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Healthcare (Basel, Switzerland) Jun 2024Prescribers often face the challenge of predicting creatinine clearance (CrCl) in elderly patients who are 65 years or older and have serum creatinine (SCr)...
Prescribers often face the challenge of predicting creatinine clearance (CrCl) in elderly patients who are 65 years or older and have serum creatinine (SCr) concentrations below 1 mg/dL. Studies have shown that utilizing rounded SCr would underestimate CrCl in this population, which could lead to the under-dosing of some medications like vancomycin. The current study aimed to compare the accuracy of vancomycin dosing using actual SCr versus rounded SCr to 1 mg/dL in elderly patients. A total of 245 patients were included. The therapeutic trough level (10-20 mg/L) was achieved in 138 (56.3%) patients using actual SCr. Sub-therapeutic (<10 mg/L) and supra-therapeutic (>20 mg/L) trough levels were observed in 32 (13.1%) and 75 (30.6%) patients, respectively. The predictive performance of different vancomycin doses based on actual SCr and rounded SCr compared to the targeted maintenance dose (TMD) showed a stronger correlation of dosing based on actual SCr with TMD (r = 0.55 vs. 0.31) compared to rounded SCr dosing; both doses showed similar precision, with ranges of ±552 mg/day for the dosing based on actual SCr and ±691 mg/day for the dosing based on rounded SCr. Furthermore, the dosing based on actual SCr showed a lower error percentage (69%) and a higher accuracy rate (57.6%) within ±10% of the TMD compared to the dosing based on rounded SCr, which had an error percentage of (92.3%) and an accuracy rate of (40%). The prevalence of vancomycin-associated nephrotoxicity (VAN) was seen in 44 (18%) patients. Patients between 75 and 84 years of age, those who were bedridden, and those with vancomycin trough concentrations greater than 20 mg/L had a higher risk of developing VAN. In conclusion, in elderly patients, estimating vancomycin dosing based on actual SCr was more accurate compared to rounded SCr to 1 mg/dL. The efficacy of vancomycin could be negatively affected by rounding up SCr, which could underestimate CrCl and result in the under-dosing of vancomycin.
PubMed: 38891219
DOI: 10.3390/healthcare12111144 -
Journal of Orthopaedic Surgery and... Jun 2024Periprosthetic joint infection after total joint arthroplasty has a large incidence, and it may often require two or more stages of revision, placing an additional... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Periprosthetic joint infection after total joint arthroplasty has a large incidence, and it may often require two or more stages of revision, placing an additional burden on clinicians and patients. The purpose of this network meta-analysis is to evaluate the effect of four different preventive strategies during total joint arthroplasty on the prevention of periprosthetic joint infection.
METHODS
The study protocol was registered at PROSPERO (CRD: 42,023,448,868), and the literature search databases included Web of Science, PubMed, OVID Cochrane Central Register of Controlled Trials, OVID EMBASE, and OVID MEDLINE (R) ALL that met the requirements. The network meta-analysis included randomized controlled trials, retrospective cohort studies and prospective cohort studies with the outcome of periprosthetic joint infection. The gemtc R package was applied to perform the network meta-analysis to evaluate the relative results of different preventive strategies.
RESULTS
This network meta-analysis study included a total of 38 articles with 4 preventive strategies and negative controls. No improvement was observed in antibiotic-loaded bone cement compared with negative controls. Chlorhexidine showed the highest probability of delivering the best preventive effect, and povidone iodine had the second highest probability. Although vancomycin ranked after chlorhexidine and povidone iodine, it still showed a significant difference compared with negative controls. In addition, the incidence after applying chlorhexidine was significantly lower than that after applying negative controls and vancomycin. In the heterogeneity test between direct and indirect evidence, there was no apparent heterogeneity between them.
CONCLUSION
The study indicated that chlorhexidine, povidone iodine and vancomycin showed significant efficacy in preventing periprosthetic joint infection after total joint arthroplasty, while antibiotic-loaded bone cement did not. Therefore, more high-quality randomized controlled trials are needed to verify the results above.
Topics: Humans; Prosthesis-Related Infections; Network Meta-Analysis; Anti-Bacterial Agents; Arthroplasty, Replacement; Vancomycin; Bone Cements; Chlorhexidine; Povidone-Iodine; Randomized Controlled Trials as Topic
PubMed: 38890743
DOI: 10.1186/s13018-024-04738-4 -
Clinical Kidney Journal Apr 2024Vancomycin is a widely used glycopeptide antibiotic with the need for therapeutic drug monitoring to avoid renal toxicity. We report a case of severe...
Vancomycin is a widely used glycopeptide antibiotic with the need for therapeutic drug monitoring to avoid renal toxicity. We report a case of severe vancomycin-associated anuric acute kidney injury managed with successful drug-removal by hemodialysis (HD) using different types of dialyzers. Medium cut-off (MCO) and high-flux dialyzers were effective in drug removal. Higher vancomycin elimination rate and lower plasma half-life were achieved with MCO dialyzer despite low-flow vascular access and intolerance to ultrafiltration. MCO dialyzers may be reasonable for drug removal in patients with intolerance of ultrafiltration, low-flow vascular access or impracticality of hemodiafiltration. Future studies should explore the use of MCO dialyzers in comparison with high-flux HD and hemodiafiltration in both the acute and chronic setting.
PubMed: 38887428
DOI: 10.1093/ckj/sfae063 -
Cureus May 2024Introduction Antimicrobial resistance poses a significant global healthcare challenge in the management of bacterial infections, which is frequently attributed to rapid...
Introduction Antimicrobial resistance poses a significant global healthcare challenge in the management of bacterial infections, which is frequently attributed to rapid bacterial adaptations. This study aims to develop an antibiogram for a tertiary care hospital, providing comprehensive antibiotic sensitivity profiles for Gram-positive and Gram-negative bacteria. It informs healthcare providers of antibiotic resistance trends, enabling informed treatment decisions and enhanced infection control measures. Methods We conducted a six-month prospective observational study, during which we gathered and analyzed data from the microbiology laboratory to identify patterns of antimicrobial sensitivity. Subsequently, the data underwent analysis and interpretation using the respected WHONET software, a readily available tool designed for this specific task. Our methodology adhered to the guidelines established by the Clinical & Laboratory Standards Institute for the standardization of antibiogram generation procedures, and these guidelines are easily integrated into the WHONET software for analytical purposes. Results There were a total of 357 isolates across various hospital departments, comprising 13 distinct bacterial species. Among them, nine were identified as Gram-negative bacteria, accounting for 262 (73.3%) isolates. accounted for 131 (36.6%) isolates, while accounted for 62 (17.3%), emerging as the predominant species among them. The remaining four bacterial species were identified as Gram-positive bacteria, totaling 95 (26.6%) isolates, with being the most frequently isolated species at 51 (14.2%), followed by at 26 (7.2%). Subsequent analysis using the WHONET software facilitated the creation of an antibiogram. Among the Gram-negative bacteria, displayed high sensitivity (100%) to aztreonam and clindamycin, followed by nitrofurantoin (98%), imipenem (94%), and meropenem (95%). However, it exhibited decreased sensitivity to ampicillin (25%), cefuroxime (34%), and ceftriaxone (39%). Conversely, among the Gram-positive bacteria, demonstrated 100% sensitivity to ampicillin, amoxiclav, cefazolin, teicoplanin, linezolid, rifampicin, nitrofurantoin, and cefotaxime. However, it exhibited zero sensitivity to vancomycin and only 6% sensitivity to cotrimoxazole. Conclusion This study advances the understanding of antibiotic susceptibility in a tertiary care setting and provides an invaluable tool for optimizing treatment strategies, enhancing infection control measures, and combating antibiotic resistance.
PubMed: 38887355
DOI: 10.7759/cureus.60542 -
Annals of Clinical Microbiology and... Jun 2024Necrotizing tracheobronchitis is a rare clinical entity presented as a necrotic inflammation involving the mainstem trachea and distal bronchi. We reported a case of...
PURPOSE AND METHOD
Necrotizing tracheobronchitis is a rare clinical entity presented as a necrotic inflammation involving the mainstem trachea and distal bronchi. We reported a case of severe necrotizing tracheobronchitis caused by influenza B and methicillin-resistant Staphylococcus aureus (MRSA) co-infection in an immunocompetent patient.
CASE PRESENTATION
We described a 36-year-old man with initial symptoms of cough, rigors, muscle soreness and fever. His status rapidly deteriorated two days later and he was intubated. Bronchoscopy demonstrated severe necrotizing tracheobronchitis, and CT imaging demonstrated multiple patchy and cavitation formation in both lungs. Next-generation sequencing (NGS) and bronchoalveolar lavage fluid (BALF) culture supported the co-infection of influenza B and MRSA. We also found T lymphocyte and NK lymphocyte functions were extremely suppressed during illness exacerbation. The patient was treated with antivirals and antibiotics including vancomycin. Subsequent bronchoscopy and CT scans revealed significant improvement of the airway and pulmonary lesions, and the lymphocyte functions were restored. Finally, this patient was discharged successfully.
CONCLUSION
Necrotizing tracheobronchitis should be suspected in patients with rapid deterioration after influenza B infection. The timely diagnosis of co-infection and accurate antibiotics are important to effective treatment.
Topics: Humans; Male; Methicillin-Resistant Staphylococcus aureus; Coinfection; Influenza, Human; Adult; Staphylococcal Infections; Bronchitis; Anti-Bacterial Agents; Tracheitis; Influenza B virus; Bronchoscopy; Necrosis; Tomography, X-Ray Computed; Bronchoalveolar Lavage Fluid; Antiviral Agents
PubMed: 38886754
DOI: 10.1186/s12941-024-00715-1 -
American Journal of Translational... 2024To investigate the prevalence, antimicrobial susceptibility, and the effects on pregnancy and neonatal outcomes of Group A Streptococcal (GAS) infections in the vagina...
OBJECTIVE
To investigate the prevalence, antimicrobial susceptibility, and the effects on pregnancy and neonatal outcomes of Group A Streptococcal (GAS) infections in the vagina of perinatal women.
METHODS
From June 2020 to October 2022, 270 perinatal pregnant women underwent vaginal swabs for GAS culture. The antibiotic sensitivity of the positive strains was assessed. Based on GAS detection results, the patients were divided into an observation group (GAS positive) and a control group (GAS negative). Clinical data from both groups were collected to compare the vaginal microecological changes. The adverse outcomes for pregnancy and infants in both groups were retrospectively analyzed. Univariate and multivariate analyses were used to identify the risk factors for adverse outcomes.
RESULTS
Among the 270 pregnant women, 30 tested positive for GAS and 240 tested negative, with a colonization rate of 11.1%. No resistance to penicillin, ampicillin, linezolid, vancomycin, or tigecycline was found among the GAS strains. The resistance rates to tetracycline and clindamycin were 73.3% and 70.0%, respectively. Higher vaginal pH (≥4.5), and increased incidences of bacterial vaginitis, aerobic vaginitis, and microecological imbalances were observed in the observation group compared to the control group (all P<0.05). The observation group also experienced more adverse pregnancy and infant outcomes, such as chorioamnionitis, postpartum infections, fetal distress, and neonatal pneumonia (all P<0.05). Univariate and multivariate analyses indicated that a vaginal pH≥4.5 and microecological imbalance were positively associated with poor maternal and infant outcomes in women with GAS infections (all P<0.05).
CONCLUSIONS
The study found no β-lactam resistant GAS strains. Additionally, a higher vaginal pH (≥4.5) and microecological imbalance were linked to an increased risk of adverse pregnancy and infant outcomes in women with GAS infections.
PubMed: 38883355
DOI: 10.62347/ZKIE2772 -
Cureus May 2024Background Cerament V (CV) is a bioactive bone graft substitute with vancomycin as an antimicrobial agent designed for the management of bone defects and infections. In...
Background Cerament V (CV) is a bioactive bone graft substitute with vancomycin as an antimicrobial agent designed for the management of bone defects and infections. In this retrospective case series, we aim to evaluate the clinical outcomes of patients treated with CV for fracture-related infections (FRI). Methods All patients who received treatment for FRI and whose dead space and bone reconstruction management was solely done utilizing CV were included. The patients were recruited between September 2015 and September 2022. Data including patient demographics, primary diagnosis, surgical procedure, antibiotic therapy, microbiological results, complications, and follow-ups were recorded. Outcomes were assessed, including the percentage of bone void filling on radiographs, infection resolution, adverse effects, and patient-reported outcome measures by EQ-5D-5L. Results We present in this retrospective case series seven patients (three female) with a mean age of 56.86 ± 16.27 years. All patients underwent surgical debridement and bone grafting using CV. Antibiotic therapy was tailored to the specific pathogens isolated in each case. Infection eradication was achieved in five patients. On average, new bone formation was 81% at six months and 99% at 12 months. Patient-reported outcome parameters (PROMs) utilizing the EQ-5D-5L questionnaire were recorded at a mean follow-up of 42.00 ± 27.97 months with a median EQ-5D-5L index of 0.541 (range: 0.459 - 0.97) and a mean EQ-5D-Visual Analogue Scale (VAS) score of 62.20 ± 24.68. No major adverse events related to CV were reported. Conclusion This retrospective case series demonstrates the potential efficacy of CV in managing FRIs. The bioactive and antibiotic properties of CV appear to facilitate infection resolution and bone healing, with an advantageous safety profile. Larger prospective studies are needed to further investigate the utility of CV in orthopedic practice.
PubMed: 38883114
DOI: 10.7759/cureus.60390 -
Journal of Pharmacy & Bioallied Sciences Apr 2024Marginal failure at the resin dentin interface promotes biofilm formation, which further leads to secondary caries and hypersensitivity. This likelihood also increases...
BACKGROUND
Marginal failure at the resin dentin interface promotes biofilm formation, which further leads to secondary caries and hypersensitivity. This likelihood also increases if residual bacteria are present following cavity preparation. In order to achieve a proper biological seal without jeopardizing bonding, efforts were made to functionalize the adhesive system with antibacterial activity. Aim and objectives: To appraise the antibacterial activity of a total-etch adhesive system against . mutans with and without incorporation of antibiotics Vancomycin and Cefotaxime.
MATERIALS AND METHOD
A commercially available 5th-generation total-etch bonding agent (Te-Econorm) was used. S. mutans broth had been standardized and streaked over Muller-Hinton agar culture medium and round wells about 6 mm in diameter were made in the centre of the agar plates. Each experimental group comprised 10 samples, which include: Group 1 - 30µg Cefotaxime, Group 2- 30µg Cefotaxime + Bonding agent, Group 3- 30µg Vancomycin, Group 4- 30µg Vancomycin + Bonding agent, Group 5- Bonding agent, and Group 6- No material. Inoculated culture plates were examined for the zone of inhibition after incubation at 37° C for 24 hours.
RESULTS
There was a significant difference in the mean diameter of zone of inhibition (=0.000), with the maximum exhibited by Group 4, followed by Group 3 and Group 2. The least zone of inhibition was exhibited by Groups 1 and 5. The negative control showed no zone of inhibition.
CONCLUSION
The combination of Vancomycin and bonding agent had superior antibacterial activity against S. mutans in comparison to cefotaxime and bonding agent.
PubMed: 38882884
DOI: 10.4103/jpbs.jpbs_1046_23 -
Infection and Drug Resistance 2024The escalating incidence of infective endocarditis (IE) caused by aminoglycoside-resistant Enterococcus is a growing concern for clinicians. This issue is particularly...
The escalating incidence of infective endocarditis (IE) caused by aminoglycoside-resistant Enterococcus is a growing concern for clinicians. This issue is particularly pronounced in elderly patients, who face an elevated risk of renal damage during antibiotic treatment, thereby limiting available pharmacological options. Furthermore, elderly patients often present with multiple comorbidities, leading to heightened mortality rates. In this article, we present a case involving an elderly male patient who sought medical attention on two separate occasions due to inflammation of the lower extremities and lumbosacral pain. Subsequent diagnosis revealed infective endocarditis (IE) caused by high-level gentamicin-resistant through blood culture and echocardiography. The patient also experienced peripheral and cerebral arterial embolism, secondary spine infection, and subsequent heart failure, highlighting the severity of the clinical situation. Following an initial 10-day course of vancomycin and ceftriaxone therapy, the patient developed renal impairment, necessitating a switch to bactericidal therapy with ampicillin in combination with ceftriaxone. Additionally, aortic valve replacement was performed during this period. Ultimately, the patient achieved clinical remission. This case underscores the critical importance of prompt and accurate diagnosis, appropriate antibiotic selection, and timely surgical intervention in enhancing the prognosis of elderly patients with IE.
PubMed: 38882654
DOI: 10.2147/IDR.S448612 -
Medicine Jun 2024Infective endophthalmitis is an ophthalmic infection that in severe cases can cause complete loss of vision. In children, the defense against infection is low and eye... (Observational Study)
Observational Study
Infective endophthalmitis is an ophthalmic infection that in severe cases can cause complete loss of vision. In children, the defense against infection is low and eye tissue is not fully developed, leading to increased vulnerability to endophthalmitis. Children may be unable to understand the symptoms; thus, developing a method for prevention and treatment of this disease in children is important. Therefore, we analyzed the clinical and pathogenic characteristics of infectious endophthalmitis in children and provided evidence for clinical treatment. The clinical data of 78 children (78 eyes) with infectious endophthalmitis were retrospectively analyzed. The clinical characteristics, pathogen distribution, drug sensitivity, clinical medication, and treatments were summarized and analyzed. In total, 74 (94.87%) had ocular infections caused by trauma and 75 (96.15%) were from rural townships. A total of 108 sterile specimens were examined, with a positive detection rate of 37.04%. The sensitivity rates of Gram-positive cocci and bacilli to vancomycin were 100%. The sensitivity rates of Gram-negative bacilli to ceftazidime, piperacillin/tazobactam, amikacin, gentamicin, ciprofloxacin, and levofloxacin were 100%. Of the 78 patients, 53 (67.95%) received intravitreal injection and 54 (69.23%) underwent vitrectomy. Trauma is the main factor leading to infectious endophthalmitis in children, wherein Gram-positive bacteria are the most common pathogens. Thus, a timely understanding of the pathogen and drug sensitivity is needed. Intravitreal injection and vitrectomy are effective treatments.
Topics: Humans; Endophthalmitis; Retrospective Studies; Child; Male; Female; Child, Preschool; Anti-Bacterial Agents; Infant; Eye Infections, Bacterial; Adolescent; Microbial Sensitivity Tests; Vitrectomy; Intravitreal Injections
PubMed: 38875407
DOI: 10.1097/MD.0000000000038456