Cephalosporin-Related Neurotoxicity in a Ceftriaxone-Treated Critically Ill Child: A Case Report

Chapter 125 - Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy in Adults and Children

Renal Support for Acute Kidney Injury in the Developing World

Outcomes of Patients with Haematological Malignancies Admitted to Either High Dependency Unit (HDU) or Intensive Care Unit (ICU) with or without Haemopoeitic Stem Cell Transplantation (HSCT): Analysis of Prognostic Factors for Survival

Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases.

Experience with delivery of renal replacement therapy (RRT) in support of combat operations by the U.S. military has not been reported since the 1970s. We describe the tri-service military medical experience with RRT in support of Operation Iraqi Freedom. Through December 31, 2006, RRT was provided to 12 individuals inside the theater of operations. Navy medical personnel provided RRT to three patients (two U.S. active duty service members and one host nation individual) aboard the USNS Comfort, a mobile level 4 hospital. Dialysis was performed using conventional single-pass hemodialysis machines equipped with portable reverse osmosis systems. Army and Air Force medical personnel provided RRT to nine patients in theater (eight host nation patients and one U.S. active duty service member), using peritoneal dialysis and continuous renal replacement therapy (CRRT), not requiring trained renal nurses or technicians. Originally, U.S. military personnel with acute kidney injury (AKI) who were evacuated from theater to Landstuhl Regional Medical Center (LRMC), or those who developed AKI at LRMC were transferred to the German civilian medical system, if RRT was required. After creation of a rapid-response dialysis team and, later, positioning of a full-time active duty reserve nephrologist at LRMC, 16 patients received RRT at LRMC. None had required RRT in theater. Renal failure requiring RRT during combat operations remains an unusual but serious event, calling for flexibility in the provision of care. Notably, the Operation Iraqi Freedom experience has highlighted the needs of injured host nation patients with AKI and future military medical planning will need to account for their intratheater renal care.

In children, stone formation after ceftriaxone (CTRX) therapy by increasing calcium excretion was showed in the literature. In this study, we investigated the effect of CTRX, cephalothin (CP) and ampicillin (AS) therapy on urinary calcium excretion in adults. 180 participants included in the study who divided into six equal groups. The groups were; (1) CTRX therapy in stone free patients, (2) CTRX therapy in patients who have urinary stone; (3) CP therapy in stone free patients, (4) CP therapy in patients with urinary stone, (5) AS therapy in stone free patients, (6) AS therapy in patients with urinary stone. The patients received 2 g/day intravenous CTRX, CP and AS for 5 days in all groups respectively. There were no significant differences in demographic characteristics and blood biochemistry between the groups. Before and 5 days after the antibiotic therapies, the participants were evaluated by 24-h urinary calcium to creatinine ratio. Results were compared between the groups statistically by ANOVA and Tukey test. After drug therapies in group 2 and 4, the excretion of calcium to creatinine ratio in 24-h urine was more than the other groups. We found that both groups of two drugs therapy with or without stones (groups 1, 2, 3, 4), have significantly increased calcium to creatinine ratio in 24-h urine (p < 0.05). We did not find statistically difference in groups 5 and 6, after AS therapy. As a result of the study, we suggest that the patients who have taken antibiotic therapy with CTRX or CP, have an increased risk for the urolithiasis. In addition, we think that these drugs should be used carefully especially in patients with urolithiasis.

Acute kidney injury requiring renal replacement therapy during the COVID-19 pandemic: what are our options for treating it in Latin America?

Influence of renal replacement therapy on outcome of patients with acute renal failure

Objectives: To compare the clinical effectiveness of oral azithromycin versus intravenous (IV) ceftriaxone for treating uncomplicated enteric fever. Methods: Children aged 2-17 years with uncomplicated enteric fever and positive blood cultures for Salmonella typhi were included in the study. These were grouped as Group A (50 cases) and Group B (50 cases). Group A was given oral azithromycin 10 mg/kg/day once a day (azithromycin group) and Group B was given IV ceftriaxone 100 mg/kg/day in 2 divided doses (ceftriaxone group) for 6 and 7 days, respectively. Every day the child was examined, and the study results were assigned as a clinical and microbiological cure or failure. Results: A total of 100 patients in sex ratio of 1.2:1 (male:female) with uncomplicated enteric fever were enrolled in the study. Mean duration to become afebrile was less with azithromycin (2.72 days) as compared to ceftriaxone (5.52 days) treatment (p=0.000). 96% of the cases treated with azithromycin attained defervescence by the 5th day of treatment, but only 27% of cases treated with ceftriaxone attained defervescence by the 5th day of treatment. A clinical cure was earlier with azithromycin than with ceftriaxone treatment (p=0.027). Microbiological cure was achieved in 100% and 98% cases treated with azithromycin and ceftriaxone, respectively (p=0.5). Conclusion: Oral azithromycin was more efficacious in the treatment of uncomplicated enteric fever in children as compared to IV ceftriaxone.

Many recent randomized controlled trials in the field of septic shock failed to demonstrate a benefit on mortality. Randomized controlled trials increasingly report organ support duration and organ support-free days as primary or secondary outcomes. We conducted a methodologic systematic review to assess how organ support outcomes were defined and reported in septic shock randomized controlled trials. MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science. We included randomized controlled trials published between January 2004 and March 2018 that involved septic shock adults and assessed organ support duration and/or organ support-free days for hemodynamic support, respiratory support, or renal replacement therapy. For each randomized controlled trial, we extracted the definitions of organ support duration and organ support-free days. We particularly evaluated how nonsurvivors were accounted for. Study authors were contacted to provide any missing information regarding these definitions. We included 28 randomized controlled trials. Organ support duration and organ support-free days outcomes were reported in 17 and 15 randomized controlled trials, respectively, for hemodynamic support, 15 and 15 for respiratory support, and five and nine for renal replacement therapy. Nonsurvivors were included in the organ support duration calculation in 13 of 14 randomized controlled trials (93%) for hemodynamic support and nine of 10 (90%) for respiratory support. The organ support-free days definition for hemodynamic support, respiratory support, and renal replacement therapy was reported in six of 15 randomized controlled trials (40%), eight of 15 randomized controlled trials (53%), and six of nine randomized controlled trials (67%) reporting an organ support-free days outcome, respectively. Of these, one half assigned "0" to nonsurvivors, and the other half attributed one point per day alive free of organ support up to a predefined time point. This study highlights the heterogeneity and infrequency of organ support duration/organ support-free days outcome reporting in septic shock trials. When reported, the definitions of these outcome measures and methods of calculation are also infrequently reported, in particular how nonsurvivors were accounted for, which may have an important impact on interpretation.

The bioartificial kidney

Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. To examine this phenomenon further, serial gallbladder sonograms were evaluated in 44 adult patients who received intravenous ceftriaxone at 2 g or a placebo daily for 14 days in a double-blind controlled study. Ultrasound examinations of gallbladders were performed on days 1 and 14 of therapy and 2 weeks posttherapy if abnormalities were observed on day 14. Eight patients were unevaluable because of abnormal base-line gallbladder sonograms. Thirty-six patients (ceftriaxone, n = 28; placebo, n = 8) demonstrated normal baseline gallbladder sonograms and were evaluated for the development of change. A total of 6 of 28 (21.4%) ceftriaxone-treated patients and 1 of 8 (12.5%) patients who received the placebo demonstrated abnormal gallbladder sonograms on day 14 (P = 0.491). Four of the six ceftriaxone-treated patients demonstrating abnormal sonograms were clinically asymptomatic, while two patients reported vomiting. The abnormal sonograms of gallbladders of patients treated with ceftriaxone returned to normal between 9 and 26 days posttherapy. These data suggest an association between ceftriaxone treatment and the development of gallbladder abnormalities on ultrasound examination which resolve spontaneously on discontinuation of ceftriaxone therapy.

Early renal replacement therapy (RRT) initiation should theoretically influence many physiological disorders related to acute kidney injury (AKI). Currently, there is no consensus about RRT timing in intensive care unit (ICU) patients. We performed a retrospective analysis of all critically ill patients who received RRT in our ICU during a 3 year-period. Our goal was to identify mortality risk factors and if RRT initiation timing had an impact on survival. RRT timing was calculated from the moment the patient was classified as having acute kidney injury in the RIFLE classification. A hundred and ten patients received RRT. We identified four independent mortality risk factors: need for mechanical ventilation (OR = 12.82 (1.305 - 125.868, p = 0.0286); RRT initiation timing >16 h (OR = 5.66 (1.954 - 16.351), p = 0.0014); urine output on admission <500 ml/day (OR = 4.52 (1.666 - 12.251), p = 0.003); and SAPS II on admission >70 (OR = 3.45 (1.216 - 9.815), p = 0.02). The RRT initiation =16 h and RRT initiation >16 h groups presented the same baseline characteristics, except for more severe gravity scores and kidney failure in the early RRT group. Early RRT in ICU patients with acute kidney injury or failure was associated with increased survival.

Purpose Early renal replacement therapy (RRT) initiation should theoretically influence many physiological disorders related to acute kidney injury (AKI). Currently, there is no consensus about RRT timing in intensive care unit (ICU) patients. Methods We performed a retrospective analysis of all critically ill patients who received RRT in our ICU during a 3 year-period. Our goal was to identify mortality risk factors and if RRT initiation timing had an impact on survival. RRT timing was calculated from the moment the patient was classified as having acute kidney injury in the RIFLE classification. Results A hundred and ten patients received RRT. We identified four independent mortality risk factors: need for mechanical ventilation (OR = 12.82 (1.305 - 125.868, p = 0.0286); RRT initiation timing &gt;16 h (OR = 5.66 (1.954 - 16.351), p = 0.0014); urine output on admission &lt;500 ml/day (OR = 4.52 (1.666 - 12.251), p = 0.003); and SAPS II on admission &gt;70 (OR = 3.45 (1.216 - 9.815), p = 0.02). The RRT initiation &lt;16 h and RRT initiation &gt;16 h groups presented the same baseline characteristics, except for more severe gravity scores and kidney failure in the early RRT group. Conclusions Early RRT in ICU patients with acute kidney injury or failure was associated with increased survival.

Left Ventricular Assist Devices and Renal Ramifications.