A high-dose aminoglycoside regimen combined with renal replacement therapy for the treatment of MDR pathogens: a proof-of-concept study

The Journal of Antimicrobial Chemotherapy
Alexandre BrasseurFabio Silvio Taccone

Abstract

Infections caused by MDR Gram-negative (GN) organisms in critically ill patients are a therapeutic challenge. The administration of high-dose aminoglycoside (HDA) therapy coupled with high-flow continuous veno-venous haemodiafiltration (CVVHDF) could allow required high drug peaks to be achieved with acceptable drug elimination. All adult patients present on the ICU between October 2009 and July 2014 who had MDR GN sepsis were considered for HDA and high-flow (>45 mL/kg/h) CVVHDF when an isolated pathogen was susceptible or had intermediate susceptibility to aminoglycosides and the patient's condition was not improving with conventional therapy. Optimal antibacterial activity was defined as a peak concentration of at least eight times the MIC. Fifteen patients infected with MDR GN pathogens (11 with Pseudomonas aeruginosa; 10 with abdominal infections and 5 with respiratory infections) were treated with amikacin (n = 11), gentamicin (n = 3) or tobramycin (n = 1) and high-flow CVVHDF. A favourable clinical response was observed in eight (53%) patients, including three in whom microbial eradication was obtained. Six patients were discharged alive from the ICU, and five from the hospital. No renal toxicity was observed among survi...Continue Reading

References

Jan 1, 1976·Nephron·D W Cockcroft, M H Gault
Jan 1, 1993·Intensive Care Medicine·F KonradM Georgieff
Feb 27, 1999·Antimicrobial Agents and Chemotherapy·A D KashubaJ S Bertino
Apr 12, 2003·Critical Care Medicine·Mitchell M LevyUNKNOWN SCCM/ESICM/ACCP/ATS/SIS
Aug 4, 2004·The Lancet Infectious Diseases·Nasia SafdarDennis G Maki
Feb 20, 2007·International Journal of Antimicrobial Agents·Matthew E Falagas, Ioannis A Bliziotis
Aug 23, 2007·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·George L DrusanoArnold Louie
Sep 1, 2007·Current Opinion in Critical Care·Matthew E Falagas, Petros Kopterides
Dec 25, 2007·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·G Kahlmeter
Dec 6, 2008·Therapeutic Drug Monitoring·Rhonda S ReaHoward Lee
Feb 25, 2009·Critical Care Medicine·Jason A Roberts, Jeffrey Lipman
May 15, 2009·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Joshua D HartzellGlenn Wortmann
Sep 15, 2009·Current Opinion in Pharmacology·Malcolm G P Page, Jutta Heim
Oct 23, 2009·The New England Journal of Medicine·Rinaldo BellomoSteve Su
Apr 8, 2010·Critical Care : the Official Journal of the Critical Care Forum·Fabio Silvio TacconeFrédérique Jacobs
Jul 20, 2010·Critical Care Medicine·Anand KumarUNKNOWN Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group
Sep 9, 2010·Antimicrobial Agents and Chemotherapy·Brice LayeuxFrédérique Jacobs
Apr 15, 2011·Critical Care : the Official Journal of the Critical Care Forum·John R ProwleRinaldo Bellomo
Apr 15, 2011·International Journal of Antimicrobial Agents·Fabio Silvio TacconeFrédérique Jacobs
May 27, 2011·International Journal of Antimicrobial Agents·Ricardo GálvezJosé Castro
Sep 13, 2011·Annals of Intensive Care·Argyris S Michalopoulos, Matthew E Falagas
Jul 28, 2013·Critical Care : the Official Journal of the Critical Care Forum·Wieslawa DuszynskaAndrzej Kübler
Jun 3, 2014·Critical Care : the Official Journal of the Critical Care Forum·Gennaro De PascaleMassimo Antonelli
Mar 21, 2015·Intensive Care Medicine·Matteo BassettiGaryphallia Poulakou
Apr 19, 2015·Critical Care : the Official Journal of the Critical Care Forum·Claudio RoncoJean-Louis Vincent

❮ Previous
Next ❯

Citations

Oct 18, 2016·Anaesthesia Critical Care & Pain Medicine·Alexis TabahJason A Roberts
Apr 8, 2017·Intensive Care Medicine·Jason A RobertsJeffrey Lipman
Feb 16, 2018·Clinical Microbiology Reviews·Jesús Rodríguez-BañoAlvaro Pascual
Oct 10, 2018·Current Opinion in Infectious Diseases·Aaron J HeffernanJason A Roberts
Nov 21, 2018·Microbial Drug Resistance : MDR : Mechanisms, Epidemiology, and Disease·Fatma ErdemZerrin Aktas
Nov 23, 2019·Expert Review of Anti-infective Therapy·Filippo AnnoniFabio Silvio Taccone
Jun 28, 2019·Frontiers in Public Health·Ilias KaraiskosGaryphallia Poulakou
Jan 20, 2019·Intensive Care Medicine·Jean-François TimsitFrançois Barbier
Apr 5, 2017·Expert Review of Anti-infective Therapy·Alexandre P ZavasckiJürgen B Bulitta
Mar 19, 2021·Expert Opinion on Drug Metabolism & Toxicology·Marco FioreMaya Hites
Oct 14, 2019·Anaesthesia Critical Care & Pain Medicine·Marc LeoneBoris Jung

❮ Previous
Next ❯

Related Concepts

Related Feeds

Aminoglycosides

Aminoglycoside is a medicinal and bacteriologic category of traditional Gram-negative antibacterial medications that inhibit protein synthesis and contain as a portion of the molecule an amino-modified glycoside. Discover the latest research on aminoglycoside here.

Aminoglycosides (ASM)

Aminoglycoside is a medicinal and bacteriologic category of traditional Gram-negative antibacterial medications that inhibit protein synthesis and contain as a portion of the molecule an amino-modified glycoside. Discover the latest research on aminoglycoside here.