Intensive care units antibiotics

A 48-year-old woman was admitted to the intensive care unit with sepsis and hemodynamic instability. Three days earlier, she had undergone an abdominal surgery. After treatment with intravenous antibiotics and fluid administration, the patient was described as stable. Several hours later, the patient s nurse identified extravasation from the intravascular lines and abdominal drains. 

Garnacho-Montero J, Garcia-Garmendia JL, Barrero-AImodovar A, et al. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003 31 2742-2751. 

One study that has tackled this issue, however, was recently published by de Souza et al. [104], who set up an environmental risk assessment of the 21 intravenous antibiotics most used in an intensive care unit of a hospital in Curitiba (Brazil). They evaluated the RQ, based on PEC, both in the raw effluent and after a dedicated conventional biological treatment. They found that, in the raw effluent from the ward, the environmental risk was high for 15 compounds, medium for 4 and low for 2 similarly, the treated effluent was labelled as high risk in terms of 14 compounds, medium for 5 and low for 2. 

The water-soluble salt of vitamin K3 (menadione) should never be used in therapeutics. It is particularly ineffective in the treatment of warfarin overdosage. Vitamin K deficiency frequently occurs in hospitalized patients in intensive care units because of poor diet, parenteral nutrition, recent surgery, multiple antibiotic therapy, and uremia. Severe hepatic failure results in diminished protein synthesis and a hemorrhagic diathesis that is unresponsive to vitamin K. 

There was an unexpectedly high frequency of adverse effects in a pediatric intensive care unit with the combination of high-dose phenobarbital and beta-lactam antibiotics, mainly cefotaxime (353). The reactions, which mostly affected the skin and blood, were only rarely reproduced by a single component, suggesting an interaction. However, these findings have not been confirmed, and their impact is unclear. 

Procedure Beta-lactam desensitization should be done in an intensive care unit and any concomitant risk factors for anaphylaxis, such as use of beta-blockers should be corrected. Protocols based on incremental use of the drug orally or parenterally have been described (190,193). The oral route is preferable and is associated with a lower incidence of adverse events, but mild transient reactions are frequent (171,194,195). Pregnant women with limited antibiotic choices have been treated with immunotherapy (196). Repeated administration will maintain a state of anergy, which is often lost after withdrawal (197). At the conclusion of therapy, patients must be informed that after withdrawal, they may once again become allergic to penicillin, with a new reaction to the first subsequent application (197). 

Gelone et al. conducted a 3-year prospective study of antimicrobial rotation in three intensive care units at Temple University (the START trial).This study, like those described above, used a before and after approach. Daily rounds were performed, and the following were assessed on every patient 1) demographics 2) antibiotic regimen and dosing 3) the presence of infection (based on predefined criteria) and 4) organ-... 

Gruson, D. Hilbert, G. Vargas, F. Valentino, R. Bebear, C Allery, A. Bebear, C. Gbikpi-Benissan, G. Cardinaud, J.P. Rotation and restricted use of antibiotics in a medical intensive care unit. Impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistant gramnegative bacteria. Am. J. Respir. Crit. Care Med. 2000, 162 (3 Pt. 1), 837 843. 

Gelone, S.P. Lorber, B. St. John, K. Badelino, M. Axelrod, P. Criner, G. Prospective evaluation of antibiotic rotation on three intensive care units at a tertiary care university hospital. Pharmacotherapy 2000, 20, abstract 107. 

F. Alvarez-Lerma, Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. ICU-Acquired Pneumonia Study Group, Intens. Care Med., 1996, 22, 387-394. 

Gastinne H, Wolff M, Delatour F, Faurisson F, Chevret S. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N Engl J Med 1992 326 594-599. 

Once the diagnosis of nosocomial pneumonia has been established, several important factors must be considered before a rational empirical antimicrobial regimen can be chosen. These include severity of illness and comorbid conditions of the patient, prior antibiotic use, early versus late onset of infection, results of the sputum Gram s stain, and the resident flora profile of the institution, particularly in the intensive care unit (Table 1). Empirical antimicrobial therapy for nosocomial pneumonia in a ventilated patient with renal failure in whom multiple intra-abdominal abscesses develop following colon resection is very different from the patient who aspirates following an otherwise uncomplicated cholecystectomy. 

Lynch JP. Combination antibiotic therapy is appropriate for nosocomial pneumonia in the intensive care unit. Semin Respir Infect 1993 8(4) 268-284. 

Use antibiotics carefully, especially on high-risk patients such as those in the intensive care unit. 

Stoutenbeek CP, van Saene HK, Zandstra DF. The effect of oral non-absorbable antibiotics on the emergence of resistant bacteria in patients in an intensive care unit. J Antimicrob Chemother 1987 19 513-520. 

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