Vancomycine en perfusion continue et infections ostéo-articulaires à staphylocoques multirésistants

Desplaces, Nicole; Mamoudy, P.; Ducroquet, F.; Larrouturou, P.; Kitzis, Marie-Dominique

doi:10.1016/s0399-077x(97)80199-0

Cited by 18 publications

(10 citation statements)

References 18 publications

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“…Because ␤-lactams have time-dependent antimicrobial activity, a potential advantage could be exploited by maintaining local antibiotic concentrations permanently above the MIC of the isolated pathogen; this seems particularly relevant for slowly growing bacteria, which are observed in chronic osteitis and implant-associated infections (7,29). The results of several studies showed that the bone antibiotic concentration is proportional to its serum concentration (10,11,19,30). Therefore, it is likely that constant serum concentrations yield constant bone concentrations.…”

Section: Discussionmentioning

confidence: 99%

Continuous Cefazolin Infusion To Treat Bone and Joint Infections: Clinical Efficacy, Feasibility, Safety, and Serum and Bone Concentrations

Zeller

Durand

Kitzis

et al. 2009

Antimicrob Agents Chemother

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Cefazolin has been used for many years to treat bone and joint infections. Because of its time-dependent antimicrobial activity, continuous infusion would potentially be beneficial. We report on the feasibility, safety, and efficacy of prolonged continuous intravenous cefazolin therapy in a cohort of 100 patients, their serum cefazolin levels, and the concomitant bone cefazolin concentrations in 8 of them. This retrospective cohort study included all the patients treated for bone or joint infection with a continuous cefazolin infusion administered over a 12-h period twice daily for >2 weeks. Drug monitoring was performed at least twice for all the patients. Serum and bone cefazolin concentrations were determined by standardized disk diffusion microbiological assays. The absence of clinical, biological, and radiological signs of infection after 2 years of follow-up and the same criteria after 1 year of follow-up defined cures and probable cures, respectively. The median treatment duration was 42 days, and the median daily cefazolin dose was 6 g. Half of the patients received parenteral antibiotic therapy on an outpatient basis. Two moderate-grade adverse events were observed. The median serum cefazolin concentrations were 63 g/ml (range, 13 to 203 g/ml) and 57 g/ml (range, 29 to 128 g/ml) on days 2 to 10 and days 11 to 21, respectively. The median bone cefazolin concentration reached 13.5 g/g (range, 3.5 to 29 g/g). The median bone concentration/serum concentration ratio was 0.25 (range, 0.06 to 0.41). Among 88 patients with a median follow-up of 25 months (range, 12 to 53 months), 52 were considered cured and 29 were considered probably cured. Thus, the treatment of bone and joint infections with a prolonged continuous intravenous cefazolin infusion was feasible, effective, well-tolerated, safe, and convenient, making it a strong candidate for home therapy.

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Section: Discussionmentioning

confidence: 99%

Continuous Cefazolin Infusion To Treat Bone and Joint Infections: Clinical Efficacy, Feasibility, Safety, and Serum and Bone Concentrations

Zeller

Durand

Kitzis

et al. 2009

Antimicrob Agents Chemother

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“…To our knowledge there are no published reports of prospective clinical trials investigating the efficacy, safety and pharmacodynamics of prolonged continuous infusion of vancomycin for the treatment of osteomyelitis. Prolonged and high dose vancomycin serum concentrations appear necessary for success because vancomycin bone diffusion is limited (10, 17). CVI has been used for short durations in various clinical situations (18–21) and offers the theoretical advantage of sustained high serum levels of vancomycin without adverse effects.…”

Section: Discussionmentioning

confidence: 99%

High dose vancomycin for osteomyelitis: continuous vs. intermittent infusion

Vuagnat¹,

et al. 2004

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“…Continuous infusion of vancomycin makes it possible to achieve a constant bactericidal level in blood and may also result in better CSF penetration (4). The benefit of prescribing continuous infusion has been reported for children (1) with postneurosurgical meningitis (2) and staphylococcus-resistant bone infections (3). The pharmacokinetics of antibiotics are modified in intensive care unit (ICU) patients due to the large daily fluid balance, acute changes in body weight, hypoalbuminemia, edema, and low hematocrit values.…”

mentioning

confidence: 99%

“…Clinical successes with administering vancomycin by continuous infusion have been reported for different infections: catheter infection, pneumonia, osteomyelitis, and septic arthritis (3,6,19,24). Comparisons of patients treated by continuous infusion with those treated by conventional discontinuous infusion for severe methicillin-resistant staphylococcal infections showed that continuous infusion reduced the period of bacteremia in relation to infection (24,25).…”

mentioning

confidence: 99%

Cerebrospinal Fluid Penetration and Pharmacokinetics of Vancomycin Administered by Continuous Infusion to Mechanically Ventilated Patients in an Intensive Care Unit

Albanèse¹,

Leone²,

Bruguerolle³

et al. 2000

Antimicrob Agents Chemother

138

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Cerebrospinal fluid (CSF) penetration and the pharmacokinetics of vancomycin were studied after continuous infusion (50 to 60 mg/kg of body weight/day after a loading dose of 15 mg/kg) in 13 mechanically ventilated patients hospitalized in an intensive care unit. Seven patients were treated for a sensitive bacterial meningitis and the other six patients, who had a severe concomitant neurologic disease with intracranial hypertension, were treated for various infections. Vancomycin CSF penetration was significantly higher (P < 0.05) in the meningitis group (serum/CSF ratio, 48%) than in the other group (serum/CSF ratio, 18%). Vancomycin pharmacokinetic parameters did not differ from those obtained with conventional dosing. No adverse effect was observed, in particular with regard to renal function.Vancomycin has a slow bactericidal activity with a low MIC and a time-dependent activity with a limited penetration in cerebrospinal fluid (CSF) when administered by intermittent infusion over a period of at least 90 min every 8 or 12 h (5). Continuous infusion of vancomycin makes it possible to achieve a constant bactericidal level in blood and may also result in better CSF penetration (4). The benefit of prescribing continuous infusion has been reported for children (1) with postneurosurgical meningitis (2) and staphylococcus-resistant bone infections (3). The pharmacokinetics of antibiotics are modified in intensive care unit (ICU) patients due to the large daily fluid balance, acute changes in body weight, hypoalbuminemia, edema, and low hematocrit values. These modifications lead to marked changes in elimination half-life, volume of distribution, and clearance (12,20,25).The aim of this study was to evaluate vancomycin penetration of CSF and its pharmacokinetics after administration by continuous infusion in ICU patients under mechanical ventilation in whom pharmacokinetic modifications could be expected.After institutional approval and informed consent from a close relative were obtained, 13 consecutive patients of either sex, 25 to 58 years of age, hospitalized in the ICU and infected by vancomycin-sensitive bacteria were enrolled in the study. These patients underwent mechanical ventilation for acute respiratory failure. Exclusionary criteria included an age of Ͻ18 years, renal dysfunction, and an expected hospital stay of Ͻ72 h. Seven patients were treated for sensitive bacterial meningitis. Primary pathologies were head trauma (five cases) and medical coma (two cases). The other six patients were treated for various infections, and an external CSF shunt was already in place for the treatment of a primary pathology (severe neurologic disease with intracranial hypertension). Primary pathologies were medical coma (three cases), subarachnoid hemorrhage (two cases), and stroke (one case). The bacteria involved in infections were Staphylococcus epidermidis (six cases), Staphylococcus aureus (three cases), Streptococcus pneumoniae (two cases), Enterococcus faecalis (one case), and Corynebacterium (one case). The cases...

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Vancomycine en perfusion continue et infections ostéo-articulaires à staphylocoques multirésistants

Cited by 18 publications

References 18 publications

Continuous Cefazolin Infusion To Treat Bone and Joint Infections: Clinical Efficacy, Feasibility, Safety, and Serum and Bone Concentrations

Continuous Cefazolin Infusion To Treat Bone and Joint Infections: Clinical Efficacy, Feasibility, Safety, and Serum and Bone Concentrations

High dose vancomycin for osteomyelitis: continuous vs. intermittent infusion

Cerebrospinal Fluid Penetration and Pharmacokinetics of Vancomycin Administered by Continuous Infusion to Mechanically Ventilated Patients in an Intensive Care Unit

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