrics in R. The probability of pharmacokinetic/pharmacodynamic target attainment (unbound trough concentrations ≥1 mg/L) and toxicity [trough concentrations (total) ≥100 mg/L] were simulated for various dosing strategies. RESULTS Total and unbound concentrations were measured in 122 plasma samples collected from 16 patients (13 female) with median age 57 years. A two-compartment model including protein-binding adequately described the data, with serum bilirubin concentrations associated (inversely) with ceftriaxone clearance. The 2 g three-times-weekly regimen achieved 98% probability to maintain unbound ceftriaxone concentrations ≥1 mg/L for a serum bilirubin of 5 µmol/L. Incremental accumulation of ceftriaxone was observed in those with bilirubin concentrations >5 µmol/L. Three-times-weekly regimens were less probable to achieve toxic exposures compared with once-daily regimens. Ceftriaxone clearance was increased by >10-fold during dialysis. CONCLUSIONS A novel 2 g three-times-weekly post-dialysis ceftriaxone regimen can be recommended for a bacterial infection with an MIC ≤1 mg/L. A 1 g three-times-weekly post-dialysis regimen is recommended for those with serum bilirubin ≥10 µmol/L. Administration of ceftriaxone during dialysis is not recommended.
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Affiliation(s)
- Danny Tsai
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Betty B Zam
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
| | - Carleigh Tongs
- Northern Territory Medical Program, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Fabian Chiong
- Department of Medicine, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Cherian Sajiv
- Department of Nephrology, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Basant Pawar
- Department of Nephrology, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Aadith Ashok
- Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia
| | - Brynley P Cooper
- Pharmacy Department, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Sonja Janson
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, NT, Australia
| | - Steven C Wallis
- UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, QLD, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Suzanne L Parker
- UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
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Williams PG, Tabah A, Cotta MO, Sandaradura I, Kanji S, Scheetz MH, Imani S, Elhadi M, Luque-Pardos S, Schellack N, Sanches C, Timsit JF, Xie J, Farkas A, Wilks K, Roberts JA. International survey of antibiotic dosing and monitoring in adult intensive care units. Crit Care 2023; 27:241. [PMID: 37331935 DOI: 10.1186/s13054-023-04527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND In recent years, numerous dosing studies have been conducted to optimize therapeutic antibiotic exposures in patients with serious infections. These studies have led to the inclusion of dose optimization recommendations in international clinical practice guidelines. The last international survey describing dosing, administration and monitoring of commonly prescribed antibiotics for critically ill patients was published in 2015 (ADMIN-ICU 2015). This study aimed to describe the evolution of practice since this time. METHODS A cross-sectional international survey distributed through professional societies and networks was used to obtain information on practices used in the dosing, administration and monitoring of vancomycin, piperacillin/tazobactam, meropenem and aminoglycosides. RESULTS A total of 538 respondents (71% physicians and 29% pharmacists) from 409 hospitals in 45 countries completed the survey. Vancomycin was mostly administered as an intermittent infusion, and loading doses were used by 74% of respondents with 25 mg/kg and 20 mg/kg the most favoured doses for intermittent and continuous infusions, respectively. Piperacillin/tazobactam and meropenem were most frequently administered as an extended infusion (42% and 51%, respectively). Therapeutic drug monitoring was undertaken by 90%, 82%, 43%, and 39% of respondents for vancomycin, aminoglycosides, piperacillin/tazobactam, and meropenem, respectively, and was more frequently performed in high-income countries. Respondents rarely used dosing software to guide therapy in clinical practice and was most frequently used with vancomycin (11%). CONCLUSIONS We observed numerous changes in practice since the ADMIN-ICU 2015 survey was conducted. Beta-lactams are more commonly administered as extended infusions, and therapeutic drug monitoring use has increased, which align with emerging evidence.
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Affiliation(s)
- Paul G Williams
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, QLD, 4029, Australia.
- Pharmacy Department, Sunshine Coast University Hospital, Birtinya, QLD, Australia.
| | - Alexis Tabah
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, QLD, 4029, Australia
- Intensive Care Unit, Redcliffe Hospital, Redcliffe, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
| | - Menino Osbert Cotta
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, QLD, 4029, Australia
| | - Indy Sandaradura
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia
- Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, NSW, Australia
| | - Salmaan Kanji
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marc H Scheetz
- Pharmacometric Center of Excellence, Departments of Pharmacy Practice and Pharmacology, College of Pharmacy, Midwestern University, Downers Grove, IL, USA
| | - Sahand Imani
- Nepean Blue Mountains Local Health District, Nepean Hospital, Sydney, NSW, Australia
| | | | - Sònia Luque-Pardos
- Pharmacy Department, Parc de Salut Mar, Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBER of Pharmacy, Saint Clare's Infectious Diseases (CIBERINFEC CB21/13/0002) Institute of Health Carlos III, Madrid, Spain
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Cristina Sanches
- Campus Centro Oeste Dona Lindu, Federal University of Sao João del Rei, Divinópolis, Minas Gerais, Brasil
| | - Jean-Francois Timsit
- Assistance Publique Hôpitaux de Paris - Bichat hospital Medical and infectious diseases ICU (MI2), 75018, Paris, France
- IAME U 1137 Université Paris-Cité Site Bichat, 75018, Paris, France
| | - Jiao Xie
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Andras Farkas
- Optimum Dosing Strategies, Bloomingdale, NJ, USA
- Department of Pharmacy, Saint Clare's Health, Denville, NJ, USA
| | - Kathryn Wilks
- Infectious Diseases Department, Sunshine Coast University Hospital, Birtinya, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, QLD, 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Beraldi-Magalhaes F, Parker SL, Sanches C, Garcia LS, Souza Carvalho BK, Costa AA, Fachi MM, de Liz MV, de Souza AB, Safe IP, Pontarolo R, Wallis S, Lipman J, Roberts JA, Cordeiro-Santos M. Is the Pharmacokinetics of First-Line Anti-TB Drugs a Cause of High Mortality Rates in TB Patients Admitted to the ICU? A Non-Compartmental Pharmacokinetic Analysis. Trop Med Infect Dis 2023; 8:312. [PMID: 37368730 DOI: 10.3390/tropicalmed8060312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Patients with tuberculosis (TB) may develop multi-organ failure and require admission to intensive care. In these cases, the mortality rates are as high as 78% and may be caused by suboptimal serum concentrations of first-line TB drugs. This study aims to compare the pharmacokinetics of oral rifampin, isoniazid, pyrazinamide and ethambutol patients in intensive care units (ICU) to outpatients and to evaluate drug serum concentrations as a potential cause of mortality. METHODS A prospective pharmacokinetic (PK) study was performed in Amazonas State, Brazil. The primary PK parameters of outpatients who achieved clinical and microbiological cure were used as a comparative target in a non-compartmental analysis. RESULTS Thirteen ICU and twenty outpatients were recruited. The clearance and volume of distribution were lower for rifampin, isoniazid, pyrazinamide and ethambutol. ICU thirty-day mortality was 77% versus a cure rate of 89% in outpatients. CONCLUSIONS ICU patients had a lower clearance and volume of distribution for rifampin, isoniazid, pyrazinamide and ethambutol compared to the outpatient group. These may reflect changes to organ function, impeded absorption and distribution to the site of infection in ICU patients and have the potential to impact clinical outcomes.
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Affiliation(s)
- Francisco Beraldi-Magalhaes
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
- Secretaria de Estado da Saúde do Paraná, Curitiba 80010-130, Brazil
- School of Medicine, Faculdades Pequeno Príncipe, Curitiba 80230-020, Brazil
| | - Suzanne L Parker
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Cristina Sanches
- Department of Pharmacy, Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Divinopolis 35501-296, Brazil
| | - Leandro Sousa Garcia
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Brenda Karoline Souza Carvalho
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Amanda Araujo Costa
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Mariana Millan Fachi
- Department of Pharmacy, Campus Jardim Botânico, Universidade Federal do Paraná, Curitiba 80210-170, Brazil
| | - Marcus Vinicius de Liz
- Department of Chemistry & Biology, Campus Curitiba, Universidade Tecnológica Federal do Paraná, Curitiba 81280-340, Brazil
| | - Alexandra Brito de Souza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Izabella Picinin Safe
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Roberto Pontarolo
- Department of Pharmacy, Campus Jardim Botânico, Universidade Federal do Paraná, Curitiba 80210-170, Brazil
| | - Steven Wallis
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30900 Nimes, France
| | - Jason A Roberts
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30900 Nimes, France
- Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| | - Marcelo Cordeiro-Santos
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
- School of Medicine, Universidade Nilton Lins, Manaus 69058-040, Brazil
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Hernández-Mitre MP, Won H, Wallis SC, Parker SL, Roberts JA. Stability of nafamostat in intravenous infusion solutions, human whole blood and extracted plasma: implications for clinical effectiveness studies. Bioanalysis 2023; 15:673-681. [PMID: 37272603 DOI: 10.4155/bio-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Aim: To describe the stability of nafamostat in infusion solutions, during blood sample collection and in extracted plasma samples in the autosampler. Methods: Nafamostat infusion solutions were stored at room temperature in the light for 24 h. For sample collection stability, fresh blood spiked with nafamostat was subjected to combinations of anticoagulants, added esterase inhibitor and temperature. Nafamostat was monitored in the extracted plasma samples in the autosampler. Results: Nafamostat was stable in infusion solutions. Nafamostat in whole blood was stable for 3 h before centrifugation when collected in sodium fluoride/potassium oxalate tubes (4°C). Nafamostat in extracted plasma samples degraded at 4.7 ± 0.7% per h. Conclusion: Viable samples can be obtained using blood collection tubes with sodium fluoride, chilling and processing promptly.
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Affiliation(s)
| | - Hayoung Won
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia
| | - Steven C Wallis
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia
| | - Suzanne L Parker
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, 4029, Australia
- Departments of Pharmacy & Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, 4029, Australia
- Division of Anaesthesiology Critical Care Emergency & Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, 30029, France
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Giuliano S, Angelini J, D'Elia D, Geminiani M, Barison RD, Giacinta A, Sartor A, Campanile F, Curcio F, Cotta MO, Roberts JA, Baraldo M, Tascini C. Ampicillin and Ceftobiprole Combination for the Treatment of Enterococcus faecalis Invasive Infections: "The Times They Are A-Changin". Antibiotics (Basel) 2023; 12:antibiotics12050879. [PMID: 37237782 DOI: 10.3390/antibiotics12050879] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/23/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Enterococcus faecalis is responsible for a large variety of severe infections. This study is a case series reporting our experience in the treatment of E. faecalis invasive infections with ampicillin in combination with ceftobiprole (ABPR). METHODS We retrospectively analyzed all the medical records of patients admitted to the University Hospital of Udine from January to December 2020 with a diagnosis of infective endocarditis or primary or non-primary complicated or uncomplicated bacteremia caused by E. faecalis. RESULTS Twenty-one patients were included in the final analysis. The clinical success rate was very high, accounting for 81% of patients, and microbiological cure was obtained in 86% of patients. One relapse was recorded in one patient who did not adhere to the partial oral treatment prescribed. Therapeutic drug monitoring (TDM) was always performed for ampicillin and ceftobiprole, and serum concentrations of both drugs were compared to the MICs of the different enterococcal isolates. CONCLUSIONS ABPR is a well-tolerated antimicrobial regimen with anti-E. faecalis activity. TDM can help clinicians optimize medical treatments to achieve the best possible efficacy with fewer side effects. ABPR might be a reasonable option for the treatment of severe invasive infections caused by E. faecalis due to the high level of enterococcal penicillin-binding protein (PBP) saturation.
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Affiliation(s)
- Simone Giuliano
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Jacopo Angelini
- Clinical Pharmacology and Toxicology Institute, University Hospital Friuli Centrale ASUFC, 33100 Udine, Italy
- Department of Medicine, University of Udine (UNIUD), 33100 Udine, Italy
| | - Denise D'Elia
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Monica Geminiani
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Roberto Daniele Barison
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Alessandro Giacinta
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Assunta Sartor
- Microbiology Unit, Udine University Hospital, 33100 Udine, Italy
| | - Floriana Campanile
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, 95123 Catania, Italy
| | - Francesco Curcio
- Department of Medicine, University of Udine (UNIUD), 33100 Udine, Italy
- Institute of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Menino Osbert Cotta
- Faculty of Medicine, University of Queensland, Centre for Clinical Research (UQCCR), Brisbane, QLD 4029, Australia
- Herston Infectious Diseases Institute, Herston, QLD 4029, Australia
| | - Jason A Roberts
- Faculty of Medicine, University of Queensland, Centre for Clinical Research (UQCCR), Brisbane, QLD 4029, Australia
- Herston Infectious Diseases Institute, Herston, QLD 4029, Australia
- Departments of Intensive Care Medicine and Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 34095 Nîmes, France
| | - Massimo Baraldo
- Clinical Pharmacology and Toxicology Institute, University Hospital Friuli Centrale ASUFC, 33100 Udine, Italy
- Department of Medicine, University of Udine (UNIUD), 33100 Udine, Italy
| | - Carlo Tascini
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
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Legg A, Carmichael S, Chai MG, Roberts JA, Cotta MO. Beta-Lactam Dose Optimisation in the Intensive Care Unit: Targets, Therapeutic Drug Monitoring and Toxicity. Antibiotics (Basel) 2023; 12:antibiotics12050870. [PMID: 37237773 DOI: 10.3390/antibiotics12050870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023] Open
Abstract
Beta-lactams are an important family of antibiotics used to treat infections and are commonly used in critically ill patients. Optimal use of these drugs in the intensive care unit (ICU) is important because of the serious complications from sepsis. Target beta-lactam antibiotic exposures may be chosen using fundamental principles of beta-lactam activity derived from pre-clinical and clinical studies, although the debate regarding optimal beta-lactam exposure targets is ongoing. Attainment of target exposures in the ICU requires overcoming significant pharmacokinetic (PK) and pharmacodynamic (PD) challenges. For beta-lactam drugs, the use of therapeutic drug monitoring (TDM) to confirm if the desired exposure targets are achieved has shown promise, but further data are required to determine if improvement in infection-related outcomes can be achieved. Additionally, beta-lactam TDM may be useful where a relationship exists between supratherapeutic antibiotic exposure and drug adverse effects. An ideal beta-lactam TDM service should endeavor to efficiently sample and report results in identified at-risk patients in a timely manner. Consensus beta-lactam PK/PD targets associated with optimal patient outcomes are lacking and should be a focus for future research.
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Affiliation(s)
- Amy Legg
- Menzies School of Health Research, Tiwi, Darwin, NT 0810, Australia
- Herston Infectious Diseases Institute, Herston, Brisbane, QLD 4029, Australia
| | - Sinead Carmichael
- Royal Brisbane and Women's Hospital, Departments of Intensive Care Medicine and Pharmacy, Brisbane, QLD 4029, Australia
| | - Ming G Chai
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), Brisbane, QLD 4029, Australia
| | - Jason A Roberts
- Herston Infectious Diseases Institute, Herston, Brisbane, QLD 4029, Australia
- Royal Brisbane and Women's Hospital, Departments of Intensive Care Medicine and Pharmacy, Brisbane, QLD 4029, Australia
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30029 Nîmes, France
| | - Menino O Cotta
- Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), Brisbane, QLD 4029, Australia
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Speck P, Mackenzie J, Bull RA, Slobedman B, Drummer H, Fraser J, Herrero L, Helbig K, Londrigan S, Moseley G, Prow N, Hansman G, Edwards R, Ahlenstiel C, Abendroth A, Tscharke D, Hobson-Peters J, Kriiger-Loterio R, Parry R, Marsh G, Harding E, Jacques DA, Gartner MJ, Lee WS, McAuley J, Vaz P, Sainsbury F, Tate MD, Sinclair J, Imrie A, Rawlinson S, Harman A, Carr JM, Monson EA, Hibma M, Mahony TJ, Tu T, Center RJ, Shrestha LB, Hall R, Warner M, Ward V, Anderson DE, Eyre NS, Netzler NE, Peel AJ, Revill P, Beard M, Legione AR, Spencer AJ, Idris A, Forwood J, Sarker S, Purcell DFJ, Bartlett N, Deerain JM, Brew BJ, Asgari S, Farrell H, Khromykh A, Enosi Tuipulotu D, Anderson D, Mese S, Tayyar Y, Edenborough K, Uddin JM, Hussain A, Daymond CJI, Agius J, Johnson KN, Shirmast P, Abedinzadeshahri M, MacDiarmid R, Ashley CL, Laws J, Furfaro LL, Burton TD, Johnson SMR, Telikani Z, Petrone M, Roby JA, Samer C, Suhrbier A, Van Der Kamp A, Cunningham A, Donato C, Mahar J, Black WD, Vasudevan S, Lenchine R, Spann K, Rawle DJ, Rudd P, Neil J, Kingston R, Newsome TP, Kim KW, Mak J, Lowry K, Bryant N, Meers J, Roberts JA, McMillan N, Labzin LI, Slonchak A, Hugo LE, Henzeler B, Newton ND, David CT, Reading PC, Esneau C, Briody T, Nasr N, McNeale D, McSharry B, Fakhri O, Horsburgh BA, Logan G, Howley P, Young P. Statement in Support of: "Virology under the Microscope-a Call for Rational Discourse". mBio 2023:e0081523. [PMID: 37097032 DOI: 10.1128/mbio.00815-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Affiliation(s)
- Peter Speck
- Flinders University, Bedford Park, South Australia
| | - Jason Mackenzie
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Rowena A Bull
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | - Lara Herrero
- Griffith University, Southport, Queensland, Australia
| | - Karla Helbig
- La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Londrigan
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie Prow
- Hull York Medical School, University of York, York, United Kingdom
| | - Grant Hansman
- Griffith University, Southport, Queensland, Australia
| | | | | | | | - David Tscharke
- Australian National University, Canberra, Australian Capital Territory, Australia
| | | | | | - Rhys Parry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Glenn Marsh
- Commonwealth Scientific and Industrial Research Organisation, Geelong, Victoria, Australia
| | - Emma Harding
- University of New South Wales, Sydney, New South Wales, Australia
| | - David A Jacques
- University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew J Gartner
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Wen Shi Lee
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Julie McAuley
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Paola Vaz
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Michelle D Tate
- Monash University, Melbourne, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jane Sinclair
- University of Queensland, St. Lucia, Queensland, Australia
| | - Allison Imrie
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Andrew Harman
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | | | | | - Thomas Tu
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | - Robyn Hall
- Ausvet Pty Ltd., Canberra, Australian Capital Territory, Australia
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | - Morgyn Warner
- University of Adelaide, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
| | | | - Danielle E Anderson
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie E Netzler
- University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre of Research Excellence, Auckland, New Zealand
| | | | - Peter Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael Beard
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - Adi Idris
- Griffith University, Southport, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jade Forwood
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Subir Sarker
- La Trobe University, Melbourne, Victoria, Australia
| | - Damian F J Purcell
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Nathan Bartlett
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joshua M Deerain
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Bruce J Brew
- University of New South Wales, Sydney, New South Wales, Australia
- University of Notre Dame, Sydney, New South Wales, Australia
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sassan Asgari
- University of Queensland, St. Lucia, Queensland, Australia
| | - Helen Farrell
- University of Queensland, St. Lucia, Queensland, Australia
| | | | | | | | - Sevim Mese
- University of Queensland, St. Lucia, Queensland, Australia
- Istanbul University, Istanbul, Turkey
| | - Yaman Tayyar
- Griffith University, Southport, Queensland, Australia
- Prorenata Biotech, Moledinar, Queensland, Australia
| | | | | | - Abrar Hussain
- Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - Connor J I Daymond
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | | | | | - Robin MacDiarmid
- The New Zealand Institute for Plant & Food Research Limited, Auckland, New Zealand
| | | | - Jay Laws
- La Trobe University, Melbourne, Victoria, Australia
| | - Lucy L Furfaro
- University of Western Australia, Perth, Western Australia, Australia
| | | | | | | | - Mary Petrone
- The University of Sydney, New South Wales, Australia
| | - Justin A Roby
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Carolyn Samer
- The University of Sydney, New South Wales, Australia
| | - Andreas Suhrbier
- University of Queensland, St. Lucia, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Anthony Cunningham
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Celeste Donato
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jackie Mahar
- The University of Sydney, New South Wales, Australia
| | - Wesley D Black
- Biotopia Environmental Assessment Pty Ltd., Melbourne, Victoria, Australia
| | | | | | - Kirsten Spann
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Daniel J Rawle
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Penny Rudd
- Griffith University, Southport, Queensland, Australia
| | - Jessica Neil
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | - Ki Wook Kim
- University of New South Wales, Sydney, New South Wales, Australia
| | - Johnson Mak
- Griffith University, Southport, Queensland, Australia
| | - Kym Lowry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Nathan Bryant
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joanne Meers
- University of Queensland, St. Lucia, Queensland, Australia
| | - Jason A Roberts
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | | | | | - Leon E Hugo
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | | | - Patrick C Reading
- University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia
| | - Camille Esneau
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tatiana Briody
- University of Queensland, St. Lucia, Queensland, Australia
| | - Najla Nasr
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | - Brian McSharry
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Omid Fakhri
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | | | - Grant Logan
- Children's Medical Research Institute, Westmead, NSW, Australia
| | - Paul Howley
- Vaxmed Pty Ltd., Berwick, Victoria, Australia
| | - Paul Young
- University of Queensland, St. Lucia, Queensland, Australia
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Speck P, Mackenzie J, Bull RA, Slobedman B, Drummer H, Fraser J, Herrero L, Helbig K, Londrigan S, Moseley G, Prow N, Hansman G, Edwards R, Ahlenstiel C, Abendroth A, Tscharke D, Hobson-Peters J, Kriiger-Loterio R, Parry R, Marsh G, Harding E, Jacques DA, Gartner MJ, Lee WS, McAuley J, Vaz P, Sainsbury F, Tate MD, Sinclair J, Imrie A, Rawlinson S, Harman A, Carr JM, Monson EA, Hibma M, Mahony TJ, Tu T, Center RJ, Shrestha LB, Hall R, Warner M, Ward V, Anderson DE, Eyre NS, Netzler NE, Peel AJ, Revill P, Beard M, Legione AR, Spencer AJ, Idris A, Forwood J, Sarker S, Purcell DFJ, Bartlett N, Deerain JM, Brew BJ, Asgari S, Farrell H, Khromykh A, Enosi Tuipulotu D, Anderson D, Mese S, Tayyar Y, Edenborough K, Uddin JM, Hussain A, Daymond CJI, Agius J, Johnson KN, Shirmast P, Abedinzadeshahri M, MacDiarmid R, Ashley CL, Laws J, Furfaro LL, Burton TD, Johnson SMR, Telikani Z, Petrone M, Roby JA, Samer C, Suhrbier A, Van Der Kamp A, Cunningham A, Donato C, Mahar J, Black WD, Vasudevan S, Lenchine R, Spann K, Rawle DJ, Rudd P, Neil J, Kingston R, Newsome TP, Kim KW, Mak J, Lowry K, Bryant N, Meers J, Roberts JA, McMillan N, Labzin LI, Slonchak A, Hugo LE, Henzeler B, Newton ND, David CT, Reading PC, Esneau C, Briody T, Nasr N, McNeale D, McSharry B, Fakhri O, Horsburgh BA, Logan G, Howley P, Young P. Statement in Support of: "Virology under the Microscope-a Call for Rational Discourse". mSphere 2023:e0016523. [PMID: 37097028 DOI: 10.1128/msphere.00165-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Affiliation(s)
- Peter Speck
- Flinders University, Bedford Park, South Australia
| | - Jason Mackenzie
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Rowena A Bull
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | - Lara Herrero
- Griffith University, Southport, Queensland, Australia
| | - Karla Helbig
- La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Londrigan
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie Prow
- Hull York Medical School, University of York, York, United Kingdom
| | - Grant Hansman
- Griffith University, Southport, Queensland, Australia
| | | | | | | | - David Tscharke
- Australian National University, Canberra, Australian Capital Territory, Australia
| | | | | | - Rhys Parry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Glenn Marsh
- Commonwealth Scientific and Industrial Research Organisation, Geelong, Victoria, Australia
| | - Emma Harding
- University of New South Wales, Sydney, New South Wales, Australia
| | - David A Jacques
- University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew J Gartner
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Wen Shi Lee
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Julie McAuley
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Paola Vaz
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Michelle D Tate
- Monash University, Melbourne, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jane Sinclair
- University of Queensland, St. Lucia, Queensland, Australia
| | - Allison Imrie
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Andrew Harman
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | | | | | - Thomas Tu
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | - Robyn Hall
- Ausvet Pty Ltd., Canberra, Australian Capital Territory, Australia
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | - Morgyn Warner
- University of Adelaide, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
| | | | - Danielle E Anderson
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie E Netzler
- University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre of Research Excellence, Auckland, New Zealand
| | | | - Peter Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael Beard
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - Adi Idris
- Griffith University, Southport, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jade Forwood
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Subir Sarker
- La Trobe University, Melbourne, Victoria, Australia
| | - Damian F J Purcell
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Nathan Bartlett
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joshua M Deerain
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Bruce J Brew
- University of New South Wales, Sydney, New South Wales, Australia
- University of Notre Dame, Sydney, New South Wales, Australia
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sassan Asgari
- University of Queensland, St. Lucia, Queensland, Australia
| | - Helen Farrell
- University of Queensland, St. Lucia, Queensland, Australia
| | | | | | | | - Sevim Mese
- University of Queensland, St. Lucia, Queensland, Australia
- Istanbul University, Istanbul, Turkey
| | - Yaman Tayyar
- Griffith University, Southport, Queensland, Australia
- Prorenata Biotech, Moledinar, Queensland, Australia
| | | | | | - Abrar Hussain
- Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - Connor J I Daymond
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | | | | | - Robin MacDiarmid
- The New Zealand Institute for Plant & Food Research Limited, Auckland, New Zealand
| | | | - Jay Laws
- La Trobe University, Melbourne, Victoria, Australia
| | - Lucy L Furfaro
- University of Western Australia, Perth, Western Australia, Australia
| | | | | | | | - Mary Petrone
- The University of Sydney, New South Wales, Australia
| | - Justin A Roby
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Carolyn Samer
- The University of Sydney, New South Wales, Australia
| | - Andreas Suhrbier
- University of Queensland, St. Lucia, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Anthony Cunningham
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Celeste Donato
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jackie Mahar
- The University of Sydney, New South Wales, Australia
| | - Wesley D Black
- Biotopia Environmental Assessment Pty Ltd., Melbourne, Victoria, Australia
| | | | | | - Kirsten Spann
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Daniel J Rawle
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Penny Rudd
- Griffith University, Southport, Queensland, Australia
| | - Jessica Neil
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | - Ki Wook Kim
- University of New South Wales, Sydney, New South Wales, Australia
| | - Johnson Mak
- Griffith University, Southport, Queensland, Australia
| | - Kym Lowry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Nathan Bryant
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joanne Meers
- University of Queensland, St. Lucia, Queensland, Australia
| | - Jason A Roberts
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | | | | | - Leon E Hugo
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | | | - Patrick C Reading
- University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia
| | - Camille Esneau
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tatiana Briody
- University of Queensland, St. Lucia, Queensland, Australia
| | - Najla Nasr
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | - Brian McSharry
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Omid Fakhri
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | | | - Grant Logan
- Children's Medical Research Institute, Westmead, NSW, Australia
| | - Paul Howley
- Vaxmed Pty Ltd., Berwick, Victoria, Australia
| | - Paul Young
- University of Queensland, St. Lucia, Queensland, Australia
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Speck P, Mackenzie J, Bull RA, Slobedman B, Drummer H, Fraser J, Herrero L, Helbig K, Londrigan S, Moseley G, Prow N, Hansman G, Edwards R, Ahlenstiel C, Abendroth A, Tscharke D, Hobson-Peters J, Kriiger-Loterio R, Parry R, Marsh G, Harding E, Jacques DA, Gartner MJ, Lee WS, McAuley J, Vaz P, Sainsbury F, Tate MD, Sinclair J, Imrie A, Rawlinson S, Harman A, Carr JM, Monson EA, Hibma M, Mahony TJ, Tu T, Center RJ, Shrestha LB, Hall R, Warner M, Ward V, Anderson DE, Eyre NS, Netzler NE, Peel AJ, Revill P, Beard M, Legione AR, Spencer AJ, Idris A, Forwood J, Sarker S, Purcell DFJ, Bartlett N, Deerain JM, Brew BJ, Asgari S, Farrell H, Khromykh A, Enosi Tuipulotu D, Anderson D, Mese S, Tayyar Y, Edenborough K, Uddin JM, Hussain A, Daymond CJI, Agius J, Johnson KN, Shirmast P, Abedinzadeshahri M, MacDiarmid R, Ashley CL, Laws J, Furfaro LL, Burton TD, Johnson SMR, Telikani Z, Petrone M, Roby JA, Samer C, Suhrbier A, Van Der Kamp A, Cunningham A, Donato C, Mahar J, Black WD, Vasudevan S, Lenchine R, Spann K, Rawle DJ, Rudd P, Neil J, Kingston R, Newsome TP, Kim KW, Mak J, Lowry K, Bryant N, Meers J, Roberts JA, McMillan N, Labzin LI, Slonchak A, Hugo LE, Henzeler B, Newton ND, David CT, Reading PC, Esneau C, Briody T, Nasr N, McNeale D, McSharry B, Fakhri O, Horsburgh BA, Logan G, Howley P, Young P. Statement in Support of: "Virology under the Microscope-a Call for Rational Discourse". J Virol 2023; 97:e0045123. [PMID: 37097023 DOI: 10.1128/jvi.00451-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Affiliation(s)
- Peter Speck
- Flinders University, Bedford Park, South Australia
| | - Jason Mackenzie
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Rowena A Bull
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | - Lara Herrero
- Griffith University, Southport, Queensland, Australia
| | - Karla Helbig
- La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Londrigan
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie Prow
- Hull York Medical School, University of York, York, United Kingdom
| | - Grant Hansman
- Griffith University, Southport, Queensland, Australia
| | | | | | | | - David Tscharke
- Australian National University, Canberra, Australian Capital Territory, Australia
| | | | | | - Rhys Parry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Glenn Marsh
- Commonwealth Scientific and Industrial Research Organisation, Geelong, Victoria, Australia
| | - Emma Harding
- University of New South Wales, Sydney, New South Wales, Australia
| | - David A Jacques
- University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew J Gartner
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Wen Shi Lee
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Julie McAuley
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Paola Vaz
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Michelle D Tate
- Monash University, Melbourne, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jane Sinclair
- University of Queensland, St. Lucia, Queensland, Australia
| | - Allison Imrie
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Andrew Harman
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | | | | | - Thomas Tu
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | | | - Robyn Hall
- Ausvet Pty Ltd., Canberra, Australian Capital Territory, Australia
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | - Morgyn Warner
- University of Adelaide, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
| | | | - Danielle E Anderson
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Natalie E Netzler
- University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre of Research Excellence, Auckland, New Zealand
| | | | - Peter Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael Beard
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - Adi Idris
- Griffith University, Southport, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jade Forwood
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Subir Sarker
- La Trobe University, Melbourne, Victoria, Australia
| | - Damian F J Purcell
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Nathan Bartlett
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joshua M Deerain
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Bruce J Brew
- University of New South Wales, Sydney, New South Wales, Australia
- University of Notre Dame, Sydney, New South Wales, Australia
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sassan Asgari
- University of Queensland, St. Lucia, Queensland, Australia
| | - Helen Farrell
- University of Queensland, St. Lucia, Queensland, Australia
| | | | | | | | - Sevim Mese
- University of Queensland, St. Lucia, Queensland, Australia
- Istanbul University, Istanbul, Turkey
| | - Yaman Tayyar
- Griffith University, Southport, Queensland, Australia
- Prorenata Biotech, Moledinar, Queensland, Australia
| | | | | | - Abrar Hussain
- Balochistan University of Information Technology, Engineering and Management Sciences, Quetta, Pakistan
| | - Connor J I Daymond
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | | | | | - Robin MacDiarmid
- The New Zealand Institute for Plant & Food Research Limited, Auckland, New Zealand
| | | | - Jay Laws
- La Trobe University, Melbourne, Victoria, Australia
| | - Lucy L Furfaro
- University of Western Australia, Perth, Western Australia, Australia
| | | | | | | | - Mary Petrone
- The University of Sydney, New South Wales, Australia
| | - Justin A Roby
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Carolyn Samer
- The University of Sydney, New South Wales, Australia
| | - Andreas Suhrbier
- University of Queensland, St. Lucia, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Anthony Cunningham
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Celeste Donato
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jackie Mahar
- The University of Sydney, New South Wales, Australia
| | - Wesley D Black
- Biotopia Environmental Assessment Pty Ltd., Melbourne, Victoria, Australia
| | | | | | - Kirsten Spann
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Daniel J Rawle
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Penny Rudd
- Griffith University, Southport, Queensland, Australia
| | - Jessica Neil
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | | | - Ki Wook Kim
- University of New South Wales, Sydney, New South Wales, Australia
| | - Johnson Mak
- Griffith University, Southport, Queensland, Australia
| | - Kym Lowry
- University of Queensland, St. Lucia, Queensland, Australia
| | - Nathan Bryant
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Joanne Meers
- University of Queensland, St. Lucia, Queensland, Australia
| | - Jason A Roberts
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | | | | | - Leon E Hugo
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | | | - Patrick C Reading
- University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia
| | - Camille Esneau
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tatiana Briody
- University of Queensland, St. Lucia, Queensland, Australia
| | - Najla Nasr
- The University of Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | | | - Brian McSharry
- Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Omid Fakhri
- Commonwealth Scientific and Industrial Research Organisation, Black Mountain, Australian Capital Territory, Australia
| | | | - Grant Logan
- Children's Medical Research Institute, Westmead, NSW, Australia
| | - Paul Howley
- Vaxmed Pty Ltd., Berwick, Victoria, Australia
| | - Paul Young
- University of Queensland, St. Lucia, Queensland, Australia
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Setiawan E, Cotta MO, Roberts JA, Abdul-Aziz MH. A Systematic Review on Antimicrobial Pharmacokinetic Differences between Asian and Non-Asian Adult Populations. Antibiotics (Basel) 2023; 12:antibiotics12050803. [PMID: 37237706 DOI: 10.3390/antibiotics12050803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
While the relevance of inter-ethnic differences to the pharmacokinetic variabilities of antimicrobials has been reported in studies recruiting healthy subjects, differences in antimicrobial pharmacokinetics between Asian and non-Asian patients with severe pathologic conditions require further investigation. For the purpose of describing the potential differences in antimicrobial pharmacokinetics between Asian and non-Asian populations, a systematic review was performed using six journal databases and six theses/dissertation databases (PROSPERO record CRD42018090054). The pharmacokinetic data of healthy volunteers and non-critically ill and critically ill patients were reviewed. Thirty studies on meropenem, imipenem, doripenem, linezolid, and vancomycin were included in the final descriptive summaries. In studies recruiting hospitalised patients, inconsistent differences in the volume of distribution (Vd) and drug clearance (CL) of the studied antimicrobials between Asian and non-Asian patients were observed. Additionally, factors other than ethnicity, such as demographic (e.g., age) or clinical (e.g., sepsis) factors, were suggested to better characterise these pharmacokinetic differences. Inconsistent differences in pharmacokinetic parameters between Asian and non-Asian subjects/patients may suggest that ethnicity is not an important predictor to characterise interindividual pharmacokinetic differences between meropenem, imipenem, doripenem, linezolid, and vancomycin. Therefore, the dosing regimens of these antimicrobials should be adjusted according to patients' demographic or clinical characteristics that can better describe pharmacokinetic differences.
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Affiliation(s)
- Eko Setiawan
- University of Queensland Centre for Clinical Research [UQCCR], Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia
- Department of Clinical and Community Pharmacy, Center for Medicines Information and Pharmaceutical Care [CMIPC], Faculty of Pharmacy, University of Surabaya, Surabaya 60293, Indonesia
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research [UQCCR], Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research [UQCCR], Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30029 Nîmes, France
| | - Mohd Hafiz Abdul-Aziz
- University of Queensland Centre for Clinical Research [UQCCR], Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia
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Roberts JA, Nicolau DP, Martin-Loeches I, Deryke CA, Losada MC, Du J, Patel M, Rizk ML, Paschke A, Chen LF. Imipenem/cilastatin/relebactam efficacy, safety and probability of target attainment in adults with hospital-acquired or ventilator-associated bacterial pneumonia among patients with baseline renal impairment, normal renal function, and augmented renal clearance. JAC Antimicrob Resist 2023; 5:dlad011. [PMID: 36880088 PMCID: PMC9985325 DOI: 10.1093/jacamr/dlad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/17/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives To assess the relationship between renal function and efficacy/safety of imipenem/cilastatin/relebactam for the treatment of hospital-acquired/ventilator-associated pneumonia (HABP/VABP) from RESTORE-IMI 2 and determine the PTA. Methods Adults with HABP/VABP were randomized 1:1 to IV imipenem/cilastatin/relebactam 1.25 g or piperacillin/tazobactam 4.5 g every 6 h for 7-14 days. Initial doses were selected by CLCR and adjusted thereafter, as appropriate. Outcomes included Day 28 all-cause mortality (ACM), clinical response, microbiological response and adverse events. Population pharmacokinetic modelling and Monte Carlo simulations assessed PTA. Results The modified ITT population comprised those with normal renal function (n = 188), augmented renal clearance (ARC; n = 88), mild renal impairment (RI; n = 124), moderate RI (n = 109) and severe RI (n = 22). ACM rates were comparable between treatment arms among all baseline renal function categories. Clinical response rates were comparable between treatment arms for participants with RI and normal renal function but were higher (91.7% versus 44.4%) for imipenem/cilastatin/relebactam-treated versus piperacillin/tazobactam-treated participants with CLCR ≥250 mL/min (n = 21). Microbiologic response rates were comparable between treatment arms for participants with RI but higher among those treated with imipenem/cilastatin/relebactam in participants with CLCR ≥90 mL/min (86.6% versus 67.2%). Adverse events were comparable between treatment arms across renal function categories. Joint PTA was >98% for key pathogen MICs for susceptible pathogens (MIC ≤2 mg/L). Conclusions Prescribing information-defined dose adjustments in participants with baseline RI and full dosing of imipenem/cilastatin/relebactam 1.25 g every 6 h for participants with normal renal function or augmented renal clearance achieved sufficiently high drug exposures and favourable safety and efficacy profiles.
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Affiliation(s)
- Jason A Roberts
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia.,Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - David P Nicolau
- Center for Anti-Infective Research & Development, Hartford Hospital, Hartford, CT, USA
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Roberts JA, Croom K, Adomakoh N. Continuous infusion of beta-lactam antibiotics: narrative review of systematic reviews, and implications for outpatient parenteral antibiotic therapy. Expert Rev Anti Infect Ther 2023; 21:375-385. [PMID: 36867528 DOI: 10.1080/14787210.2023.2184347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Continuous infusion (CI) of beta-lactam antibiotics may be of benefit in some patients, particularly those with severe infections. However, most studies have been small and conflicting results have been reported. The best available evidence on clinical outcomes of beta-lactam CI comes from systematic reviews/meta-analyses that integrate the available data. AREAS COVERED A search of PubMed from inception to the end of February 2022 for systematic reviews of clinical outcomes with beta-lactam CI for any indication identified 12 reviews, all of which focused on hospitalized patients, most of whom were critically ill. A narrative overview of these systematic reviews/meta-analyses is provided. No systematic reviews evaluating the use of beta-lactam CI for outpatient parenteral antibiotic therapy (OPAT) were identified, as few studies have focused on this area. Relevant data are summarized, and consideration is given to issues that need to be addressed when using beta-lactam CI in the setting of OPAT. EXPERT OPINION Evidence from systematic reviews supports a role for beta-lactam CI in the treatment of hospitalized patients with severe/life-threatening infections. Beta-lactam CI can play a role in patients receiving OPAT for severe chronic/difficult-to-treat infections, but additional data are needed to clarify its optimal use.
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Affiliation(s)
- Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia.,Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Sharrock L, Ankravs MJ, Deane AM, Rechnitzer T, Wallis SC, Roberts JA, Bellomo R. Clearance of Piperacillin-Tazobactam and Vancomycin During Continuous Renal Replacement With Regional Citrate Anticoagulation. Ther Drug Monit 2023; 45:265-268. [PMID: 35994070 DOI: 10.1097/ftd.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of regional citrate anticoagulation during continuous venovenous hemodiafiltration (CVVHDF) has increased worldwide. However, data on its effect on the pharmacokinetics of antibiotics are limited. In this study, the authors aimed to measure the clearance of piperacillin-tazobactam and vancomycin in patients receiving CVVHDF with regional citrate anticoagulation. METHODS This study measured piperacillin-tazobactam and vancomycin concentrations in patients receiving CVVHDF with regional citrate anticoagulation. Dosing regimens were independently selected by intensivists. Arterial blood and effluent fluid samples were obtained over a single dosing interval and analyzed using ultra-high-performance liquid chromatography with tandem mass spectrometry. RESULTS Seventeen sampling intervals in 15 patients (9 receiving piperacillin-tazobactam only, 4 receiving vancomycin only, and 2 receiving both) were used. The median overall clearance for piperacillin was 35.2 mL/min [interquartile range (IQR): 32.2-38.6], 70 mL/min (IQR: 62.7-76.2) for tazobactam, and 29.5 mL/min (IQR: 26.2-32) for vancomycin. CONCLUSIONS This is the first study to quantify the pharmacokinetics of vancomycin and piperacillin-tazobactam in patients receiving CVVHDF with regional citrate anticoagulation. These results indicate high clearance and provide key information to guide optimal dosing.
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Affiliation(s)
- Lucy Sharrock
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Pharmacy Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Melissa J Ankravs
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Pharmacy Department, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Adam M Deane
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Thomas Rechnitzer
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Steven C Wallis
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology, Critical Care, Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Rinaldo Bellomo
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; and
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
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Barreto EF, Chitre PN, Pine KH, Shepel KK, Rule AD, Alshaer MH, Abdul Aziz MH, Roberts JA, Scheetz MH, Ausman SE, Moreland-Head LN, Rivera CG, Jannetto PJ, Mara KC, Boehmer KR. Why is the Implementation of Beta-Lactam Therapeutic Drug Monitoring for the Critically Ill Falling Short? A Multicenter Mixed-Methods Study. Ther Drug Monit 2023:00007691-990000000-00079. [PMID: 37076424 DOI: 10.1097/ftd.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/02/2022] [Indexed: 04/21/2023]
Abstract
BACKGROUND Beta-lactam therapeutic drug monitoring (BL TDM; drug level testing) can facilitate improved outcomes in critically ill patients. However, only 10%-20% of hospitals have implemented BL TDM. This study aimed to characterize provider perceptions and key considerations for successfully implementing BL TDM. METHODS This was a sequential mixed-methods study from 2020 to 2021 of diverse stakeholders at 3 academic medical centers with varying degrees of BL TDM implementation (not implemented, partially implemented, and fully implemented). Stakeholders were surveyed, and a proportion of participants completed semistructured interviews. Themes were identified, and findings were contextualized with implementation science frameworks. RESULTS Most of the 138 survey respondents perceived that BL TDM was relevant to their practice and improved medication effectiveness and safety. Integrated with interview data from 30 individuals, 2 implementation themes were identified: individual internalization and organizational features. Individuals needed to internalize, make sense of, and agree to BL TDM implementation, which was positively influenced by repeated exposure to evidence and expertise. The process of internalization appeared more complex with BL TDM than with other antibiotics (ie, vancomycin). Organizational considerations relevant to BL TDM implementation (eg, infrastructure, personnel) were similar to those identified in other TDM settings. CONCLUSIONS Broad enthusiasm for BL TDM among participants was found. Prior literature suggested that assay availability was the primary barrier to implementation; however, the data revealed many more individual and organizational attributes, which impacted the BL TDM implementation. Internalization should particularly be focused on to improve the adoption of this evidence-based practice.
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Affiliation(s)
- Erin F Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Pooja N Chitre
- School for the Future of Innovation in Society, Arizona State University, Tempe, Arizona
| | - Kathleen H Pine
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Kathryn K Shepel
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Division ||of Epidemiology, Mayo Clinic, Rochester, Minnesota
| | - Mohammad H Alshaer
- Infectious Disease Pharmacokinetics Lab, Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Mohd Hafiz Abdul Aziz
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Australia
| | - Marc H Scheetz
- Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois
- Pharmacometrics Center of Excellence, Midwestern University, Downers Grove, Illinois
| | - Sara E Ausman
- Department of Pharmacy, Mayo Clinic Health System, Eau Claire, Wisconsin
| | | | | | - Paul J Jannetto
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
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Cojutti PG, Heffernan AJ, Tängdén T, Della Siega P, Tascini C, Roberts JA, Pea F. Population Pharmacokinetic and Pharmacodynamic Analysis of Valganciclovir for Optimizing Preemptive Therapy of Cytomegalovirus Infections in Kidney Transplant Recipients. Antimicrob Agents Chemother 2023; 67:e0166522. [PMID: 36815856 PMCID: PMC10019259 DOI: 10.1128/aac.01665-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/18/2023] [Indexed: 02/24/2023] Open
Abstract
This study aimed to develop a population pharmacokinetic/pharmacodynamic (PK/PD) model of valganciclovir for preemptive therapy of cytomegalovirus (CMV) infection in kidney transplant patients. A population PK/PD model was developed with Monolix. Ganciclovir concentrations and CMV viral loads were obtained retrospectively from kidney transplant patients receiving routine clinical care. Ten thousand Monte Carlo simulations were performed with the licensed dosages adjusted for renal function to assess the probability of attaining a viral load target of ≤290 and ≤137 IU/mL. Fifty-seven patients provided 343 ganciclovir concentrations and 328 CMV viral loads for PK/PD modeling. A one-compartment pharmacokinetic model coupled with an indirect viral turnover growth model with stimulation of viral degradation pharmacodynamic model was devised. Simulations showed that 1- and 2-log10 reduction of CMV viral load mostly occurred between a median of 5 to 6 and 12 to 16 days, respectively. The licensed dosages achieved a probability of reaching the viral load target ≥90% at days 35 to 49 and 42 to 56 for the thresholds of ≤290 and ≤137 IU/mL, respectively. Simulations indicate that in patients with an estimated glomerular filtration rate of 10 to 24 mL/min/1.73m2, a dose increase to 450 mg every 36 h may reduce time to optimal viral load target to days 42 and 49 from a previous time of 49 and 56 days for the thresholds of ≤290 and ≤137 IU/mL, respectively. Currently licensed dosages of valganciclovir for preemptive therapy of CMV infection may achieve a viral load reduction within the first 2 weeks, but treatment should continue for ≥35 days to ensure viral load suppression.
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Affiliation(s)
- Pier Giorgio Cojutti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Aaron J. Heffernan
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Thomas Tängdén
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Paola Della Siega
- Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
| | - Carlo Tascini
- Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
| | - Jason A. Roberts
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Pharmacy, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
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Selby PR, Heffernan AJ, Yeung D, Warner MS, Peake SL, Hahn U, Wallis SC, Mcwhinney B, Ungerer JPJ, Shakib S, Roberts JA. Population Pharmacokinetics of Ganciclovir in Allogeneic Hematopoietic Stem Cell Transplant Patients. Antimicrob Agents Chemother 2023; 67:e0155022. [PMID: 36815858 PMCID: PMC10019199 DOI: 10.1128/aac.01550-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023] Open
Abstract
Treatment of cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell transplantation (alloHCT) patients with ganciclovir is complicated by toxicity and resistance. This study aimed to develop an intravenous ganciclovir population pharmacokinetic model for post-alloHCT patients and to determine dosing regimens likely to achieve suggested therapeutic exposure targets. We performed a prospective observational single-center pharmacokinetic study in adult alloHCT patients requiring treatment with intravenous ganciclovir for CMV viremia or disease. Samples were analyzed using a validated ultraperformance liquid chromatography method. Population pharmacokinetic analysis and Monte Carlo simulations (n = 1000) were performed using Pmetrics for R. Twenty patients aged 18 to 69 years were included in the study. A 2-compartment model with linear elimination from the central compartment and between occasion variability best described the data. Incorporating creatinine clearance (CLCR) estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and presence of continuous renal replacement therapy as covariates for ganciclovir clearance improved the model. Compared to current dosing recommendations, simulations demonstrated loading doses were required to achieve a target AUC24 of 80 to 120 mg.h/L on day 1 of induction therapy. Increased individualization of post-loading induction and maintenance doses based on CLCR is required to achieve the suggested exposures for efficacy (AUC24 >80/>40 mg.h/L for induction/maintenance) while remaining below the exposure thresholds for toxicity (AUC24 <120/<60 mg.h/L for induction/maintenance). Intravenous ganciclovir dosing in alloHCT patients can be guided by CLCR estimated by CKD-EPI. Incorporation of loading doses into induction dosing regimens should be considered for timely achievement of currently suggested exposures.
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Affiliation(s)
- Philip R. Selby
- School of Medicine, University of Adelaide, Adelaide, Australia
- Pharmacy Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Aaron J. Heffernan
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David Yeung
- School of Medicine, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Haematology Unit, Royal Adelaide Hospital, Adelaide, Australia
- Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Morgyn S. Warner
- School of Medicine, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Sandra L. Peake
- School of Medicine, University of Adelaide, Adelaide, Australia
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Uwe Hahn
- School of Medicine, University of Adelaide, Adelaide, Australia
- SA Pathology, Adelaide, Australia
- Haematology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Steven C. Wallis
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Brett Mcwhinney
- Pathology Queensland, Queensland Health, Brisbane, Australia
| | - Jacobus P. J. Ungerer
- Pathology Queensland, Queensland Health, Brisbane, Australia
- Faculty of Health and Behavioural Science, University of Queensland, Brisbane, Australia
| | - Sepehr Shakib
- School of Medicine, University of Adelaide, Adelaide, Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia
| | - Jason A. Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Queensland, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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