Risk Factors For C-reactive Protein Research Articles

Population Pharmacokinetics and AUC-Guided Dosing of Tobramycin in the Treatment of Infections Caused by Glucose-Nonfermenting Gram-Negative Bacteria

PurposeTobramycin (TOB) exhibits variable pharmacokinetic properties due to the clinical condition of patients. This study aimed to investigate the AUC-guided dosing of TOB based on population pharmacokinetic analysis in the treatment of infections caused by Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia. MethodsThis retrospective study was conducted between January 2010 and December 2020 after obtaining approval from our institutional review board. For 53 patients who received therapeutic drug monitoring of TOB, a population pharmacokinetic model was developed with covariates of estimated glomerular filtration rate using serum creatinine (eGFRcre) on clearance (CL) and weight on both CL and Vd in exponential error modeling (CL = 2.84 × [weight/70] × eGFRcre0.568, interindividual variability [IIV] = 31.1%; Vd = 26.3 × [weight/70], IIV = 20.2%; residual variability = 28.8%). FindingsThe final regression model for predicting 30-day mortality was developed with risk factors of AUC during a 24-hour period after the first dose to MIC ratio (odds ratio [OR] = 0.996; 95% CI, 0.968–1.003) and serum albumin (OR = 0.137; 95% CI, 0.022–0.632). The final regression model for predicting acute kidney injury was developed with the risk factors of C-reactive protein (OR = 1.136; 95% CI, 1.040–1.266) and AUC during a 72-hour period after the first dose (OR = 1.004; 95% CI, 1.000–1.001). A dose of 8 or 15 mg/kg was beneficial for achievement of AUC during a 24-hour period after the first dose/MIC >80 and trough concentration <1 µg/mL in patients with preserved kidney function and TOB CL >4.47 L/h/70 kg in the events of MIC of 1 or 2 µg/mL, respectively. We propose that the first dose of 15, 11, 10, 8, and 7 mg/kg for eGFRcre >90, 60 to 89, 45 to 59, 30 to 44, and 15 to 29 mL/min/1.73 m2 be followed by therapeutic drug monitoring at peak and 24 hours after the first dose. ImplicationsThis study suggests that TOB use encourages the replacement of trough- and peak-targeted dosing with AUC-guided dosing.

Http://www.openaccessjournals.com/articles/mesenchymal-stem-cells-in-the-reconstruction-surgery-of-the-supraspinatus-muscle-lesions-12130.html

Objective: Percutaneous endoscopic gastrostomy has been widely adopted, and its use is increasing in Japan due to the rapid aging of society and promotion of medical care at home. Percutaneous endoscopic gastrostomy is performed in patients with a variety of underlying basic diseases. Therefore, a procedure that is safe and less burdensome for the patient is required. Material and methods: We studied a percutaneous endoscopic gastrostomy procedure that is both safe and less burdensome, in 260 patients undergoing gastrostomy in our department. The items studied were postoperative risk factors for fever, postoperative risk factors for elevated leukocyte count, and risk factors for C-reactive protein (CRP) elevation. Results: Serious complications were fewer with the three-point fixing method of the abdominal and gastric walls. Multivariate analysis indicated that the conventional Pull method was an independent risk factor for fever (P<0.0001), and the bedridden state of the patient was a risk factor for leukocyte elevation. High Prognostic Nutrition Index (PNI) was an independent risk factor for CRP elevation. Conclusions: Percutaneous endoscopic gastrostomy performed with the Modified Introducer method by fixing the abdominal and gastric walls showed fewer complications and reduced burden on the patient compared to other methods.