![]() ![]() Furthermore, linezolid interacts with medications that increase concentrations of serotonin, resulting in rare but sometimes severe cases of serotonin syndrome. One study 35 reported anemia (17.6%), thrombocytopenia (12.8%), and neutropenia (2.0%) associated with linezolid use. Because of frequent myelosuppression, complete blood counts should be monitored for treatment courses > 14 days. This agent is well absorbed orally but considerably more expensive than the older oral antibiotics previously mentioned. ![]() Linezolid is available in both intravenous and oral formulations and is active against aerobic gram-positive organisms, including MRSA and vancomycin-resistant enterococcus. A pooled review 34 of 349 patients with diabetes receiving either linezolid or vancomycin for complicated skin and skin structure infections observed comparable rates of clinical success (74 and 71%, respectively). Linezolid, an oxazolidinone, has been studied in complicated skin and skin structure infections including DFIs. Because it has no demonstrated clinical superiority over other well-established treatment choices, empiric fluoroquinolone therapy should be reserved for β-lactam–allergic patients. For example, one study using moxifloxacin 6 included only 78 DFIs from among 617 patients enrolled in the original study. MSSA strains also have good susceptibility to ceftriaxone, another 3rd. Both studies included patients with DFIs, but these were smaller subsets within larger groups with skin and skin structure infections. In two trials, 6, 7 moxifloxacin monotherapy was shown to be clinically noninferior to a regimen consisting of initial piperacillin-tazobactam therapy with a sequential switch to oral amoxicillin-clavulanate. Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain. For the subset of 54 patients with DFIs, a clinical success rate of 69.2% for levofloxacin and 57.1% for ticarcillin-clavulanate/amoxicillin-clavulanate was observed. 27 compared levofloxacin in the treatment of complicated soft tissue infections to ticarcillin-clavulanate followed by oral amoxicillin-clavulanate. Pseudomonas aeruginosa antimicrobial stewardship bacteremia ceftriaxone critical care.Most of the published fluoroquinolone DFI data have been derived from smaller subsets of patients within larger studies of skin and skin structure infections. Further work is needed to determine the ideal time for critically ill adults to de-escalate from broad-spectrum antibiotics targeting Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing gram-negative pathogens. Age, gender, predicted risk of inpatient mortality and prior use of antibiotics did not predict the growth of cultures after 48 hours.Īmong a cohort of critically ill adults, 13% of respiratory cultures and 15% of blood cultures that ultimately grew GNRs resistant to ceftriaxone did not demonstrate growth until at least 48 hours after collection. At 48 hours, 87% of respiratory cultures and 85% of blood cultures that ultimately grew GNRs resistant to ceftriaxone had demonstrated growth. ![]() A total of 376 blood cultures grew GNRs, of which 70 (18.6%) had resistance to ceftriaxone. ![]() Multivariable logistic regression modeling was used to examine risk factors for the growth of cultures after 48 hours.Ī total of 524 respiratory cultures had growth of GNRs, of which 284 (54.2%) had resistance to ceftriaxone. (Ceftriaxone): Good gram negative coverage except pseudomonas, long half-life (q24 hr dosing), crosses blood-brain barrier, biliary and renal clearance. The primary endpoint was the time-to-positivity of respiratory and blood cultures that ultimately demonstrated growth of GNRs resistant to ceftriaxone. Ceftriaxone has activity in the presence of some beta-lactamases, both penicillinases and cephalosporinases, of Gram-negative and Gram-positive bacteria. We conducted a secondary analysis of data from the Isotonic Solutions and Major Adverse Renal Events Trial: a pragmatic, cluster-randomized, multiple-crossover trial comparing balanced crystalloids versus saline for intravenous fluid administration in 15,802 critically ill adults at 5 intensive care units (ICUs) at Vanderbilt University Medical Center in Nashville, TN, USA. We tested the hypothesis that cultures will identify GNRs that ultimately demonstrate resistance to ceftriaxone within 48 hours, potentially allowing safe de-escalation at this time point. The optimal timing for the de-escalation of broad-spectrum antibiotics with activity against Pseudomonas aeruginosa and resistant Gram-negative rods (GNRs) in critically ill adults remains unknown. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |