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BACKGROUND: Daptomycin is a cyclic lipopeptide antibiotic used to treat serious infectious endocarditis caused by Staphylococcus aureus. The pharmacodynamic parameter correlating best with efficacy is the ratio of the estimated area under the concentration (AUC0-24)-time curve to the minimum inhibitory concentration. The aim of the study is to develop a limited sampling strategy to estimate AUC0-24 using a reduced number of samples. METHODS: Sixty-eight daptomycin AUC0-24 values were calculated for 50 White patients who underwent treatment for at least 5 consecutive days. Plasma concentrations were detected using a validated high-performance liquid chromatography-tandem mass spectrometry analytical method, with daptomycin-d5 as an internal standard. Multiple regression was used to evaluate the ability of 2 concentration-time points to predict the AUC0-24 calculated from the entire pharmacokinetic profile. Prediction bias was calculated as the mean prediction error, whereas prediction precision was estimated as the mean absolute prediction error. The development and validation datasets comprised 40 and 10 randomly selected patients, respectively. RESULTS: The AUC0-24 (mg*h/L) was best estimated using the daptomycin trough concentration and plasma concentrations detected 2 hours after dosing. We calculated a mean prediction error of 1.6 (95% confidence interval, -10.7 to 10.9) and a mean absolute prediction error of 11.8 (95% confidence interval, 5.3-18.3), with 73% of prediction errors within ±15%. CONCLUSIONS: An equation was developed to estimate daptomycin exposure (AUC0-24), offering clinical applicability and utility in generating personalized dosing regimens, especially for individuals at high risk of treatment failure or delayed response.
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Background: Sars-CoV2 can cause severe pneumonia and acute respiratory distress syndrome (ARDS). In COVID-19-associated respiratory failure, lung transplantation might be an option (Bharat A). Case report: A previously healthy 63-year-old man with a nasopharyngeal swab positive for SarsCoV2 and radiological evidence of interstitial lung consolidations developed acute respiratory distress that required intubation and veno-venous extracorporeal membrane oxygenation support (VV ECMO). Because of no recovery of his lung function, he underwent a bilateral lung transplant. ICU stay was complicated by several episodes of bacterial superinfections and an increase of liver function tests (LFTs). Afterward, he faced a progressive clinical worsening associated to severe anemia, further rise of indices of cholestasis, hypertriglyceridemia and hyperferritinemia. Bone marrow smear showed a picture compatible with haemophagocytic lymphohistocytosis (HLH) and first and second line therapy were started. In addition, a transjugular hepatic biopsy was performed with histopathological evidence of portal and periportal fibrosis, compatible with Covid 19-related cholangiopathy. During the hospital stay, he developed several MDR opportunistic infections. The patient died few months later from multiorgan failure secondary to septic shock. A post-mortem confirmed a diagnosis of cholangiopathy, and medullary erythro-haemophagocytosis. Conclusion: Post Covid19 syndrome is a clinical entity that includes novel and old sequelae following recovery from Sars-CoV2 infections. Early identification of these diseases is crucial for adequate management and might influence the long term prognosis of these patients.
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SUMMARY: Introduction. The relationship between Self-compassion and Post-Traumatic Stress Disorder does not appear to be investigated among health professionals, in the period of the ongoing COVID-19 pandemic. This study intends to examine it in a hospital unit, where ordinary units have been converted into units for those infected with the virus. Materials and Methods. The cross-sectional observational study was carried out at a hospital in Central Italy, proposing the self-administration of the IES-R Impact Event Stress-Revised and SCS Self-Compassion Scale to nurses. The data were collected, from 10 January to 10 February 2021, on paper; the forms were handed over to the nursing coordinators, who distributed them to the operators. Results. The convenience sample includes 60 nurses, mainly female (76.7%), with an average age of 43 years (sd = 11.9) and with a presence in service of 14.6 years (sd = 11.7). The average level on the total scale Self-compassion 3.02 (ds = 1.26); the average level of Post-Traumatic Stress Disorder is 2.4 (sd = 0.64); there is a direct correlation between the common Humanity dimension and the intrusive symptoms and the mean total level of PTSD and between the Self-Criticism dimension and the avoidance symptoms. Discussion and Conclusion. The sample shows a good level in the positive dimensions of Self-compassion and low secondary Post-Traumatic Stress Disorder. Further studies, transversal, on specific more representative samples of nurses, and longitudinal, are required to evaluate the relationship between the two variables, even in the period of COVID-19. The acquisition of a personal attitude is recommended, which increases the positive dimension of Self-compassion, for one's personal well-being in the helping profession.
