Journal of critical care最新文献

{"title":"Antibiotic allergy de-labeling in the intensive care unit: The prospective ADE-ICU study","authors":"Salma Alamin ,&nbsp;Rachel Egan ,&nbsp;Barbara Cusack ,&nbsp;Amanda Sherwin ,&nbsp;Emily Naylor ,&nbsp;Fiona Carroll ,&nbsp;Marie E. Ward ,&nbsp;Mary Kelly ,&nbsp;Deirdre Doyle ,&nbsp;Ignacio Martin-Loeches ,&nbsp;Niall Conlon ,&nbsp;Sean Keane","doi":"10.1016/j.jcrc.2024.154977","DOIUrl":"10.1016/j.jcrc.2024.154977","url":null,"abstract":"<div><h3>Purpose</h3><div>Critically ill patients in the intensive care unit (ICU) are frequently prescribed antibiotics, with many reporting an antibiotic allergy label, predominantly to penicillin. Mislabeling contributes to suboptimal antibiotic use, increasing multidrug-resistant organisms and <em>Clostridium difficile</em> infections, and increased hospital length of stay. This prospective study implemented an antibiotic allergy assessment and testing program in the ICU, independently of clinical immunology/allergy services.</div></div><div><h3>Materials and methods</h3><div>Trained ICU staff prospectively identified and risk assessed eligible patients as having a non-immune mediated drug reaction, or a low, intermediate or high risk antibiotic allergy. Non-immune mediated reactions were directly de-labeled. Low-risk allergies underwent direct drug provocation testing, while intermediate-risk allergies included skin testing followed by drug provocation testing. High-risk allergies were confirmed without testing.</div></div><div><h3>Results</h3><div>Of 71 eligible patients, 62 underwent assessment. Antibiotic allergy de-labeling occurred in 48 of 51 patients (94 %) with a non-immune, low or intermediate risk allergy. High risk allergies were confirmed in 11 patients (18 %). The study resulted in increased penicillin use and decreased broad-spectrum antibiotic use. No adverse events occurred from testing.</div></div><div><h3>Conclusions</h3><div>This study shows the feasibility of ICU led antibiotic allergy assessment and testing, highlighting a potential model for implementation in settings lacking immunology/allergy services.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154977"},"PeriodicalIF":3.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interplay between organizational culture and burnout among ICU professionals: A cross-sectional multicenter study","authors":"Niek Kok ,&nbsp;Cornelia Hoedemaekers ,&nbsp;Malaika Fuchs ,&nbsp;Alexander D. Cornet ,&nbsp;Esther Ewalds ,&nbsp;Harold Hom ,&nbsp;Esther Meijer ,&nbsp;Iwan Meynaar ,&nbsp;Margo van Mol ,&nbsp;Walther van Mook ,&nbsp;Mariëlle van der Steen-Dieperink ,&nbsp;Arthur van Zanten ,&nbsp;Hans van der Hoeven ,&nbsp;Jelle van Gurp ,&nbsp;Marieke Zegers","doi":"10.1016/j.jcrc.2024.154981","DOIUrl":"10.1016/j.jcrc.2024.154981","url":null,"abstract":"<div><h3>Purpose</h3><div>Organizational culture is considered a protective factor against burnout among ICU professionals. The aim of this study is to study the association between organizational culture as a potential antecedent to previously found mediating risk factors for burnout, namely, work-life balance and moral distress.</div></div><div><h3>Materials and methods</h3><div>Multicenter cross sectional study in eleven Dutch ICUs. The primary outcome measure was the core symptom of burnout, emotional exhaustion, measured using the validated Dutch version of the Maslach Burnout Inventory. Organizational culture was assessed using the Culture of Care Barometer, which measures five aspects of organizational culture. Moral distress and work-life balance were measured with validated questionnaires.</div></div><div><h3>Results</h3><div>696 ICU professionals (39.7 %) responded. All aspects of the CoCB were negatively associated with the emotional exhaustion component of burnout, both in univariable and multivariable models. Four aspects of organizational culture were significantly associated to the serial association between moral distress, work-to-home spillovers, and emotional exhaustion. For these aspects, the total indirect association was equal or larger than the total direct association.</div></div><div><h3>Conclusions</h3><div>Multiple aspects of organizational culture reduce burnout among ICU professionals in a largely indirect manner, via moral distress and work-life balance. Improving organizational culture can mitigate burnout symptoms among ICU clinicians.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154981"},"PeriodicalIF":3.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors reply: “Outcomes of continuous renal replacement therapy versus peritoneal dialysis as a renal replacement therapy modality in patients undergoing venoarterial 72 extracorporeal membrane oxygenation\"","authors":"Peerapat Thanapongsatorn ,&nbsp;Nisha Wanichwecharungruang ,&nbsp;Nattachai Srisawat","doi":"10.1016/j.jcrc.2024.154980","DOIUrl":"10.1016/j.jcrc.2024.154980","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154980"},"PeriodicalIF":3.2,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative oliguria after intermediate and high-risk surgeries in critical care, A cohort analysis","authors":"Rodolpho Augusto de Moura Pedro ,&nbsp;Guilherme Bittar Cunha ,&nbsp;Igor Pietrobom ,&nbsp;Bruna Carla Scharanch ,&nbsp;Daniel Caraca Cubos ,&nbsp;Rafael Alves Franco ,&nbsp;Fernando Zampieri ,&nbsp;Thiago Gomes Romano","doi":"10.1016/j.jcrc.2024.154976","DOIUrl":"10.1016/j.jcrc.2024.154976","url":null,"abstract":"<div><h3>Introduction</h3><div>Oliguria is commonly used as a cutoff for acute kidney injury (AKI), however, a decrease in urine output is common during surgery and may represent an adaptative response in the perioperative setting rather than a reduction in glomerular filtration rate, leading to a possible overestimation of postoperative AKI incidence. Although this dilemma has been addressed in the intraoperative scenario, the incidence and impact of oliguria in the first postoperative day represents a gap in the current literature. Our main goal is to describe the incidence, risk factors and clinical outcomes related to postoperative oliguria.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort conducted in four intensive care units (ICUs) across two private Brazilian hospitals, analyzing patients admitted after intermediate and high-risk surgeries between January 1, 2018 and December 31, 2022.</div></div><div><h3>Results</h3><div>1476 patients were included in the final analysis. Overall, 656 (44,5 %) were males, and the median age was 61,7 years. Oliguria was identified in 508 (34,4 %) patients within the first 24 h after surgery. Vasopressor requirement at admission, non-elective procedures, male sex and baseline serum creatinine were higher among oliguric patients. Among oliguric patients, age and basal serum creatine were higher among those who experienced AKI. Although only 12,4 % of oliguric patients developed AKI according to serum creatinine criterion, this incidence was significantly higher than in non-oliguric group (3,6 %), RR 3.42, IC 95 % 2.3–5.1 (<em>p</em> &lt; 0.01). AKI recovery, RRT, ICU and hospital free days, and mortality were similar between the groups.</div></div><div><h3>Conclusions</h3><div>Postoperative oliguria is common after intermediate and high-risk surgical procedures and increases the risk of AKI. However, oliguria was largely unrelated with kidney disfunction measured by serum creatinine (87,6 %), raising doubts on whether diuresis overestimates AKI incidence in the postoperative setting.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154976"},"PeriodicalIF":3.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shock prediction with dipeptidyl peptidase-3 and renin (SPiDeR) in hypoxemic patients with COVID-19","authors":"Laurence W. Busse MD, MBA, FCCM ,&nbsp;J. Pedro Teixeira MD ,&nbsp;Christopher L. Schaich PhD ,&nbsp;Caitlin C. ten Lohuis ACNP-BC ,&nbsp;Nathan D. Nielsen MD, MSc ,&nbsp;Jeffrey M. Sturek MD, PhD ,&nbsp;Lisa H. Merck MD, MPH ,&nbsp;Wesley H. Self MD, MPH ,&nbsp;Michael A. Puskarich MD, MSCR ,&nbsp;Akram Khan MBBS ,&nbsp;Matthew W. Semler MD, MSc ,&nbsp;Ari Moskowitz MD, MPH ,&nbsp;David N. Hager MD, PhD ,&nbsp;Abhijit Duggal MD, MPH, MSc ,&nbsp;Todd W. Rice MD, MSc ,&nbsp;Adit A. Ginde MD, MPH ,&nbsp;Brian R. Tiffany MD, PhD ,&nbsp;Nicole M. Iovine MD ,&nbsp;Peter Chen MD ,&nbsp;Basmah Safdar MD, MSc ,&nbsp;Sean P. Collins MD, MSc","doi":"10.1016/j.jcrc.2024.154950","DOIUrl":"10.1016/j.jcrc.2024.154950","url":null,"abstract":"<div><h3>Background</h3><div>Plasma dipeptidyl peptidase-3 (DPP3) and renin levels are associated with organ dysfunction and mortality. However, whether these biomarkers are associated with the subsequent onset of shock in at-risk patients is unknown.</div></div><div><h3>Methods</h3><div>Using plasma samples collected from participants enrolled in the fourth Accelerating COVID-19 Therapeutic Interventions and Vaccines Host Tissue platform trial, we measured DPP3 and renin in 184 subjects hospitalized with acute hypoxemia from COVID-19 without baseline vasopressor requirement. We calculated the odds ratio of development of shock (defined as the initiation of vasopressor therapy) by Day 28 based on Day 0 DPP3 and renin levels.</div></div><div><h3>Results</h3><div>Subjects with DPP3 above the median had a significantly higher incidence of vasopressor initiation within 28 days (28.4 % vs. 16.7 %, <em>p</em> = 0.031) and higher 28-day mortality (25.0 % vs. 6.7 %, <em>p</em> &lt; 0.001). After adjusting for covariables, DPP3 above the median was associated with shorter time to vasopressor initiation, greater 28-day mortality, fewer vasopressor-free days, and greater odds of a hypotensive event over 7 days. Significant associations were not observed for renin.</div></div><div><h3>Conclusions</h3><div>In patients hospitalized with COVID-19 and hypoxemia without baseline hypotension, higher baseline plasma levels of DPP3 but not renin were associated with increased risk of subsequent shock and death.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154950"},"PeriodicalIF":3.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fever following extracorporeal membrane oxygenation decannulation: Infection, thrombosis or just physiology?","authors":"Benjamin Assouline ,&nbsp;Gianlucca Belli ,&nbsp;Karim Dorgham ,&nbsp;Quentin Moyon ,&nbsp;Alexandre Coppens ,&nbsp;Marc Pineton de Chambrun ,&nbsp;Juliette Chommeloux ,&nbsp;David Levy ,&nbsp;Ouriel Saura ,&nbsp;Guillaume Hekimian ,&nbsp;Matthieu Schmidt ,&nbsp;Alain Combes ,&nbsp;Charles-Edouard Luyt","doi":"10.1016/j.jcrc.2024.154945","DOIUrl":"10.1016/j.jcrc.2024.154945","url":null,"abstract":"<div><h3>Purpose</h3><div>Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes.</div></div><div><h3>Methods</h3><div>Adult ECMO patients who were successfully weaned from ECMO were retrospectively included. Minimal and maximal core temperatures were collected daily for each patient from 48 h before decannulation up to 5 days after. Patients were grouped according to the cause of fever (infection, thrombosis, or no evident cause) and compared. Plasma cytokine profile was obtained, each day from decannulation to 5 days after for 20 patients.</div></div><div><h3>Results</h3><div>Between January 2021 and December 2022, 123 patients successfully weaned from ECMO were included. Post-decannulation fever occurred in 54 patients (44 %). It was associated with an infection in 39 patients (72 %) and with a thrombosis in 6 patients (11 %), and no cause was identified in the remaining 9 (17 %). Prolonged ECMO duration, extended ICU length-of-stay, diabetes and vascular comorbidities were significantly associated with a higher risk of infection. Finally, the pro-inflammatory cytokine profiles did not differ between febrile and afebrile patients.</div></div><div><h3>Conclusion</h3><div>Post-decannulation fever was common, and was mainly due to infections or thrombosis. Fever should therefore not be considered as a benign inflammatory reaction until proven otherwise.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154945"},"PeriodicalIF":3.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical impact of hypermagnesemia in acute kidney injury patients undergoing continuous kidney replacement therapy: A propensity score analysis utilizing real-world data","authors":"Ming-Jen Chan ,&nbsp;Jia-Jin Chen ,&nbsp;Cheng-Chia Lee ,&nbsp;Pei-Chun Fan ,&nbsp;Yi-Jiun Su ,&nbsp;Ya-Lien Cheng ,&nbsp;Chao-Yu Chen ,&nbsp;VinCent Wu ,&nbsp;Yung-Chang Chen ,&nbsp;Chih-Hsiang Chang","doi":"10.1016/j.jcrc.2024.154947","DOIUrl":"10.1016/j.jcrc.2024.154947","url":null,"abstract":"<div><h3>Purpose</h3><div>While hypomagnesemia is known to be a risk factor for acute kidney injury (AKI), the impact of hypermagnesemia on prognosis in AKI patients undergoing continuous kidney replacement therapy (CKRT) remains unclear. This study investigates the relationship between hypermagnesemia and clinical outcomes in this patient population.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using data from a multicenter medical repository spanning from 2001 to 2019, involving patients who underwent CKRT. Patients were categorized into normomagnesemia (&lt;2 mEq/L) and hypermagnesemia groups based (≥2 mEq/L) on their levels at CKRT initiation.</div></div><div><h3>Results</h3><div>Among the 2625 patients, 1194 (45.5 %) had elevated serum magnesium levels. The hypermagnesemia group exhibited a similar rate of non-recovery of renal function at 90-days compared to the normomagnesemia group (63.1 % vs. 62.8 %, odds ratio [OR] = 1.01, 95 % confidence interval [CI] 0.90–1.14). Furthermore, the high magnesium group demonstrated higher one-year all-cause mortality (hazard ratio [HR] 1.14, 95 % CI 1.07–1.21) and an elevated risk of one-year arrhythmia (HR 4.77, 95 % CI 1.59–14.29). There was no difference of incidence of seizure between hypermagnesemia and normomagnesemia group.</div></div><div><h3>Conclusions</h3><div>Our study suggests that hypermagnesemia in AKI patients undergoing CKRT is not associated with improved renal recovery but is linked to worse clinical outcomes, including all-cause mortality and arrhythmia. Close monitoring of serum magnesium levels is recommended in this population for optimizing clinical outcomes.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154947"},"PeriodicalIF":3.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: “What every intensivist should know about: Trust in the icu”","authors":"Hannah M. Vincent BSN, RN ,&nbsp;Jan Bakker","doi":"10.1016/j.jcrc.2024.154949","DOIUrl":"10.1016/j.jcrc.2024.154949","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154949"},"PeriodicalIF":3.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased renal cortical perfusion post-EGDT is associated with MAKE-30 in sepsis","authors":"Qiqi Li ,&nbsp;Rong Li ,&nbsp;Can Wang ,&nbsp;Qian Zhang ,&nbsp;Qian Zhang ,&nbsp;Yan Huo ,&nbsp;Yangong Chao ,&nbsp;Xiaoting Wang ,&nbsp;Zhenjie Hu ,&nbsp;Lixia Liu ,&nbsp;for the Chinese Critical UltraSound Study Group(CCUSG)","doi":"10.1016/j.jcrc.2024.154943","DOIUrl":"10.1016/j.jcrc.2024.154943","url":null,"abstract":"<div><h3>Objective</h3><div>This study explores alterations in renal cortical perfusion post-Early Goal-Directed Therapy (EGDT) in sepsis patients, to investigate its association with major adverse kidney events within 30 days (MAKE-30) and identify hemodynamic factors associated with renal cortical perfusion.</div></div><div><h3>Methods</h3><div>Sepsis patients admitted to the ICU from Jan 2022 to Jul 2023 were prospectively enrolled. Contrast-enhanced ultrasound (CEUS) assessed renal cortical perfusion post-EGDT. Hemodynamic parameters and renal resistive index (RRI) were collected. Patients were categorized into MAKE-30 and non-MAKE-30 groups. The study examined the association between renal cortical perfusion and MAKE-30, explored the hemodynamic factors related to renal cortical perfusion.</div></div><div><h3>Results</h3><div>Of 94 sepsis patients, 46 (48.9 %) experienced MAKE-30. Distinctions in pulmonary (<em>P</em> = 0.012) and abdominal infection sites (<em>P</em> = 0.001) and significant SOFA (<em>P</em> &lt; 0.001) and APACHE II scores (<em>P</em> = 0.003) differences were observed. No significant differences in baseline characteristics, vasopressor, or diuretic doses were noted (<em>P</em> &gt; 0.05). Hemodynamic parameters in MAKE-30 and non-MAKE-30 patients showed no significant differences. RRI was higher in MAKE-30 patients (0.71 vs 0.66 <em>P</em> = 0.005). Renal microcirculation parameters, including AUC (<em>p</em> = 0.035), rBV (<em>p</em> = 0.021), and PI (<em>p</em> = 0.003), were lower in MAKE-30. Reduced cortical renal perfusion was associated with an increased risk of MAKE-30. Renal cortical perfusion RT was identified as an independent factor associated with this risk (HR 2.278, 95 % CI (1.152–4.507), <em>P</em> = 0.018). RRI correlated with renal cortical perfusion AUC (<em>r</em> = −0.220 p 0.033).</div></div><div><h3>Conclusion</h3><div>Despite normal systemic hemodynamics post-sepsis EGDT, MAKE-30 patients show reduced renal cortical perfusion. CEUS-derived RT is an independent factor associated with this change. RRI correlates with renal cortical perfusion.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154943"},"PeriodicalIF":3.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing fosfomycin dosing regimens in critically ill patients with and without continuous renal replacement therapy","authors":"Taniya Charoensareerat ,&nbsp;Phongphak Bunrit ,&nbsp;Sasina Phanpoka ,&nbsp;Thananya Netthanomsak ,&nbsp;Dhakrit Rungkitwattanakul ,&nbsp;Sutthiporn Pattharachayakul ,&nbsp;Nattachai Srisawat ,&nbsp;Weerachai Chaijamorn","doi":"10.1016/j.jcrc.2024.154946","DOIUrl":"10.1016/j.jcrc.2024.154946","url":null,"abstract":"<div><h3>Purpose</h3><div>To define the optimal fosfomycin dosing regimens for drug-resistant gram-negative bacteria in critically ill patients and those receiving continuous renal replacement therapy (CRRT) via Monte Carlo simulations.</div></div><div><h3>Materials and methods</h3><div>A pharmacokinetic model for patients with and without CRRT was created to predict fosfomycin deposition in these patients. The pharmacodynamics (PD) targets were AUC/MIC ratio &gt; 21.5, 28.2, and 98.8 for drug-resistant <em>Klebsiella pneumoniae</em> (KP), <em>Pseudomonas aeruginosa</em> (PA) and <em>Escherichia coli</em> (EC) infections, respectively. The optimal regimen was defined when the probability of target attainment (PTA) was &gt;90 % of the virtual patients.</div></div><div><h3>Results</h3><div>The fosfomycin dosing regimens for KP infections with MIC 64 mg/L in critically ill patients and who received CRRT were 6 g every 8 h and 8 g every 12 h, respectively. For PA infections, the regimens of 6 g every 6 h and 7 g every 8 h achieved the target in critically ill patients and those undergoing CRRT. No regimen achieved the 90 % PTA against the EC infection with MIC &gt;32 mg/L.</div></div><div><h3>Conclusions</h3><div>Dosing regimens for bacteria with high MICs as 64 mg/L in these patients were 18–24 g/day. Dose adjustments were required in those undergoing CRRT. Clinical validation is strongly needed.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"85 ","pages":"Article 154946"},"PeriodicalIF":3.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}