Risk factors for target non-attainment during empirical treatment with β-lactam antibiotics in critically ill patients

PURPOSE

Risk factors for β-lactam antibiotic underdosing in critically ill patients have not been described in large-scale studies. The objective of this study was to describe pharmacokinetic/pharmacodynamic (PK/PD) target non-attainment envisioning empirical dosing in critically ill patients and considering a worst-case scenario as well as to identify patient characteristics that are associated with target non-attainment.

METHODS

This analysis uses data from the DALI study, a prospective, multi-centre pharmacokinetic point-prevalence study. For this analysis, we assumed that these were the concentrations that would be reached during empirical dosing, and calculated target attainment using a hypothetical target minimum inhibitory concentration (MIC), namely the susceptibility breakpoint of the least susceptible organism for which that antibiotic is commonly used. PK/PD targets were free drug concentration maintained above the MIC of the suspected pathogen for at least 50 % and 100 % of the dosing interval respectively (50 % and 100 % f T (>MIC)). Multivariable analysis was performed to identify factors associated with inadequate antibiotic exposure.

RESULTS

A total of 343 critically ill patients receiving eight different β-lactam antibiotics were included. The median (interquartile range) age was 60 (47-73) years, APACHE II score was 18 (13-24). In the hypothetical situation of empirical dosing, antibiotic concentrations remained below the MIC during 50 % and 100 % of the dosing interval in 66 (19.2 %) and 142 (41.4 %) patients respectively. The use of intermittent infusion was significantly associated with increased risk of non-attainment for both targets; creatinine clearance was independently associated with not reaching the 100 % f T( >MIC) target.

CONCLUSIONS

This study found that-in empirical dosing and considering a worst--case scenario--19 % and 41 % of the patients would not achieve antibiotic concentrations above the MIC during 50 % and 100 % of the dosing interval. The use of intermittent infusion (compared to extended and continuous infusion) was the main determinant of non-attainment for both targets; increasing creatinine clearance was also associated with not attaining concentrations above the MIC for the whole dosing interval. In the light of this study from 68 ICUs across ten countries, we believe current empiric dosing recommendations for ICU patients are inadequate to effectively cover a broad range of susceptible organisms and need to be reconsidered.

Effect of gating and pressure on the electronic transport properties of crossed nanotube junctions: formation of a Schottky barrier

The electronic transport properties of crossed carbon nanotube junctions are investigated using ab initio methods. The optimal atomic structures and the intertube distances of the junctions are obtained using van der Waals corrected density functional theory. The effect of gating on the intertube conductance of the junctions is explored, showing the charge accumulation to the nanotube contact and the charge depletion region at the metal-semiconductor Schottky contact. Finally, it is shown how the conductance of the junctions under the gate voltage is affected by pressure applied to the nanotube film.

Structures of thermal double donors in silicon

Accurate total-energy calculations are used to study the structures and formation energies of oxygen chains as models for thermal double donors (TDD's) in Si. We find that the first three TDD's (TDD0-TDD2) consist of one four-member ring, with one or two adjacent interstitial O atoms. These metastable TDD's form bistable negative-U systems with the corresponding stable, electrically inactive staggered structures. The TDD3-TDD7 structures are found to consist of four-member rings with adjacent interstitial O atoms at both ends. The TDD's with a central "di-Y-lid" core are found to become energetically competitive with the four-member ring TDD's only for clusters larger than ten O atoms.