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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EResults of a large case series of broad spectrum \u03b2-lactam agents in obese noncritically ill patients with infection treated using standard dose regimens showed insufficient measured serum concentrations to treat difficult-to-treat pathogens. This article presents a poster [Hites et al. ICAAC 2012 a-637] that suggested altered pharmacokinetics in obese patients may be responsible.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEmerging Therapies\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBacterial Infections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EResults of a large case series of broad spectrum \u03b2-lactam agents in obese noncritically ill patients with infection treated using standard dose regimens showed insufficient measured serum concentrations to treat difficult-to-treat pathogens. Maya Hites, MD, H\u00f4pital Erasme, Brussels, Belgium, presented a poster [Hites et al. ICAAC 2012 a-637] that suggested altered pharmacokinetics (PKs) in obese patients may be responsible.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThis prospective study was conducted between October 2011 and May 2012 at a single institution. All consecutive adult (\u0026gt;18 years of age) obese (body mass index [BMI] \u226530 kg\/m\u003Csup\u003E2\u003C\/sup\u003E) patients with acute infection treated with standard doses of broad spectrum \u03b2-lactams (cefepime or ceftazidime [CEF], piperacillin-tazobactam [TZP], or meropenem [MEM]) were enrolled (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12902\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12902\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12902\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EStandard Doses of \u03b2-lactams Adapted to Renal Function.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003ETwo serum samples were taken during the elimination phase after 30 minutes of intravenous \u03b2-lactam infusion to estimate PK and calculate the percentage of time spent above minimum inhibitory concentration (MIC). Serum drug concentrations were measured with high-pressure liquid chromatography. Adequate therapy was defined as a serum concentration 4 to 8 times the MIC for difficult-to-treat Gram-negative bacteria (eg, for \u003Cem\u003EPseudomonas aeruginosa\u003C\/em\u003E, optimal time\u0026gt;MIC: \u0026gt;70% for CEF, \u0026gt;50% for TZP, or \u0026gt;40% for MEM).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThirteen men and 16 women were enrolled in the study. Subjects were a mean age of 64 years. Mean BMI and creatinine clearance were 35 kg\/m\u003Csup\u003E2\u003C\/sup\u003E and 91.5 mL\/min, respectively. Comorbidities included chronic obstructive pulmonary disease (13.8%), diabetes (41%), cardiomyopathy (48%), renal insufficiency (21%), and neoplasia (41%); 28% of patients reported no comorbidities. The sites of infection included the abdomen (48%), skin (21%), urinary tract (17%), lung (10%), and other (4%).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThirty-eight drug levels were obtained from the 29 patients treated with standard-dose regimens; 10 serum drug concentrations were obtained in 5 of these patients who were treated with an increased dose regimen (1 g every 6 hours of MEM as a 3-hour infusion and a median of 22 g\/day TZP as a continuous infusion). Twenty-nine of 38 serum drug concentrations (3\/5 CEF, 10\/11 MEM, 16\/22 TZP) were insufficient to treat difficult-to-treat pathogens. Four of 10 serum drug concentrations in 5 patients treated with increased drug regimens were adequate (1\/2 MEM, 3\/8 TZP).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EProf. Hites concluded that recommended dosage regimens of broad spectrum \u03b2-lactam agents for obese noncritically ill patients needs to be reconsidered.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/14\/28.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn9u2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzn9u2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}