Pharmaceutical Care of a Neonate with Septicemia Based on Population Pharmacokinetics / 医药导报

Objective To introduce a pharmaceutical care method based on population pharmacokinetics(PPK)and Bayesian method. Methods A predictive model for individualized vancomycin dosing was established based on the JPKD-Bayesian software and a PPK model according to the intervenous drop infusion of vancomycin in Chinese children.Individualized dosage regimen of vancomycin was devised for a neonate with septicemia caused by methicillin-resistant staphylococcus epidermidis (MRSE)using the predictive model. Results The model prediction error of the trough concentration of vancomycin was 0.8 mg·L-1 ,and the weighted residual(WRES)was 8.7%,and thus the predictive accuracy of the model was satisfactory.The MRSE infection in this patient was effectively controlled following individualized vancomycin dosage regimen according to the model predicted results,and there were no vancomycin-caused adverse reactions. Conclusion Application of advanced pharmaceutical knowledge such as PPK contributes to clinical medication,and it can promote the quality of pharmaceutical care provided by clinical pharmacists.

Resistencia a antimicrobianos y evaluación del tratamiento combinado en la septicemia neonatal / Resistance to antimicrobials and combination therapy assessment in neonatal sepsis

OBJETIVOS: Estudiar la resistencia a los antibióticos de las cepas bacterianas aisladas de pacientes con septicemia neonatal en un hospital ginecobstétrico de La Habana, Cuba, en el período comprendido entre enero de 1994 y diciembre de 1998, y evaluar el valor predictivo del método del "tablero de damas" (checkerboard) para seleccionar el tratamiento con combinaciones de antibióticos en pacientes graves. MÉTODOS: Se estudió a 229 neonatos, a quienes se les extrajo sangre para hemocultivo y estudios de sensibilidad a antimicrobianos. El estudio de la susceptibilidad de las cepas se realizó por el método de microdilución en caldo y se utilizó el tablero de damas en bandejas de caldo para evaluar la eficacia del tratamiento antimicrobiano combinado. RESULTADOS: Cincuenta por ciento de las cepas aisladas de Staphylococcus spp. coagulasa-negativas y 37 por ciento de las cepas de S. aureus, principales agentes causales de sepsis neonatal, fueron resistentes a la meticilina. De ellas, 94,5 por ciento resultaron resistentes a varios antibióticos. Cuatro cepas de Staphylococcus spp. coagulasa-negativas y una de Enterococcus faecium fueron resistentes a la vancomicina (concentración mínima inhibidora = 128 myg/mL). Se observó una alta probabilidad de eficacia clínica (P < 0,01) con combinaciones de antibióticos que mostraron un efecto sinérgico in vitro, mientras que las reacciones antagónicas se correspondieron con la probabilidad altamente significativa de fracaso terapéutico clínico. DISCUSION: La principal causa de septicemia neonatal en la Unidad de Cuidados Intensivos del Hospital "América Arias" en La Habana, Cuba, está constituida por las cepas de estafilococo resistentes a la meticilina y a otros antibióticos. En pacientes graves (atendiendo a lo establecido en el programa de política de este centro), la primera línea de tratamiento la constituye la combinación de un antibiótico aminoglucósido con un betalactámico. Este estudio demostró que la eficacia clínica de un tratamiento antibiótico combinado no está condiciona por el patrón de resistencia de la cepa y que se puede alcanzar, con una probabilidad elevada, un buen resultado clínico cuando se demuestra un efecto sinérgico in vitro

Objectives. To estimate antibiotic resistance among bacterial strains isolated from patients with neonatal sepsis from January 1994 through December 1998, and to assess the predictive value of the checkerboard method for selecting treatment with combination antibiotic therapy in seriously ill patients. Methods. The study of strain susceptibility was carried out by microdilution in broth, and the checkerboard method in broth trays was used to assess the efficacy of antibiotic combination therapy. Results. Fifty per cent of the strains of coagulase-negative Staphylococcus spp. and 37% of S. aureus strains, which are the main pathogens involved in neonatal sepsis, were resistant to methycillin. Of these strains, 94.5% were resistant to several antibiotics. Four strains of coagulase-negative Staphylococcus spp. and one strain of Enterococcus faecium were resistant to vancomycin (minimal inhibitory concentration = 128 g/mL). We having a synergistic effect in vitro, whereas antagonic reactions were seen in close association with a highly significant probability of clinical therapeutic failure. Discussion. The main cause of neonatal sepsis in the Neonatal Intensive Care Unit at "América Arias" Hospital in Havana, Cuba, were strains of Staphylococcus resistant to methycillin and other antibiotics. In seriously ill patients (according to policy established at this institution), the first line of treatment is a combination of an aminoglycoside antibiotic and a beta-lactamic antibiotic. This study showed that the clinical efficacy of combination antibiotic therapy is not determined by the resistance pattern of the strain and that good clinical results can be attained, in all likelihood, when a synergistic effect can be shown in vitro

Frecuencia de aislamiento de streptococcus agalactiae en un grupo de embarazadas y sus productos / Frequency of isolation of streptococus agalactiae in pregnant women and their offspring

Se estudiaron 86 madres y 61 de sus recien nacidos con el fin de determinar la frecuencia de aislamiento de Streptococcus agalactiae (esptreptococo beta hemolitico del grupo B); no se aislo el germen de ninguno de los cultivos tomados de las secreciones del cuello uterino pero si a partir de las muestras faringeas, en tres de las madres (3.4%) y en dos de sus hijos. El tercer nino no se estudio porque su nacimiento ocurrio por cesarea. Las cifras encontradas en el presente trabajo estan de acuerdo con lo que relata la literatura, pero el bajo numero de casos estudiado no permite hacer consideraciones epidemiologicas mas profundas

A group of 88 pregnant women and 61 of their newborn Infants was studied In order to determine the frequency of isolation of Streptococcus agalactiae; all genital maternal cultures were negative but 3 mothers and 2 Infants had positive pharyngeal secretions; no evidence of streptococcal disease was found in the colonized Infants. The frequency of colonization found in this study agrees with that reported by other authors but the reduced number of cases does not allow In depth epidemiological considerations.