A multifaceted strategy to optimize pharmacokinetics of antimicrobial therapy in patients with hospital-acquired infections-a monocentre quality improvement project.

Objective: We assessed the efficacy of a quality improvement programme to optimize the delivery of antimicrobial therapy in critically ill patients with hospital-acquired infections (HAI).

Patients And Methods: Before-after trial in a university hospital in France. Consecutive adults receiving systemic antimicrobial therapy for HAI were included.

Feasibility and impact of the implementation of a clinical scale-based sedation-analgesia protocol in severe burn patients undergoing mechanical ventilation. A before-after bi-center study.

Background: Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients.

Methods: We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24h of invasive mechanical ventilation.

Efficacy and tolerability of a cocktail of bacteriophages to treat burn wounds infected by Pseudomonas aeruginosa (PhagoBurn): a randomised, controlled, double-blind phase 1/2 trial.

Background: Wound infections are the main cause of sepsis in patients with burns and increase burn-related morbidity and mortality. Bacteriophages, natural bacterial viruses, are being considered as an alternative therapy to treat infections caused by multidrug-resistant bacteria. We aimed to compare the efficacy and tolerability of a cocktail of lytic anti-Pseudomonas aeruginosa bacteriophages with standard of care for patients with burns.

Perineal burn care: French working group recommendations.

Objectives: Burns to the perineum are frequently exposed to faeces. Diverting colostomy is often described to prevent faecal soiling. Because this technique is invasive with frequent complications, use of non-surgical devices including specifically designed faecal management systems has been reported in perineal burns.

Antibiotics and the burn patient.

Infection is a major problem in burn care and especially when it is due to bacteria with hospital-acquired multi-resistance to antibiotics. Moreover, when these bacteria are Gram-negative organisms, the most effective molecules are 20 years old and there is little hope of any new product available even in the distant future. Therefore, it is obvious that currently available antibiotics should not be misused.

Klebsiella pneumoniae clinical isolate coproducing SHV-2a, DHA-1, QnrB4, and AAC(6')-Ib-cr determinants in France.

We report on a Klebsiella pneumoniae clinical isolate coproducing bla(DHA-1), bla(SHV-2a), qnrB4, and aac(6')-Ib-cr genes. Molecular analysis demonstrated the presence of this combination on the same large plasmid. Despite a negative result for extended-spectrum beta-lactamase (ESBL) by Vitek2(R) system (bioMérieux, Marcy-l'Etoile, France), an ESBL was detected by a double-disk test.

Influence of glomerular filtration rate on the clearance of vancomycin administered by continuous infusion in burn patients.

The relationship between clearance of vancomycin administered by continuous infusion and the glomerular filtration rate (GFR) estimated by creatinine clearance (CL(Cr)) was investigated in a large cohort of burn patients. Individual vancomycin clearance (CL(Van)) was estimated from the ratio between the rate of infusion and the plasma concentration at steady state for 70 patients (149 samples). The average value of CL(Van) (7.

Effect of systematic empiric treatment with imipenem on the bacterial ecology in a burns unit.

This study took place over 18 months and was divided into three 6 month periods. During the first and third periods, the bacterial ecology of the unit was reviewed, including the observation of bacteria which were isolated and led us to prescribe general antimicrobial therapy, and record the subsequent antibiograms that became available. During the second 6 month period, any patient developing an infection due (or possibly due) to a "Gram negative" strain received imipenem (as beta lactam antimicrobial agent), usually combined with tobramycin.