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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Optimizing antimicrobial therapy for gram-positive bloodstream infections in patients on hemodialysis

Amy Barton Pai1, Manjunath P Pai

  • 1Department of Pharmacy and Nephrology, University of New Mexico College of Pharmacy, Albuquerque, NM 87131, USA. abpai@salud.unm.edu

Advances in Chronic Kidney Disease
|July 4, 2006
PubMed

Insights

Gram-positive infections are common in hemodialysis patients, leading to resistance against crucial antibiotics like vancomycin. Understanding antimicrobial pharmacokinetics is vital for effective treatment and avoiding side effects.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Gram-positive bacterial infections are a significant cause of illness and death in hemodialysis patients.
  • Widespread antimicrobial use in this population has led to increasing resistance, particularly in Enterococcus spp. and Staphylococcus aureus.
  • Emerging resistance to vancomycin and newer agents like linezolid and daptomycin poses a therapeutic challenge.

Purpose of the Study:

  • To review mechanisms of antimicrobial resistance in common gram-positive organisms.
  • To discuss pharmacokinetic and pharmacodynamic principles of key antimicrobial agents.
  • To explore the application of these principles in treating bloodstream infections in hemodialysis patients.

Main Methods:

  • Literature review focusing on antimicrobial resistance mechanisms.
  • Analysis of pharmacokinetic and pharmacodynamic data for selected antibiotics.
  • Discussion of clinical applications in hemodialysis patients.

Main Results:

  • Gram-positive organisms, including Enterococcus spp. and Staphylococcus aureus, exhibit increasing resistance to vancomycin and newer antibiotics.
  • Antimicrobial pharmacokinetics and pharmacodynamics are significantly altered in patients with chronic kidney disease.
  • Understanding these altered profiles is crucial for optimizing treatment efficacy.

Conclusions:

  • Antimicrobial resistance in gram-positive pathogens is a growing concern in hemodialysis.
  • Tailoring antimicrobial therapy based on pharmacokinetic and pharmacodynamic principles is essential for effective treatment and minimizing adverse events.
  • Further research and careful drug selection are needed to manage infections in this vulnerable patient group.

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