Infectious Disease in Critically Ill

Infectious Disease in Critically Ill - Resident ICU Course...

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Unformatted text preview: Resident ICU Course 1 Slide Sub-Title Principles of Treating Infectious Illnesses in Principles of Treating Infectious Illnesses in Critical Care: Focus on Antibiotic Resistance Critical Care: Focus on Antibiotic Resistance and Choice and Choice Robert Owens, PharmD Gil Fraser, PharmD, FCCM University of Vermont College of Medicine and Maine Medical Center, Portland We shall now discuss in a little We shall now discuss in a little more detail the struggle for more detail the struggle for existence. C Darwin 1859 existence. C Darwin 1859 Resident ICU Course 2 Discussion Topics Discussion Topics Using antibiotics wisely Impact on microbial resistance Impact on patient outcomes Choosing initial antibiotics and tailoring when data become available Using pharmacology and pharmacodynamics to optimize bacterial killing Applying clinically relevant specific antibiotic information Resident ICU Course 3 Post-Antibiotic Era Mortality: What the Post-Antibiotic Era Mortality: What the Future Holds? Future Holds? Resident ICU Course 4 Clinical Relevance of Resistance Clinical Relevance of Resistance Ann Intern Med 2001; 134:298 Ann Intern Med 2001; 134:298 Increased morbidity/mortality 60-80,000 deaths Increased hospitalization Transmission to others Influences antibiotic choices Direct/indirect costs 2 million pts suffer nosocomial infections/yr; 50-60% involve resistant pathogens Cost = <$30 billion/yr at $24K per case Resident ICU Course 5 Mechanisms of Bacterial Resistance to Mechanisms of Bacterial Resistance to Antibiotics Antibiotics Resident ICU Course 6 Resident ICU Course 7 The Pharmacology of Infectious Diseases The Pharmacology of Infectious Diseases Involves Many Factors Involves Many Factors HOST BUG DRUG Nicolau DP Am J Man Care 1998:4(10 Suppl) S525-30 Resident ICU Course 8 Selection of Antimicrobial Therapy: Selection of Antimicrobial Therapy: Host Factors Host Factors Allergies, age, pregnancy, hepatic and renal function, concomitant drug therapy, immunocompentence, and co- morbidities Site of infection Must cover common pathogens for specific infectious diagnosis until culture results return Must consider temporal relationships Organisms differ with early vs late onset hospital-acquired pneumonia Organisms may reflect selective pressure if antibiotics previously administered (Antimicrobial history taking is extremely important!) Resident ICU Course 9 Selection of Antimicrobial Therapy: Selection of Antimicrobial Therapy: Drug Drug Factors Factors Variable antibiotic tissue penetration Protected sites: pulmonary secretions, the central nervous system, eye, prostate, abscess, bone Drug clearance: many are renally cleared Exceptions: the macrolides, amphotericin, caspofungin, voriconazole, clindamycin, s, moxifloxacin, linezolid, ceftriaxone, and the antistaphylococcal penicillins Bioavailability Good absorption for most quinolones, linezolid, cotrimoxazole, metronidazole,...
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Infectious Disease in Critically Ill - Resident ICU Course...

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