Antibiotic dosing in the 'at risk' critically ill patient: Linking pathophysiology with pharmacokinetics/pharmacodynamics in sepsis and trauma patients

Background

Critical illness, mediated by trauma or sepsis, can lead to physiological changes that alter the pharmacokinetics of antibiotics and may result in sub-therapeutic concentrations at the sites of infection. The first aim of this project is to identify the clinical characteristics of critically ill patients with significant trauma that have been recently admitted to ICU that may predict the dosing requirements for the antibiotic, cefazolin. The second aim of this is to identify the clinical characteristics of critically ill patients with sepsis that may predict the dosing requirements for the combination antibiotic, piperacillin-tazobactam.

Methods/Design

This is an observational pharmacokinetic study of patients with trauma (cefazolin) or with sepsis (piperacillin-tazobactam). Participants will have samples from blood and urine, collected at different intervals. Patients will also have a microdialysis catheter inserted into subcutaneous tissue to measure interstitial fluid penetration of the antibiotic. Participants will be administered sinistrin, indocyanine green and sodium bromide as well as have cardiac output monitoring performed and tetrapolar bioimpedance to determine physiological changes resulting from pathology. Analysis of samples will be performed using validated liquid chromatography tandem mass-spectrometry. Pharmacokinetic analysis will be performed using non-linear mixed effects modeling to determine individual and population pharmacokinetic parameters of antibiotics.

Discussion

The study will describe cefazolin and piperacillin-tazobactam concentrations in plasma and the interstitial fluid of tissues in trauma and sepsis patients respectively. The results of this study will guide clinicians to effectively dose these antibiotics in order to maximize the concentration of antibiotics in the interstitial fluid of tissues.     

Effect of temperature on seed production in the invasive grass Glyceria maxima (Hartm.) Holmb. (Poaceae) in South Africa

Temperature is one of the main factors that determine sexual reproduction in terrestrial and emergent aquatic plant species. The effect of temperature on sexual reproduction and seed production of Glyceria maxima (Hartm.) Holmb. in the southern hemisphere is unknown. Glyceria maxima collections in February 2010 at three isolated infestations in KwaZulu-Natal failed to yield a single seed, only empty panicles. Laboratory experiments showed that vernalisation had no consistent effect on seed production. Field- and laboratory-grown plants produced seeds in the 2010/2011 season, because of having sufficient time at optimum temperatures required for seed production (1 491 and 1 585 hours, respectively), compared to a shorter period (1 352 hours) of suitable temperatures during the 2009/2010 growing season. An inadequate period of optimum temperatures (15–25°C) during seed production resulted in the lack of seeds in the field in the 2009/2010 growing season. This study showed that temperature and duration of exposure thereto during the seed-production period play vital roles in G. maxima sexual reproduction.     

Regional changes in amino acid content in developing rat brain

Abstract— The content of several amino acids was measured in five discrete regions of the central nervous system of the developing rat, using a [³H]dansylation assay procedure. Both regional differences in amino acid content and regional differences in rate of change of amino acids during maturation were found. Particularly prominent were the maturational changes and high adult contents of glutamic acid in the cerebral cortex, GABA in the hypothalamus, and aspartic acid in the medulla.     

1-Thio-beta-D-galactofuranosides: synthesis and evaluation as beta-D- galactofuranosidase inhibitors

Beta-D-galactofuranosidase is a good chemotherapeutic target for the design of inhibitors, since beta-D-galactofuranose is a constituent of important parasite glycoconjugates but is not present in the host mammals. With this aim, we have synthesized for the first time alkyl, benzyl and aryl 1-thio-beta-D-galactofuranosides by condensation of penta-O-benzoyl-alpha,beta-D-galactofuranose with the corresponding thiols, in the presence of SnCl4as catalyst. The complete chemical and spectroscopical characterization of these compounds showed that the reaction was stereoselective. Debenzoylation with sodium methoxide afforded the beta-S-galactofuranosides in high yield. The thioglycosides were tested as inhibitors of the beta-D- galactofuranosidase of Penicillium fellutanum, using for the first time 4-nitrophenyl-beta-D-galactofuranoside as chromogenic substrate. The 4- aminophenyl-1-thio-beta-D-galactofuranoside, obtained by catalytic hydrogenation of the nitrophenyl derivative, was the best inhibitor being then an adequate ligand for the preparation of an affinity phase aimed at the isolation of beta-d-galactofuranosidases from different sources. Also the inhibitory activity of d-galactono-1, 4-lactone was shown.      

Persistent nuclear ribosomal DNA sequence polymorphism in the Amelanchier agamic complex (Rosaceae)

Individual plants of several Amelanchier taxa contain many polymorphic nucleotide sites in the internal transcribed spacers (ITS) of nuclear ribosomal DNA (nrDNA). This polymorphism is unusual because it is not recent in origin and thus has resisted homogenization by concerted evolution. Amelanchier ITS sequence polymorphism is hypothesized to be the result of gene flow between two major North American clades resolved by phylogenetic analysis of ITS sequences. Western North American species plus A. humilis and A. sanguinea of eastern North America form one clade (A), and the remaining eastern North American Amelanchier make up clade B. Five eastern North American taxa are polymorphic at many of the nucleotide sites where clades A and B have diverged and are thought to be of hybrid origin, with A. humilis or A. sanguinea as one parent and various members of clade B as the other parent. Morphological evidence suggests that A. humilis is one of the parents of one of the polymorphic taxa, a microspecies that we refer to informally as A. "erecta." Sequences of 21 cloned copies of the ITS1- 5.8S gene-ITS2 region from one A. "erecta" individual are identical to A. humilis sequence or to the clade B consensus sequence, or they are apparent recombinants of A. humilis and clade B ITS repeats. Amelanchier "erecta" and another polymorphic taxon are suspected to be relatively old because both grow several hundred kilometers beyond the range of one of their parents. ITS sequence polymorphisms have apparently persisted in these two taxa perhaps because of polyploidy and/or agamospermy (asexual seed production), which are prevalent in the genus.      

Digestion by the larva of the pruinose scarab, Sericesthis geminata

An in vitro study of digestion by the subterranean larva of S. geminata revealed the presence of enzymes able to digest starch, trehalose, salicin, cellobiose, melibiose, maltose, sucrose, casein, and several forms of cellulose. The midgut is the major source of all enzymes except invertase and CMC-cellulase, for which hindgut preparations are more active. The pH values of the gut contents are: foregut 6.9, midgut 9.0 and hindgut 7.5. The midgut fluid is pumped forward into the foregut, and the carbohydrases in it are generally more active at the pH of the foregut than at the pH of the midgut. It is possible, therefore, that the foregut, which is itself insignificant as a source of enzymes, is the site of considerable carbohydrate digestion. The proteinase is inhibited 28% by trypsin inhibitors.

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Zusammenfassung Eine in vitro-Untersuchung über die Verdauungsvorgänge in den unterirdisch lebenden Larven von S. geminata wies Enzyme nach, die Stärke, Trehalose, Salicin, Cellobiose, Melibiose, Maltose, Rohrzucker, Kasein und mehrere Celluloseformen abbauen können. Versuche mit Vorder-, Mittel- und Enddarmextrakten zeigten, daß der Abbau von Rohrzucker und CMC-Cellulose in Ansätzen mit Enddarmpräparaten prozentual am höchsten war. Maximale Verdauung aller anderen geprüften Substrate erfolgte dagegen mit Mitteldarmpräparaten.Die pH-Werte betrugen im Vorderdarm 6,9, im Mitteldarm 9,0 und im Enddarm 7,5. Im Mittel- und Enddarm lagen die jewciligen optimalen pH-Werte für Maltose bei 6,5–7,0 und 7,5, für Melibiose bei 6,0–7,0 und 7,0–7,5, für Cellobiose bei 6,0–7,0 und 4,5, für Rohrzucker bei 7,0 und 6,0, für CMC bei 5,2 und 5,6.Die Verdauung unlöslicher Celluloseformen war durchweg gering, die der CMC dagegen beträchtlich.Die Mitteldarmflüssigkeit wird nach vorn in den Vorderdarm gepumpt. Die darin enthaltenen Carbohydrasen sind beim pH-Wert des Vorderdarmes meistens wirksamer als in dem des Mitteldarmes. Es ist deshalb möglich, daß im Vorderdarm, welcher selbst wahrscheinlich keine Enzyme produziert, doch eine beträchtliche Kohlenhydratverdauung stattfindet.Die Wirksamkeit der Proteinase wird durch bekannte Tryptin-Hemmstoffe um 28% reduziert.