Impact of administration of vancomycin or linezolid to critically ill patients with impaired renal function.

The aim of this study was to assess the impact of vancomycin (VAN) versus linezolid (LZD) on renal function in patients with renal failure (RF) admitted to intensive care units. This was a multicenter, retrospective, comparative cohort study. Renal failure patients were treated with VAN or LZD for proven or suspected infections by multiresistant Gram-positive cocci. Changes in plasma creatinine levels and creatinine clearance at the start and end of treatment were used as endpoints. A total of 147 patients were treated with VAN (group A, n = 68) or LZD (group B, n = 79). Group B included more patients with diabetes mellitus [9 (13.2%) vs. 25 (31.6%); p = 0.007], septic shock [39 (57.4%) vs. 60 (75.9%); p = 0.013] and greater RF (mean ClCr 42.24 ml/min vs. 37.57 ml/min; p = 0.04). Renal function improved in patients from both groups who did not require renal replacement therapy. A greater improvement was seen in group B [percent decrease in Cr (27.94 vs. 9.48; p = 0.02) and percent increase in ClCr (95.96 vs. 55.06; p = 0.05)]. In group A, nine patients (13.2%) experienced an antibiotic-related increase in RF, and antibiotic was discontinued in five patients due to adverse effects. It is reasonable to avoid use of VAN in critically ill patients with acute renal failure.

[Summary of the GEIPC-SEIMC and GTEI-SEMICYUC recommendations for the treatment of infections caused by gram positive cocci in critical patients]. / Resumen de las recomendaciones GEIPC-SEIMC y GTEI-SEMICYUC para el tratamiento antibiótico de infecciones por cocos gram positivos en la paciente crítico

OBJECTIVE: In recent years there has been an increase in infections caused by gram-positive cocci in critical patients, together with a rapid development of resistance to the antibiotics which are normally used to treat them. The objective is to prepare an antibiotic treatment guide for the most common infections caused by gram positive cocci in critical patients. This guide will help in the decision-making process regarding the care of such patients. METHOD: Experts from two scientific societies worked together to prepare a consensus document. They were members of the Study Group on Infections in Critical Patients (GEIPC), which is part of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and the Infectious Diseases Working Group (GTEI), belonging to the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). There was a systematic review of the literature published up to September 2006 regarding this type of infections and the antibiotic treatments marketed to that date. An evidence grading system was applied according to the strength of the recommendation (categories A, B or C) and the level of evidence (categories I, II or III). Recommendations were given if there was consensus among the experts from both societies. RESULTS: The antibiotic regimens recommended for treating infections caused by gram-positive cocci were presented in the form of tables, showing the recommendation grade. Alternatives were given for allergic patients. The scientific basis supporting the aforementioned recommendations is explained within the text and the references upon which they are based are cited. CONCLUSIONS: A summary of an evidence-based practical guide for the treatment of infections caused by gram-positive cocci in critical patients is presented.

[Antibiotic policy in critical patients]. / Política de antibióticos en pacientes críticos.

The combination of guidelines and strategies developed to improve and optimize the use of antimicrobials receives the name of antibiotic policy. Critical patients admitted to the Intensive Medicine Services have special characteristics (severity, pathogen agents, organ and/or system disorders) that justify the use of antibiotics differentially than for other hospitalized patients. The influence and impact of the antibiotics are observed in the patients who receive them (clinical response, course) and in the ecosystem surrounding the patient (hospital flora). This impact is especially visible in the critical patients in the endemic flora of the ICU. This article describes a combination of guidelines (guideline decalogue) and strategies (therapeutic de-escalation, cycling of antibiotics, preemptive treatment and pharmacokinetic/pharmacodynamic parameters) that have been applied and developed in the critical patients to optimize the use of the antimicrobials in order to achieve the maximum effectivity and minimum morbidity.

[Use of antibiotics for the treatment of multiresistant gram positive cocci infections in critical patients]. / Utilización de antibióticos en el tratamiento de infecciones por cocos grampositivos multirresistentes en pacientes críticos.

INTRODUCTION: This study has been designed to know the use of these antibiotics (ATB) in Intensive Care Units (ICUs). DESIGN AND PATIENTS: A multicentric, prospective, observational study was conducted. In cluded as cases were the indications of vancomycin (VAN), teicoplanin (TPN), quinupristin/dalfopristin (Q/D) and linezolid (LZD). RESULTS: A total of 826 indications (VAN 52.1%, TPN 36.6%, LZD 11.6% and Q/D 0%) were analyzed, 793 (96%) as treatment and 33 (4%) as prophylaxis in 818 patients. Serious sepsis or septic should occurred in 55.9% of the patients treated. The most common infections were pneumonia and catheter-related bacteremia, 48.3% of all the infections being acquired in ICUs. LZD was used mostly in mechanical-ventilation related pneumonia (p = 0.001), VAN in community Central Nervous System infections (p = 0.01) and in catheter-related bacteremia (p = 0.001), TPN in community pneumonia (p = 0.01) and in catheter-related bacteremia (p = 0.001). Treatments were empirical in 65.8% and diagnosis of gram positive cocci was confirmed in 48.3% of them. Staphylococcus aureus was isolated more in the LZD-treated group. Initial treatment was modified 224 times, this occurring more frequently in the VAN-treated group. The reason for this change was clinical failure 59 times, this being more frequent in the TPN group and less frequent in the patients treated with LZD, which was the drug used the most in rescue therapies (43/69, 62.3%). Adverse events, probably related to the ATB, were identified in 36/826 (4.4%) cases. CONCLUSIONS: The most common use of this ATB was to treat ICU-acquired infections. VAN was the most frequently used drug. Treatments with LZD were modified less frequently for clinical failure and this drug was the one most used in rescue therapies. This information indicates an appropriate use of these ATB in an important percentage of critically patients.

[GEIPC-SEIMC and GTEI-SEMICYUC recommendations for antibiotic treatment of gram positive coccal infections in the critical patient]. / Recomendaciones GEIPC-SEIMC y GTEI-SEMICYUC para el tratamiento antibiótico de infecciones por cocos grampositivos en el paciente crítico.

In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Critico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.

Política de antibióticos en pacientes críticos / Antibiotic policy in critical patients

El conjunto de normas y estrategias desarrolladas para mejorar y optimizar el empleo de los antimicrobianos recibe el nombre de política de antibióticos. Los pacientes críticos ingresados en servicios de medicina intensiva presentan unas características especiales (gravedad, agentes patógenos, alteración de órganos o sistemas) que justifican el empleo de los antibióticos de forma diferencial al de otros pacientes hospitalizados. La influencia y el impacto de los antibióticos se observa en los pacientes que los reciben (respuesta clínica, evolución) y en el ecosistema que rodea al paciente (flora hospitalaria). Este impacto es especialmente visible en los pacientes críticos y en la flora endémica de las unidades de cuidados intensivos. En este artículo se describe un conjunto de normas (decálogo de normas) y estrategias (desescalada terapéutica, ciclado de antibióticos, tratamiento anticipado y parámetros farmacocinéticos/farmacodinámicos) que se han aplicado y desarrollado en los pacientes críticos para optimizar el empleo de los antimicrobianos con el objetivo de conseguir la máxima efectividad y la mínima morbilidad (AU)

The combination of guidelines and strategies developed to improve and optimize the use of antimicrobials receives the name of antibiotic policy. Critical patients admitted to the Intensive Medicine Services have special characteristics (severity, pathogen agents, organ and/or system disorders) that justify the use of antibiotics differentially than for other hospitalized patients. The influence and impact of the antibiotics are observed in the patients who receive them (clinical response, course) and in the ecosystem surrounding the patient (hospital flora). This impact is especially visible in the critical patients in the endemic flora of the ICU. This article describes a combination of guidelines (guideline decalogue) and strategies (therapeutic de-escalation, cycling of antibiotics, preemptive treatment and pharmacokinetic/pharmacodynamic parameters) that have been applied and developed in the critical patients to optimize the use of the antimicrobials in order to achieve the maximum effectivity and minimum morbidity (AU)

Utilización de antibióticos en el tratamiento de infecciones por cocos grampositivos multirresistentes en pacientes críticos / Use of antibiotics for the treatment of multiresistant gram positive cocci infections in critical patients

Introducción. Este estudio se ha diseñado paraconocer el uso de antibióticos (ATB) específicosfrente a cocos grampositivos multirresistentes enCuidados Intensivos.Diseño y pacientes. Estudio observacional, prospectivo y multicéntrico. Se incluyeron como casos las indicaciones de vancomicina (VAN), teicoplanina (TPN), quimipristina/dalfopristina (Q/D) y linezolid (LZD).Resultados. Se analizaron 826 indicaciones (VAN 52,1%; TPN 36,6%; LZD 11,6% y Q/D 0%), 793 (96%) como tratamiento y 33 (4%) como profilaxis en 818 pacientes. El 55,9% de las infecciones se presentaron con sepsis grave o shock séptico. Las más frecuentes fueron neumonías y bacteriemias relacionadas con catéter, y el48,3% fueron adquiridas en la Unidad de Cuidados Intensivos (UCI). LZD fue más utilizado en neumonías relacionadas con ventilación mecánica (p = 0,001), VAN en infecciones del sistema nervioso central (p = 0,01) y en bacteriemias relacionadas con catéter (p = 0,001) y TPN en neumonías comunitarias (p = 0,01) y en bacteriemias relacionadas con catéter (p = 0,001). El 65,8% de los tratamientos fueron empíricos. Staphylo cocus aureus resistente a meticilina fue el más aisladoen el grupo de pacientes tratados con LZD.El tratamiento inicial se modificó en 224 ocasiones,circunstancia más frecuente en tratados con VAN. El motivo de esta modificación fue por fracaso clínico en 59 ocasiones, siendo más frecuente en el grupo tratado con TPN y menos en el tratado con LZD, que además fue el fármaco más utilizado en los tratamientos de rescate(43/69, 62,3%). Se han identificado efectos adversosprobablemente relacionados con los ATB en 36/826 (4,4%) casos.Conclusiones. Las indicaciones más frecuentesfueron para tratar infecciones adquiridas en laUCI. VAN fue el fármaco más utilizado. El tratamientocon LZD se modificó en menos ocasiones por fracaso clínico y fue el más empleado como tratamiento de rescate. El conjunto de la información muestra un empleo adecuado de estos ATB en un importante porcentaje de pacientes críticos

Introduction. This study has been designed toknow the use of these antibiotics (ATB) in Intensive Care Units (ICUs).Design and patients. A multicentric, prospective,observational study was conducted. Included as cases were the indications of vancomycin(VAN), teicoplanin (TPN), quinupristin/dalfopristin (Q/D) and linezolid (LZD).Results. A total of 826 indications (VAN 52.1%,TPN 36.6%, LZD 11.6% and Q/D 0%) were analyzed,793 (96%) as treatment and 33 (4%) as prophylaxis in 818 patients. Serious sepsis or septic should occurred in 55.9% of the patients treated.The most common infections were pneumonia and catheter- related bacteremia, 48.3% of all the infections being acquired in ICUs. LZD was used mostly in mechanical-ventilation related pneumonia (p = 0.001), VAN in community Central Nervous System infections (p = 0.01) and in catheter-related bacteremia (p = 0.001), TPN in community pneumonia (p = 0.01) and in catheter-related bacteremia (p = 0.001). Treatments were empirical in65.8% and diagnosis of gram positive cocci wasconfirmed in 48.3% of them. Staphylococcus aureuswas isolated more in the LZD-treated group.Initial treatment was modified 224 times, this occurringmore frequently in the VAN-treated group.The reason for this change was clinical failure 59times, this being more frequent in the TPN groupand less frequent in the patients treated with LZD,which was the drug used the most in rescue therapies(43/69, 62.3%). Adverse events, probably relatedto the ATB, were identified in 36/826 (4.4%)cases.Conclusions. The most common use of this ATBwas to treat ICU-acquired infections. VAN was themost frequently used drug. Treatments with LZDwere modified less frequently for clinical failureand this drug was the one most used in rescuetherapies. This information indicates an appropriateuse of these ATB in an important percentageof critically patients

Recomendaciones GEIPC-SEIMC y GTEI-SEMICYUC para el tratamiento antibiótico de infecciones por cocos grampositivos en el paciente crítico / GEIPC-SEIMC and GTEI-SEMICYUC recommendations for antibiotic treatment of gram positive coccal infections in the critical patient

En los últimos años se ha constatado un incremento en las infecciones causadas por cocos grampositivos tanto en infecciones comunitarias como nosocomiales. En algunos países, se ha observado un rápido desarrollo de resistencias a los antibióticos habitualmente empleados para su tratamiento, y se supone que esa situación puede llegar en el futuro a nuestro país. Se están desarrollando nuevos antimicrobianos específicamente dirigidos para el tratamiento de estas infecciones, pero es necesario profundizar en el conocimiento de las propiedades farmacocinéticas de los antibióticos tanto antiguos como nuevos, para aprovechar al máximo sus cualidades frente a estos patógenos y evitar en lo posible su toxicidad. En el paciente crítico estos problemas son más acuciantes, ya que la inadecuación del tratamiento, tanto en la elección del antibiótico como en la dosis y en la administración, se acompañan frecuentemente de fracasos terapéuticos y por tanto de mal pronóstico. Expertos de dos grupos de trabajo de dos Sociedades científicas, pertenecientes al Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC (GEIPC-SEIMC) y al Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC (GTEI- SEMICYUC) se han reunido con el objetivo de elaborar un documento de consenso, basado en la evidencia científica, que recoge las recomendaciones para el tratamiento antibiótico de las infecciones graves causadas por cocos grampositivos en el paciente crítico y que ayude en la toma de decisiones asistenciales

In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Critico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients

Recomendaciones GEIPC-SEIMC y GTEI-SEMICYUC para el tratamiento antibiótico de infecciones por cocos grampositivos en el paciente crítico / GEIPC-SEIMC and GTEI-SEMICYUC recommendations for antibiotic treatment of gram positive coccal infections in the critical patient

En los últimos años se ha constatado un incremento en las infecciones causadas por cocos grampositivos tanto en infecciones comunitarias como nosocomiales. En algunos países, se ha observado un rápido desarrollo de resistencias a los antibióticos habitualmente empleados para su tratamiento, y se supone que esa situación puede llegar en el futuro a nuestro país. Se están desarrollando nuevos antimicrobianos específicamente dirigidos para el tratamiento de estas infecciones, pero es necesario profundizar en el conocimiento de las propiedades farmacocinéticas de los antibióticos tanto antiguos como nuevos, para aprovechar al máximo sus cualidades frente a estos patógenos y evitar en lo posible su toxicidad. En el paciente crítico estos problemas son más acuciantes, ya que la inadecuación del tratamiento, tanto en la elección del antibiótico como en la dosis y en la administración, se acompañan frecuentemente de fracasos terapéuticos y por tanto de mal pronóstico. Expertos de dos grupos de trabajo de dos Sociedades científicas, pertenecientes al Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC (GEIPC-SEIMC) y al Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC (GTEI-SEMICYUC) se han reunido con el objetivo de elaborar un documento de consenso, basado en la evidencia científica, que recoge las recomendaciones para el tratamiento antibiótico de las infecciones graves causadas por cocos grampositivos en el paciente crítico y que ayude en la toma de decisiones asistenciales (AU)

In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired-infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients (AU)

Resumen de las recomendaciones GEIPC-SEIMC y GTEISEMICYUC para el tratamiento antibiótico de infecciones por cocos gram positivos en el paciente crítico / No disponible

Objetivo: En los últimos años se ha constatado un incremento en las infecciones causadas por cocos gram positivos en pacientes críticos, junto a un rápido desarrollo de resistencias a los antibióticos habitualmente empleados para su tratamiento. El objetivo es elaborar una guía de tratamiento antibiótico de las infecciones más frecuentes causadas por cocos gram positivos en pacientes críticos, que ayude a la toma de decisiones asistenciales.Método: Expertos de dos grupos de trabajo de dos sociedades científicas, pertenecientes al Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC (GEIPC-SEIMC) y al Grupo de Trabajo de Enfermedades Infecciosas de la SEMICYUC (GTEI-SEMICYUC),se reunieron con el objetivo de elaborar un documento de consenso. Se hizo una revisión sistemática de la literatura publicada hasta septiembre de 2006 referida a estas infecciones, y con los tratamientos antibióticos comercializados hasta entonces. Se aplicó un sistema de graduación de la evidencia según la fuerza de la recomendación (categorías A, B o C) y el grado de evidencia (categorías I, II o III). Se realizaron las recomendaciones por consenso entre los expertos de ambas sociedades.Resultados: Se presentan en forma de tablas las pautas antibióticas recomendadas para el tratamiento de las infecciones causadas por cocos gram positivos, reflejando el grado de recomendación. Se expresan las alternativas para el caso de pacientes alérgicos. En el texto se razona la base científica sobre la que se sustentan dichas recomendaciones citando las referencias en las que se apoyan.Conclusiones: Se presenta el resumen de una guía práctica, basada en la evidencia, para el tratamiento antibiótico de infecciones por cocos gram positivos en el paciente crítico

Objective: In recent years there has been an increase in infections caused by gram-positive cocci in critical patients, together with a rapid development of resistance to the antibiotics which arenormally used to treat them. The objective is to prepare an antibiotic treatment guide for the most common infections caused bygram positive cocci in critical patients. This guide will help in the decision-making process regarding the care of such patients.Method: Experts from two scientific societies worked together to prepare a consensus document. They were members of the Study Group on Infections in Critical Patients (GEIPC), which is part of the Spanish Society of Infectious Diseases and Clinical Microbiology(SEIMC), and the Infectious Diseases Working Group (GTEI), belonging to the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). There was a systematic review of the literature published up to September 2006 regarding this type of infections and the antibiotic treatments marketed to that date. An evidence grading system was applied according to the strength of the recommendation (categories A, B or C) and the level of evidence (categories I, II or III). Recommendations were given if there was consensus among the experts from both societies.Results: The antibiotic regimens recommended for treatinginfections caused by gram-positive cocci were presented in the form of tables, showing the recommendation grade. Alternatives were given for allergic patients. The scientific basis supporting the aforementioned recommendations is explained within the text and the references upon which they are based are cited.Conclusions: A summary of an evidence-based practicalguide for the treatment of infections caused by gram-positive cocci in critical patients is presented