Thomas Lodise

..6 ml/min, and intensive care unit residence were independently associated with time to nephrotoxicity. The data suggest that higher-dose vancomycin regimens are associated with a higher likelihood of vancomycin-related nephrotoxicity...

..The data strongly suggest that delaying appropriate therapy for approximately 2 days significantly increases the risk of 30-day mortality in patients with P. aeruginosa bloodstream infections...

..4; P = 0.01). These data strongly suggest that patients with MRSA bloodstream infections with vancomycin MICs of >or=1.5 mg/liter respond poorly to vancomycin. Alternative anti-MRSA therapies should be considered for these patients...

..The CL(CR) adjustments for traditional and extended-infusion TZP dosing regimens should be considered at a CL(CR) of <or=20 ml/min...

..Further studies are needed to determine if these drugs can better eradicate MRSA than vancomycin and remedy the adverse outcomes frequently observed with this organism...

..The median AUC(ELF)/free AUC(plasma) penetration ratio was 0.73, and the 25th and 75th percentile value ratios were 0.43 and 1.24, respectively. In uninfected lung tissue, the median AUC(ELF) is approximately 75% of the free AUC(plasma)...

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..aeruginosa infections and potentially maximize clinical outcomes by increasing the likelihood of appropriate empirical antimicrobial therapy...

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..01]), but no difference in LOS was noted among PSI class V patients. Our study showed that improved outcomes may be realized with BL+M in cases of severe CAP. A randomized clinical study is warranted based on these results...

..This study evaluates the clinical implications of extended infusion of piperacillin-tazobactam therapy for critically ill patients with P. aeruginosa infection...

..aeruginosa respiratory tract infections at our institution. Identifying these risk factors enabled us to develop a prediction tool to assess the risk of resistance and thus guide empirical antibiotic therapy...

..03 and 8 microg/mL for each regimen examined. In CSF, none of the regimens achieved 50-100% T>MIC for>80% of patients for MICs>0.5 mg/L...

..With the advent of new treatment options, the impact of MRSA will need to be revisited to determine if these therapies can remedy the increased morbidity associated with MRSA...

..5 mg/L). However, scant research exists on factors predictive of high vancomycin MICs (> or = 1.5 mg/L) among MRSA bacteraemic patients. Empirical therapy decisions would greatly benefit from such information...

..No study has been undertaken to determine the pharmacodynamic index (ie, the area under the curve [AUC] or the trough value) that best describes the relationship between vancomycin exposure and onset of nephrotoxicity...

..v. q12h, for patients who had a creatinine clearance rate of < or =50 ml/min, was identified as the most appropriate treatment regimen for patients who require renal dose adjustment for mild to moderate renal impairment...

..When the specific antibiotic used was replaced by the number of prior exposures, the number of exposures was the only variable associated with an increased risk of antibiotic resistance at each time threshold...

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..This study indicates that piperacillin-tazobactam should have utility for empirical therapy of hospital-onset infections...

..1% for H. influenzae. This study demonstrated a relationship between telithromycin drug exposure and microbiological outcome. Telithromycin is expected to achieve the drug exposure breakpoint for the majority of isolates causing CAP...

..002) than those of gatifloxacin. The order of resistance development determined from fAUC/MIC breakpoints was levofloxacin>gatifloxacin>moxifloxacin=gemifloxacin, which may be related to structural differences within the class...

..Moreover, they achieved the targeted fT>MIC with less administration time/day than would be needed for continuous infusion...

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..2 days versus 14.3 days; P=.05). These findings support the notion that delay of therapy has deleterious effects on clinical outcomes, and efforts should be made to ensure that appropriate therapy is initiated promptly...

..This knowledge can be used to guide empiric antibiotic selection. In the era of antibiotic resistance, such tools are essential to prevent indiscriminate antibiotic use and preserve the longevity of current antimicrobials...

..However, due to the significant history of fluoroquinolone-induced hepatic failure and dermatologic complications, the use of this drug should be closely monitored...

..These findings suggest that newer agents with enhanced clinical activity in NBSAP are needed and that these should be evaluated in a real-world setting, where outcomes of the most ill patients can be assessed...

..06 mg/liter, which includes most S. pneumoniae isolates with intermediate susceptibility to penicillin, when given in the fasting state in both plasma and ELF...

..8% and 82%, respectively. The CSF pharmacodynamics against S. pneumoniae for cefepime were superior to that of ceftriaxone. The implications of these findings need to be reexamined in the clinical setting...

..In brief, future studies should define "inappropriate" therapy on the basis of in vitro susceptibility data, should separately evaluate empiric and definitive therapy, and should control for the baseline severity of illness...

..7plus minus1.88 vs. 15.9 +/- 1.7, P=.006). These observations indicate that vancomycin resistance in EB independently affects outcomes...