I have to admit, I am not particularly impressed to start prolonged infusion necessarily on every patient we suspect pseudomonas in- for zosyn. I read that AJHSP article and agree with Dr. Silvers- if you believe the PD data than we should be using merop. and doripenem on our patients and when using pip/taz you need the higher dose (As we do)? But I don't see an overwhelming amount of clinical data to support this- as I am sure many people can agree we have been treating GNR infections with drugs and doses that would not have a CFR > 90%. Sure I read the Albany Med study- and noted the difference in the two treatment groups based on type of infection, and did anyone see the dose for the intermittent group? Also, this is a retrospective cohort study, that for reasons that seem soft, they didn't do the ideal randomized control trial. When we are struggling with the cost of healthcare in our ICUs, I respect a lower cost to these antibiotics, but is this negated by the need for more vascular access or the associated complications of more access? While I agree, the AJHSP article was pretty convincing about clearly higher CFRs with continuous or extended infusions, and I understand that Beta Lactams are time dependent drugs, but what if the CFR was 70? What is a truly clinically relevant CFR in today's ICUs with all the supportive sepsis care? Please bring me to where you guys are... Melissa Lee, MDSEattle, Washington
Date: Wed, 13 Jun 2012 09:40:36 -0700 From: [email protected] To: [email protected]; [email protected]; [email protected]; [email protected] Subject: Re: [Sepsis Groups] Extended Infusion Beta Lactam Antibiotics Very interesting references. however, if you use the data from the pharmacodynanmic study in AJHSP, you need to increase the Zosyn to 4.5 gms every 6 hrs over a 3 hr infusion to obtain maximal CFR. This would negate any cost savings on medication cost but theoretically offers the best survival advantage for the patient. Since this is all about the patient, that seems like the beter choice. Jeffrey Silvers, M.D. From: [email protected] on behalf of Mary ann David Sent: Thu 6/7/2012 6:57 PM To: 'Mary Draper'; 'Shawver, Stephanie'; [email protected] Subject: Re: [Sepsis Groups] Extended Infusion Beta Lactam Antibiotics We have implemented the extended Zosyn and Doripenem infusion in our facilities as a result of these studies. I’ve attached a list of our sources and a couple of articles for your review. Thanks. Mary Ann David, RN, MSN, CNS Clinical Nurse Specialist SCVMC ICU Tel. No. 619-502-3165 Hospital Cell No. 619-502-5578 Pager No. 619-892-2047 Fax. No. 619-502-4076 Email. [email protected] þÜThink GREEN before printing this e-mail. CONFIDENTIALITY NOTICE: The information transmitted in this e-mail is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material, including 'protected health information'. If you are not the intended recipient, you are hereby notified that any review, retransmission, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please destroy and delete this message from any computer and contact me immediately at (619) 502-3165 or by return e-mail to [email protected]. From: [email protected] [mailto:[email protected]] On Behalf Of Mary Draper Sent: Wednesday, June 06, 2012 11:01 AM To: 'Shawver, Stephanie'; [email protected] Subject: Re: [Sepsis Groups] Extended Infusion Beta Lactam Antibiotics Do you have access to these studies? Our sepsis committee has not heard about this. Thanks. Please note: Will be on PTO June 12-20, returning the 21st Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 [email protected] From: [email protected] [mailto:[email protected]] On Behalf Of Shawver, Stephanie Sent: Friday, June 01, 2012 2:55 PM To: [email protected] Subject: [Sepsis Groups] Extended Infusion Beta Lactam Antibiotics Colleagues, I am curious to hear feedback on the recent studies indicating that extended or continuous infusion of certain beta-lactam antibiotics have shown better outcomes for severe sepsis and septic shock patients. Our hospital’s Sepsis Committee is considering changing the antibiotic regime on our protocol to have the applicable beta-lactam antibiotics infused over an extended period of time, if not continuous. Are there any other facilities out there going this route? Stephanie Shawver BSN, RN Infection Prevention Practitioner & SLMV Sepsis Coordinator St. Luke's Magic Valley 801 Pole Line Road West | Twin Falls, ID 83301 Office: (208) 814.3052 | Email: [email protected] Infection Prevention Line: (208)-814-5120 “ We are what we repeatedly do. Excellence then, is not an act but a habit.” - Aristotle mg.slrmc.org made the following annotations --------------------------------------------------------------------- "This message is intended for the use of the person or entity to which it is addressed and may contain information that is confidential or privileged, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this information is strictly prohibited. If you have received this message by error, please notify us immediately and destroy the related message." --------------------------------------------------------------------- _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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