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2. Antimicrobial stewardship, therapeutic drug monitoring and infection management in the ICU: results from the international A- TEAMICU survey

Author

Lanckohr, Christian, Boeing, Christian, Waele, Jan J. De, Lange, Dylan W. de, Schouten, J.A., Prins, Menno, Morris, Andrew Conway, and Bracht, Hendrik

Subjects
All institutes and research themes of the Radboud University Medical Center, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
Abstract

Contains fulltext : 237020.pdf (Publisher’s version ) (Open Access)

Published
2021

3. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis

Author

Pappas, Peter G., Rotstein, Coleman M. F., Betts, Robert F., Nucci, Marcio, Talwar, Deepak, Waele, Jan J. De, Vazquez, Jose A., Dupont, Bertrand F., Horn, David L., Ostrosky-Zeichner, Luis, Reboli, Annette C., Suh, Byungse, Digumarti, Raghunadharao, Wu, Chunzhang, Kovanda, Laura L., Arnold, Leah J., and Buell, Donald N.

Subjects
Caspofungin -- Dosage and administration, Caspofungin -- Research, Candidiasis -- Care and treatment, Health, Health care industry
Published
2007

4. Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

Author

Bus, Liesbet De, Depuydt, Pieter, Steen, Johan, Dhaese, Sofie, Smet, Ken De, Tabah, Alexis, Akova, Murat, Cotta, Menino Osbert, Pascale, Gennaro De, Dimopoulos, George, Fujitani, Shigeki, Garnacho-Montero, Jose, Leone, Marc, Lipman, Jeffrey, Ostermann, Marlies, Paiva, José-Artur, Schouten, Jeroen, Sjövall, Fredrik, Timsit, Jean-François, Roberts, Jason A., Zahar, Jean-Ralph, Zand, Farid, Zirpe, Kapil, Waele, Jan J. De, Rios, Fernando, Vazquez, Alejandro Risso, Vidal, Maria Gabriela, Zakalik, Graciela, Attokaran, Antony George, Banakh, Iouri, Dey-Chatterjee, Smita, Ewan, Julie, Ferrier, Janet, Forbes, Loretta, Fourie, Cheryl, Leditschke, Anne, Murray, Lauren, Eller, Philipp, Biston, Patrick, Bracke, Stephanie, Crop, Luc De, Schryver, Nicolas De, Frans, Eric, Spapen, Herbert, Malderen, Claire Van, Vansteelandt, Stijn, Vermeiren, Daisy, Arévalo, Elias Pablo, Crespo, Mónica, Flores, Roberto Zelaya, Píza, Petr, Tutillo, Diego Morocho, Elme, Andreas, Kallaste, Anne, Starkopf, Joel, Bourenne, Jeremy, Calypso, Mathieu, Cohen, Yves, Dahyot-Fizelier, Claire, Depret, François, Guillot, Max, Imzi, Nadia, Jochmans, Sebastien, Kouatchet, Achille, Lepape, Alain, Martin, Olivier, Heim, Markus, Schaller, Stefan J, Arvaniti, Kostoula, Bekridelis, Anestis, Ioannidis, Panagiotis, Mitrakos, Cornelia, Papanikolaou, Metaxia N., Pouriki, Sofia, Vemvetsou, Anna, Abraham, Babu, Bhattacharya, Pradip Kumar, Budugu, Anusha, Dixit, Subhal, Gurav, Sushma, Kandanuri, Padmaja, Prabhu, Dattatray Arun, Rathod, Darshana, Savaru, Kavitha, Udupa, Ashwin Neelavar, Varghese, Sunitha Binu, Bakhodaei, Hossein Haddad, Dabiri, Gholamreza, Fallahi, Mohammad Javad, Feiz, Farnia, Firoozifar, Mohammad, Khaloo, Vahid, Maghsudi, Behzad, Masjedi, Mansoor, Nikandish, Reza, Sabetian, Golnar, Marsh, Brian, Martin-Loeches, Ignacio, Steiner, Jan, Barbagallo, Maria, Caricato, Anselmo, Cortegiani, Andrea, D’Andrea, Rocco, Deana, Cristian, Donati, Abele, Girardis, Massimo, Mandalà, Giuliana, Panarello, Giovanna, Pasero, Daniela, Pelagalli, Lorella, Soave, Paolo Maurizio, Spadaro, Savino, Fujita, Yoshihito, Fujiwara, Shinsuke, Hara, Yuya, Hashi, Hideki, Hashimoto, Satoru, Hashimoto, Hideki, Hayakawa, Katsura, Inoue, Masash, Isokawa, Shutaro, Kameda, Shinya, Kamohara, Hidenobu, Kanamoto, Masafumi, Katayama, Shinshu, Kawagishi, Toshiomi, Kawano, Yasumasa, Kida, Yoshiko, Kita, Mami, Kobayashi, Atsuko, Kuriyama, Akira, Naito, Takaki, Nashiki, Hiroshi, Nishiyama, Kei, Shindo, Shunsuke, Suzuki, Taketo, Takaba, Akihiro, Tanaka, Chie, Tetsuya, Komuro, Tomioka, Yoshihiro, Yanagawa, Youichi, Yoshida, Hideki, Adnan, Syamhanin, Hasan, Mohd Shahnaz, Sulaiman, Helmi, Lopez, Gilberto A. Gasca, Hernández-Cárdenas, Carmen M., Ñamendys-Silva, Silvio A., Bethlehem, Carina, Lange, Dylan de, Hunfeld, Nicole, Numan, Sandra, Leeuwen, Henk van, Owens, Daniel, Almeida, Mónica, Fragoso, Elsa, Leonor, Tiago, Pereira, José-Manuel, Filipescu, Daniela, Grigoras, Ioana, Popescu, Mihai, Tomescu, Dana, Alshahrani, Mohammed S., Alvarez-Gonzalez, Manuel, Barrero-García, Irene, Blasco-Navalpotro, Miguel Angel, Claverias, Laura, Estella, Ángel, Espina, Lorena Forcelledo, Garmendia, Jose Luis Garcia, Prieto, Emilio García, Gómez-Prieto, Gracia, Conde, Carlos Jiménez, Sagasti, Fernando Martinez, Cantero, Alicia Muñoz, Orejas-Gallego, Alberto, Papiol, Elisabeth, Pérez-Civantos, Demetrio, Laderas, Juan Carlos Pozo, Álvarez, Josep Trenado, Vera-Artázcoz, Paula, Cortés, Pablo Vidal, Oldner, Anders, Spångfors, Martin, Alp, Emine, Köksal, Iftihar, Korten, Volkan, Özveren, Arife, Hall, Anna, Hatton, Kevin W., Laudanski, Krzysztof, other, and, Bus, Liesbet De, Depuydt, Pieter, Steen, Johan, Dhaese, Sofie, Smet, Ken De, Tabah, Alexis, Akova, Murat, Cotta, Menino Osbert, Pascale, Gennaro De, Dimopoulos, George, Fujitani, Shigeki, Garnacho-Montero, Jose, Leone, Marc, Lipman, Jeffrey, Ostermann, Marlies, Paiva, José-Artur, Schouten, Jeroen, Sjövall, Fredrik, Timsit, Jean-François, Roberts, Jason A., Zahar, Jean-Ralph, Zand, Farid, Zirpe, Kapil, Waele, Jan J. De, Rios, Fernando, Vazquez, Alejandro Risso, Vidal, Maria Gabriela, Zakalik, Graciela, Attokaran, Antony George, Banakh, Iouri, Dey-Chatterjee, Smita, Ewan, Julie, Ferrier, Janet, Forbes, Loretta, Fourie, Cheryl, Leditschke, Anne, Murray, Lauren, Eller, Philipp, Biston, Patrick, Bracke, Stephanie, Crop, Luc De, Schryver, Nicolas De, Frans, Eric, Spapen, Herbert, Malderen, Claire Van, Vansteelandt, Stijn, Vermeiren, Daisy, Arévalo, Elias Pablo, Crespo, Mónica, Flores, Roberto Zelaya, Píza, Petr, Tutillo, Diego Morocho, Elme, Andreas, Kallaste, Anne, Starkopf, Joel, Bourenne, Jeremy, Calypso, Mathieu, Cohen, Yves, Dahyot-Fizelier, Claire, Depret, François, Guillot, Max, Imzi, Nadia, Jochmans, Sebastien, Kouatchet, Achille, Lepape, Alain, Martin, Olivier, Heim, Markus, Schaller, Stefan J, Arvaniti, Kostoula, Bekridelis, Anestis, Ioannidis, Panagiotis, Mitrakos, Cornelia, Papanikolaou, Metaxia N., Pouriki, Sofia, Vemvetsou, Anna, Abraham, Babu, Bhattacharya, Pradip Kumar, Budugu, Anusha, Dixit, Subhal, Gurav, Sushma, Kandanuri, Padmaja, Prabhu, Dattatray Arun, Rathod, Darshana, Savaru, Kavitha, Udupa, Ashwin Neelavar, Varghese, Sunitha Binu, Bakhodaei, Hossein Haddad, Dabiri, Gholamreza, Fallahi, Mohammad Javad, Feiz, Farnia, Firoozifar, Mohammad, Khaloo, Vahid, Maghsudi, Behzad, Masjedi, Mansoor, Nikandish, Reza, Sabetian, Golnar, Marsh, Brian, Martin-Loeches, Ignacio, Steiner, Jan, Barbagallo, Maria, Caricato, Anselmo, Cortegiani, Andrea, D’Andrea, Rocco, Deana, Cristian, Donati, Abele, Girardis, Massimo, Mandalà, Giuliana, Panarello, Giovanna, Pasero, Daniela, Pelagalli, Lorella, Soave, Paolo Maurizio, Spadaro, Savino, Fujita, Yoshihito, Fujiwara, Shinsuke, Hara, Yuya, Hashi, Hideki, Hashimoto, Satoru, Hashimoto, Hideki, Hayakawa, Katsura, Inoue, Masash, Isokawa, Shutaro, Kameda, Shinya, Kamohara, Hidenobu, Kanamoto, Masafumi, Katayama, Shinshu, Kawagishi, Toshiomi, Kawano, Yasumasa, Kida, Yoshiko, Kita, Mami, Kobayashi, Atsuko, Kuriyama, Akira, Naito, Takaki, Nashiki, Hiroshi, Nishiyama, Kei, Shindo, Shunsuke, Suzuki, Taketo, Takaba, Akihiro, Tanaka, Chie, Tetsuya, Komuro, Tomioka, Yoshihiro, Yanagawa, Youichi, Yoshida, Hideki, Adnan, Syamhanin, Hasan, Mohd Shahnaz, Sulaiman, Helmi, Lopez, Gilberto A. Gasca, Hernández-Cárdenas, Carmen M., Ñamendys-Silva, Silvio A., Bethlehem, Carina, Lange, Dylan de, Hunfeld, Nicole, Numan, Sandra, Leeuwen, Henk van, Owens, Daniel, Almeida, Mónica, Fragoso, Elsa, Leonor, Tiago, Pereira, José-Manuel, Filipescu, Daniela, Grigoras, Ioana, Popescu, Mihai, Tomescu, Dana, Alshahrani, Mohammed S., Alvarez-Gonzalez, Manuel, Barrero-García, Irene, Blasco-Navalpotro, Miguel Angel, Claverias, Laura, Estella, Ángel, Espina, Lorena Forcelledo, Garmendia, Jose Luis Garcia, Prieto, Emilio García, Gómez-Prieto, Gracia, Conde, Carlos Jiménez, Sagasti, Fernando Martinez, Cantero, Alicia Muñoz, Orejas-Gallego, Alberto, Papiol, Elisabeth, Pérez-Civantos, Demetrio, Laderas, Juan Carlos Pozo, Álvarez, Josep Trenado, Vera-Artázcoz, Paula, Cortés, Pablo Vidal, Oldner, Anders, Spångfors, Martin, Alp, Emine, Köksal, Iftihar, Korten, Volkan, Özveren, Arife, Hall, Anna, Hatton, Kevin W., Laudanski, Krzysztof, and other, and

Abstract

Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60–1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14–1.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.

Published
2020

5. Antimicrobial de-escalation as part of antimicrobial stewardship in intensive care: no simple answers to simple questions-a viewpoint of experts

Author

Waele, Jan J. De, Schouten, Jeroen, Beovic, Bojana, Tabah, Alexis, Leone, Marc, Waele, Jan J. De, Schouten, Jeroen, Beovic, Bojana, Tabah, Alexis, and Leone, Marc

Abstract

Antimicrobial de-escalation (ADE) is defined as the discontinuation of one or more components of combination empirical therapy, and/or the change from a broad-spectrum to a narrower spectrum antimicrobial. It is most commonly recommended in the intensive care unit (ICU) patient who is treated with broad-spectrum antibiotics as a strategy to reduce antimicrobial pressure of empirical broad-spectrum therapy and prevent antimicrobial resistance, yet this has not been convincingly demonstrated in a clinical setting. Even if it appears beneficial, ADE may have some unwanted side effects: it has been associated with prolongation of antimicrobial therapy and could inappropriately be used as a justification for unrestricted broadness of empirical therapy. Also, exposing a patient to multiple, sequential antimicrobials could have unwanted effects on the microbiome. For these reasons, ADE has important shortcomings to be promoted as a quality indicator for appropriate antimicrobial use in the ICU. Despite this, ADE clearly has a role in the management of infections in the ICU. The most appropriate use of ADE is in patients with microbiologically confirmed infections requiring longer antimicrobial therapy. ADE should be used as an integral part of an ICU antimicrobial stewardship approach in which it is guided by optimal specimen quality and relevance. Rapid diagnostics may further assist in avoiding unnecessary initiation of broad-spectrum therapy, which in turn will decrease the need for subsequent ADE.

Published
2020

6. Contributors

Author

Abaterusso, Cataldo, primary, Ahern, Stéphane P., additional, Aisa, Maria Cristina, additional, Albright, Robert C., additional, Alfaro, Vicente, additional, Al-Khafaji, Ali, additional, Allo, Jean-Christophe, additional, Amerling, Richard, additional, Amore, Alessandro, additional, Anderson, Robert J., additional, Andreucci, Michele, additional, Andreucci, Vittorio E., additional, Andrikos, Emilios, additional, Arroyo, Vicente, additional, Arthur, John M., additional, Ash, Stephen R., additional, Assanelli, Emilio, additional, Aucella, Filippo, additional, Bagshaw, Sean M., additional, Balafa, Olga, additional, Balbi, André Luís, additional, Baldwin, Ian, additional, Ballestri, Marco, additional, Bargman, Joanne M., additional, Barletta, Gina-Marie, additional, Barletta, Jeffrey F., additional, Barozzi, Libero, additional, Barsoum, Rashad S., additional, Beaulieu, Monica, additional, Beer-Stolz, Donna, additional, Bellomo, Rinaldo, additional, Bernardo, Jose, additional, Bertolotto, Michele, additional, Bestoso, John T., additional, Betro, Gerard A., additional, Bhattacharya, Mallar, additional, Bihl, Geoffrey R., additional, Blot, Stijn I., additional, Boer, Willem, additional, Boim, Mirian A., additional, Bonello, Monica, additional, Bonventre, Joseph V., additional, Booth, A.D., additional, Bourke, Edmund, additional, Braitberg, George, additional, Brancaccio, Diego, additional, Brendolan, Alessandra, additional, Brezzi, Brigida, additional, Brodie, James C., additional, Brophy, Patrick D., additional, Brown, Ryan, additional, Bucala, Richard, additional, Buckmaster, Jonathan, additional, Budisavljevic, Milos N., additional, Bunchman, Timothy E., additional, Burdmann, Emmanuel A., additional, Bussolati, Benedetta, additional, Butkus, Matthew A., additional, Buzzelli, Daniela, additional, Calzavacca, Paolo, additional, Camussi, Giovanni, additional, Canaud, Bernard, additional, Cano, Noël J.M., additional, Cantaluppi, Vincenzo, additional, Capasso, Giovambattista, additional, Cappelli, Gianni, additional, Carlesso, Eleonora, additional, Casino, Francesco G., additional, Castillo, Leticia, additional, Cerutti, Roberta, additional, Chawla, Lakhmir S., additional, Chionh, Chang Yin, additional, Chiu, Alexander, additional, Chow, May T., additional, Chugh, Kirpal S., additional, Cianciaruso, Bruno, additional, Cignarelli, Mauro, additional, Claessens, Yann-Erick, additional, Clark, John A., additional, Clark, William R., additional, Cohen, David J., additional, Cohen, Scott D., additional, Constable, Peter, additional, Coppo, Rosanna, additional, Corey, Howard E., additional, Cozzolino, Mario, additional, Craig, Maureen, additional, Cramer, Carl H., additional, Crandall, Mark, additional, Cravedi, Paolo, additional, Crepaldi, Carlo, additional, Crew, R. John, additional, Cronin, Donald F., additional, Cruz, Dinna N., additional, Canton, Antonio Dal, additional, Dan, Maurizio, additional, D'Angelo, Angela, additional, Davenport, Andrew, additional, Davies, Andrew R., additional, Dear, James W., additional, Gasperi, Andrea De, additional, Dell'Aquila, Roberto, additional, Rocca, Giorgio Della, additional, Prete, Dorella Del, additional, Delude, Russell L., additional, Depner, Thomas, additional, Derchi, Lorenzo E., additional, Devarajan, Prasad, additional, Waele, Jan J. De, additional, Dhainaut, Jean-François, additional, Diaz-Buxo, José A., additional, Micco, Lucia Di, additional, Divino-Filho, José Carolina, additional, Doernberg, Sarah, additional, Doig, Gordon S., additional, Dries, David J., additional, Drudi, Francesco Maria, additional, Druml, Wilfred, additional, Duke, Graeme, additional, Durward, Andrew, additional, Egi, Moritoki, additional, Esposito, Ciro, additional, Evenepoel, Pieter, additional, Faga, Teresa, additional, Fan, Sheung Tat, additional, Feinfeld, Donald A., additional, Féraille, Eric, additional, Fernández, Javier, additional, Finfer, Simon, additional, Fink, Mitchell P., additional, Finkel, Kevin W., additional, Flessner, Michael F., additional, Formica, Marco, additional, Forni, Lui G., additional, Fortenberry, James D., additional, French, Craig, additional, Fumagalli, Roberto, additional, Furlanut, Mario, additional, Fute, Micheline Djouguela, additional, Gabriel, Daniela Ponce, additional, Galassi, Andrea, additional, Galbusera, Miriam, additional, Galli, Francesco, additional, Galli, Giovanni, additional, Gallieni, Maurizio, additional, Gallo, Giampiero, additional, Gambaro, Giovanni, additional, Gammill, Hilary S., additional, Gangemi, Ezio Nicola, additional, Gao, Dayong, additional, Garwood, Susan, additional, Garzotto, Francesco, additional, Gatti, Antonietta M., additional, Gattinoni, Luciano, additional, Geibel, John P., additional, George, Stephen, additional, Gesualdo, Loreto, additional, Gibney, R.T. Noel, additional, Gipson, Debbie S., additional, Glezerman, Ilya G., additional, Glorieux, Griet, additional, Goldstein, Stuart L., additional, Golper, Thomas A., additional, Gowrishankar, Manjula, additional, Grandi, Fabio, additional, Gregoretti, Cesare, additional, Grinnell, Brian W., additional, Groeneveld, A.B. Johan, additional, Gruber, Steven J., additional, Guadagni, Gualtiero, additional, Gunnerson, Kyle J., additional, Gupta, Akanksha, additional, Gura, Victor, additional, Guzzo, Isabella, additional, Hackbarth, Richard, additional, Halperin, Mitchell L., additional, Harbord, Nikolas, additional, Haymann, Jean-Philippe, additional, Heffner, Alan C., additional, Hennessy, Anthony J., additional, Heyman, Samuel N., additional, Hill, Graham L., additional, Hilton, Philip J., additional, Himmelfarb, Jonathan, additional, Hirasawa, Hiroyuki, additional, Hoenich, Nicholas A., additional, Holdsworth, Stephen R., additional, Holley, Anthony, additional, Honoré, Patrick M., additional, Hoste, Eric A.J., additional, House, Andrew A., additional, Huang, David T., additional, Huang, Zhongping, additional, Hubmayr, Rolf D., additional, Hughes, Alun D., additional, Humes, H. David, additional, Ikizler, T. Alp, additional, Imberti, Barbara, additional, Ing, Todd S., additional, Jaber, Bertrand L., additional, Janvier, Gérard, additional, Jeyabalan, Arundhathi, additional, Jha, Vivekanand, additional, Joannes-Boyau, Olivier, additional, Joannidis, Michael, additional, Jones, Daryl A., additional, Jörres, Achim, additional, Kamel, Kamel S., additional, Kamp, Ryan C., additional, Kannan, Neeta, additional, Kaplan, Lewis J., additional, Karacan, Özgür, additional, Karajala-Subramanyam, Vijay, additional, Kaushal, Gur P., additional, Kellum, John A., additional, Kemper, Markus J., additional, Khan, Asjad, additional, Khanna, Ramesh, additional, Kher, Vijay, additional, Kimmel, Paul L., additional, Kindgen-Milles, Detlef, additional, Kitching, A. Richard, additional, Kjellstrand, Carl M., additional, Kohn, Orly F., additional, Kooienga, Laura A., additional, Kooman, Jeroen P., additional, Kotanko, Peter, additional, Krediet, Raymond T., additional, Kroon, A.A., additional, Kuang, Dingwei, additional, Kuhlmann, Martin K., additional, Kuiper, Jan Willem, additional, Lam, Man-Fai, additional, Lamacchia, Olga, additional, Lameire, Norbert, additional, Langenberg, Christoph, additional, Lauri, Gianfranco, additional, Leblanc, Martine, additional, Ledebo, Ingrid, additional, Lentini, Paolo, additional, Leonard, Edward F., additional, Letteri, Jeffrey J., additional, Leunissen, Karel M., additional, Leverve, Xavier M., additional, Levin, Adeera, additional, Leypoldt, John K., additional, Liangos, Orfeas, additional, Licari, Elisa, additional, Lieberthal, Wilfred, additional, Linden, Peter K., additional, Lipman, Jeffrey, additional, Liu, Kathleen D., additional, Liu, Shiguang, additional, Livigni, Sergio, additional, Lo, Wai-Kei, additional, Lugano, Manuela, additional, Lui, Sing-Leung, additional, Lupo, Antonio, additional, Luyckx, Valerie A., additional, Macias, William L., additional, Madden, Nicholas, additional, Madore, François, additional, Majors, Daniel S., additional, Mancini, Elena, additional, Mangione, Filippo, additional, Mankad, Sunil, additional, Manzini, Pier Paolo, additional, Marangella, Martino, additional, Marenzi, Giancarlo, additional, Mariano, Filippo, additional, Marik, Paul E., additional, Marini, John J., additional, Marquis, François, additional, Marshall, John C., additional, Marshall, Mark R., additional, Mathew, Roy, additional, Matsuda, Kenichi, additional, Matthay, Michael A., additional, Maxvold, Norma J., additional, May, Clive N., additional, McCauley, Jerry, additional, McCunn, Maureen, additional, McKenna, Joseph, additional, Mehta, Ravindra L., additional, Mele, Caterina, additional, Merouani, Aicha, additional, Mesnard, Laurent, additional, Messa, Piergiorgio, additional, Metnitz, Philipp G.H., additional, Misra, Madhukar, additional, Mitzner, Steffen R., additional, Mizock, Barry A., additional, Mokhlesi, Babak, additional, Molitoris, Bruce A., additional, Morelli, Andrea, additional, Morgan, Thomas John, additional, Morigi, Marina, additional, Mount, Peter, additional, Mucelli, Roberto Pozzi, additional, Mueller, Bruce A., additional, Murray, Patrick, additional, Murugan, Raghavan, additional, Nakamura, Masataka, additional, Nalesso, Federico, additional, Nester, Carla M., additional, Nissenson, Allen, additional, Nolph, Karl, additional, Ocampo, Catalina, additional, Oda, Shigeto, additional, Okusa, Mark D., additional, Opal, Steven M., additional, Opdam, Helen, additional, Osswald, Hartmut, additional, Straaten, Heleen M. Oudemans–van, additional, Padalino, Massimo A., additional, Paden, Matthew L., additional, Paganini, Emil P., additional, Palevsky, Paul M., additional, Panat, Mani John, additional, Paolini, Francesco, additional, Parikh, Dipen, additional, Patroniti, Nicolò, additional, Pavlica, Pietro, additional, de La Garanderie, Didier Payen, additional, Pea, Federico, additional, Peng, Zhiyong, additional, Perazella, Mark A., additional, Perego, Angelo F., additional, Pereira, Estela Regina, additional, Pérez, Evans R. Fernández, additional, Perico, Norberto, additional, Pertica, Nicoletta, additional, Pertosa, Giovanni, additional, Peruzzi, Licia, additional, Petras, Dimitris, additional, Pham, Phuong-Chi, additional, Pham, Phuong-Thu, additional, Phoon, Richard K.S., additional, Picca, Stefano, additional, Piccinni, Pasquale, additional, Pinsk, Maury N., additional, Pinsky, Michael R., additional, Piroddi, Marta, additional, Plamondon, Isabelle, additional, Plank, Lindsay D., additional, Plötz, Frans B., additional, Poghosyan, Lusine, additional, Polanco, Natalia, additional, Polanco, Patricio M., additional, Polaschegg, Hans Dietrich, additional, Ponikvar, Rafael, additional, Porecca, Silvia, additional, Portilla, Didier, additional, Powell, T. Brian, additional, Quigley, Raymond, additional, Rabb, Hamid, additional, Ragaller, Maximilian, additional, Rampino, Teresa, additional, Ranpuria, Reena, additional, Rastogi, Anjay, additional, Ratanarat, Ranistha, additional, Raza, Naem, additional, Reade, Michael C., additional, Reeves, John H., additional, Reiter, Karl, additional, Remuzzi, Giuseppe, additional, Ricci, Zaccaria, additional, Ricksten, Sven-Erik, additional, Ridel, Christophe, additional, Rifai, Kinan, additional, Ring, Troels, additional, Riopel, Julie, additional, Rocha, Eduardo, additional, Roessler, Eric, additional, Rona, Roberto, additional, Ronco, Claudio, additional, Rondeau, Eric, additional, Rosen, Seymour, additional, Rosenberger, Christian, additional, Rowan, Shane, additional, Roy, Thomas, additional, Saab, Georges, additional, Sadahiro, Tomohito, additional, Sala, Carla, additional, Sala, Chiara, additional, Salama, Alan D., additional, Salmon, Adrian, additional, Salvatori, Gabriela, additional, Sam, Ramin, additional, Sandoval, Ruben M., additional, Santoro, Antonio, additional, Saotome, Takao, additional, Sappington, Penny L., additional, Sarma, J. Vidya, additional, Savige, Judy, additional, Schena, Francesco Paolo, additional, Schepers, Eva, additional, Schetz, Miet, additional, Schmidt, Gregory A., additional, Schor, Nestor, additional, Schusterschitz, Nicola, additional, Segoloni, Giuseppe, additional, Shah, Nirva, additional, Shah, Shamik H., additional, Shah, Sudhir V., additional, Sharfuddin, Asif A., additional, Shaw, Andrew, additional, Shiga, Hidetoshi, additional, Shoji, Hisataka, additional, Shukla, Ashutosh, additional, Simpson, Fiona, additional, Singbartl, Kai, additional, Singer, Mervyn, additional, Solez, Kim, additional, Sowinski, Kevin M., additional, Stafford-Smith, Mark, additional, Stange, Jan, additional, Stefanelli, Luca, additional, Stein, Deborah M., additional, Stella, Maurizio, additional, Stellin, Giovanni, additional, Story, David A., additional, Subramanian, Sanjay, additional, Swärd, Kristina, additional, Symons, Jordan M., additional, Tai, Kian Bun, additional, Tattersall, James, additional, Tedeschi, Luisa, additional, Teitelbaum, Isaac, additional, Teixeira, Vicente P. Castro, additional, Tetta, Ciro, additional, Thakar, Charuhas V., additional, Theilen, Hermann, additional, Thomas, Karl W., additional, Tolwani, Ashita, additional, Trepiccione, Francesco, additional, Triolo, Giorgio, additional, Tsang, Jennifer L.Y., additional, Tutal, Emre, additional, Uchino, Shigehiko, additional, Unruh, Mark, additional, Vail, G. Matthew, additional, Valentino, Massimo, additional, Vallon, Volker, additional, Van Biesen, Wim, additional, van der Sande, Frank M., additional, Vandijck, Dominique M., additional, Vanholder, Raymond, additional, Varghese, Sanju A., additional, Venkataraman, Ramesh, additional, Venkatesh, Bala, additional, Verbine, Anton, additional, Vincent, Jean-Louis, additional, Vinsonneau, Christophe, additional, Visvanathan, Ravindran, additional, Voinescu, Alexandra, additional, Walters, Scott, additional, Wan, Li, additional, Ward, Peter A., additional, Ward, Richard A., additional, Warrillow, Stephen, additional, Webb, Steve, additional, Whitlow, Kenneth Scott, additional, Wieslander, Anders, additional, Wilkinson, Alan H., additional, Wille, Keith, additional, Winchester, James Frank, additional, Wu, Christine, additional, Yassin, James, additional, Yeun, Jane Y., additional, Yip, Terence Pok-Siu, additional, Yu, Alex W., additional, Zacchia, Miriam, additional, Zaida, Najam, additional, Zamperetti, Nereo, additional, Zappitelli, Michael, additional, and Zarbock, Alexander, additional

Published
2009
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7. Lung penetration, bronchopulmonary pharmacokinetic/pharmacodynamic profile and safety of 3 g of ceftolozane/tazobactam administered to ventilated, critically ill patients with pneumonia.

Author

Caro, Luzelena, Nicolau, David P, Waele, Jan J De, Kuti, Joseph L, Larson, Kajal B, Gadzicki, Elaine, Yu, Brian, Zeng, Zhen, Adedoyin, Adedayo, Rhee, Elizabeth G, and De Waele, Jan J

Subjects
TAZOBACTAM, CRITICALLY ill, PNEUMONIA, LUNGS, BRONCHOALVEOLAR lavage, CEFTAZIDIME, ANTIBIOTICS, RESEARCH, RESEARCH methodology, MEDICAL cooperation, EVALUATION research, CATASTROPHIC illness, CEPHALOSPORINS, COMPARATIVE studies
Abstract

Objectives: Ceftolozane/tazobactam is approved for hospital-acquired/ventilator-associated bacterial pneumonia at double the dose (i.e. 2 g/1 g) recommended for other indications. We evaluated the bronchopulmonary pharmacokinetic/pharmacodynamic profile of this 3 g ceftolozane/tazobactam regimen in ventilated pneumonia patients.Methods: This was an open-label, multicentre, Phase 1 trial (clinicaltrials.gov: NCT02387372). Mechanically ventilated patients with proven/suspected pneumonia received four to six doses of 3 g of ceftolozane/tazobactam (adjusted for renal function) q8h. Serial plasma samples were collected after the first and last doses. One bronchoalveolar lavage sample per patient was collected at 1, 2, 4, 6 or 8 h after the last dose and epithelial lining fluid (ELF) drug concentrations were determined. Pharmacokinetic parameters were estimated by non-compartmental analysis and pharmacodynamic analyses were conducted to graphically evaluate achievement of target exposures (plasma and ELF ceftolozane concentrations >4 mg/L and tazobactam concentrations >1 mg/L; target in plasma: ≥30% and ≥20% of the dosing interval, respectively).Results: Twenty-six patients received four to six doses of study drug; 22 were included in the ELF analyses. Ceftolozane and tazobactam Tmax (6 and 2 h, respectively) were delayed in ELF compared with plasma (1 h). Lung penetration, expressed as the ratio of mean drug exposure (AUC) in ELF to plasma, was 50% (ceftolozane) and 62% (tazobactam). Mean ceftolozane and tazobactam ELF concentrations remained >4 mg/L and >1 mg/L, respectively, for 100% of the dosing interval. There were no deaths or adverse event-related study discontinuations.Conclusions: In ventilated pneumonia patients, 3 g of ceftolozane/tazobactam q8h yielded ELF exposures considered adequate to cover ceftolozane/tazobactam-susceptible respiratory pathogens. [ABSTRACT FROM AUTHOR]

Published
2020
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9. Population pharmacokinetics and evaluation of the predictive performance of pharmacokinetic models in critically ill patients receiving continuous infusion meropenem: a comparison of eight pharmacokinetic models.

Author

Dhaese, Sofie A M, Farkas, Andras, Colin, Pieter, Lipman, Jeffrey, Stove, Veronique, Verstraete, Alain G, Roberts, Jason A, Waele, Jan J De, and De Waele, Jan J

Subjects
PHARMACOKINETICS, CRITICALLY ill patient care, MEROPENEM, DRUG monitoring, CREATININE
Abstract

Background: Several population pharmacokinetic (PopPK) models for meropenem dosing in ICU patients are available. It is not known to what extent these models can predict meropenem concentrations in an independent validation dataset when meropenem is infused continuously.Patients and methods: A PopPK model was developed with concentration-time data collected from routine care of 21 ICU patients (38 samples) receiving continuous infusion meropenem. The predictability of this model and seven other published PopPK models was studied using an independent dataset that consisted of 47 ICU patients (161 samples) receiving continuous infusion meropenem. A statistical comparison of imprecision (mean square prediction error) and bias (mean prediction error) was conducted.Results: A one-compartment model with linear elimination and creatinine clearance as a covariate of clearance best described our data. The mean ± SD parameter estimate for CL was 9.89 ± 3.71 L/h. The estimated volume of distribution was 48.1 L. The different PopPK models showed a bias in predicting serum concentrations from the validation dataset that ranged from -8.76 to 7.06 mg/L. Imprecision ranged from 9.90 to 42.1 mg/L.Conclusions: Published PopPK models for meropenem vary considerably in their predictive performance when validated in an external dataset of ICU patients receiving continuous infusion meropenem. It is necessary to validate PopPK models in a target population before implementing them in a therapeutic drug monitoring program aimed at optimizing meropenem dosing. [ABSTRACT FROM AUTHOR]

Published
2019
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11. Measuring Unbound Versus Total Vancomycin Concentrations in Serum and Plasma

Author

Stove, Veronique, Coene, Louise, Carlier, Mieke, Waele, Jan J. De, Fiers, Tom, and Verstraete, Alain G.

Abstract

Studies on the unbound fraction (fu) of vancomycin report highly variable results. Great controversy also exists about the correlation between unbound and total vancomycin concentrations. As differences in (pre-)analytic techniques may explain these findings, we investigated the impact of the procedure used to isolate unbound vancomycin in serumplasma on fuand the correlation between total and unbound concentrations.

Published
2015
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12. Acute pancreatitis

Author

Waele, Jan J. De

Abstract

To review the changing insights in the pathophysiology and management of acute pancreatitis.

Published
2014
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13. Candidaperitonitis

Author

Blot, Stijn I, Vandewoude, Koenraad H, and Waele, Jan J De

Abstract

The review highlights current insights in the epidemiology, diagnosis and therapy of Candidaperitonitis, focusing on complicated secondary and tertiary peritonitis.

Published
2007
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14. Extrapancreatic Inflammation on Abdominal Computed Tomography as an Early Predictor of Disease Severity in Acute Pancreatitis

Author

Waele, Jan J. De, Delrue, Louke, Hoste, Eric A., De Vos, Martine, Duyck, Philippe, and Colardyn, Francis A.

Abstract

To introduce a new scoring system based on signs of systemic inflammation on computed tomography (CT) ExtraPancreatic Inflammation on CT (EPIC) score and evaluate this score as an early prognostic tool.

Published
2007
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15. Blunt Cardiac Injury in Patients with Isolated Sternal Fractures: the Importance of Fracture Grading

Author

Waele, Jan. J. De, Calle, Paul A. A., Blondeel, Lode, and Vermassen, Frank E. G.

Abstract

Abstract Background: Sternal fractures have long been considered to harbor cardiac injury, although recent studies suggest that the clinical relevance of these injuries is limited. The risk of underlying cardiac injury may be linked to the severity of the fracture. We investigated the relation between the grade of fracture displacement and signs of blunt cardiac injury (BCI) in patients with isolated sternal fractures. Material and Methods: We retrospectively analyzed the available data of 337 patients with sternal fractures, who presented at the Emergency Department of the University Hospital Ghent, Belgium, in a 10-year period. 115 patients had isolated fractures. Fractures were classified according to the grade of displacement. We identified two categories, nondisplaced and displaced fractures. BCI was diagnosed on the basis of electrocardiographic or echocardiographic findings, available in 100% and 96% of patients, respectively. Inhospital arrhythmias were recorded in both patient groups. Results: 32% of patients had BCI. There were 37 patients with displaced fractures (32.1%). These patients showed significantly more signs of BCI (54% vs. 21%; p < 0.01), and had significantly more arrhythmias during hospitalization (23.5% vs. 5.6%; p = 0.017). Conclusion: BCI is common after sternal trauma, and the severity of the fracture is an indicator of possible myo- or pericardial damage. Patients with displaced sternal fractures should be thoroughly investigated for possible BCI.

Published
2002
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17. Adrenal Insufficiency in Severe Acute Pancreatitis

Author

Waele, Jan J. De, Hoste, E., Decruyenaere, J., and Colardyn, F.

Abstract

Relative adrenal insufficiency is common in patients with severe sepsis and septic shock. We describe three patients with severe acute pancreatitis who developed signs suggestive of adrenal insufficiency during the early phase of the disease. Clinical features and possible causes of adrenal insufficiency are discussed.

Published
2003

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