The Latest in Critical Care, 7/10/23 (Issue #8)

Jul 10, 2023

∙ Paid

Continuous meropenem infusion for critically ill patients with sepsis (MERCY trial)

July 16, 2023

Antibiotics have a time-dependent effect on bacteria, so maintaining bacteriocidal concentrations of antibiotics should theoretically help subdue infections better than intermittent dosing. A 2018 meta-analysis reviewed here suggested that prolonged infusion of antipseudomonal beta-lactams reduced mortality by 30% compared with shorter infusions, and mo…

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When to start anticoagulation after ischemic stroke from atrial fibrillation

PulmCCM

Jun 16

It’s been unclear when to start anticoagulation after an ischemic stroke presumed due to thromboembolism from atrial fibrillation. There’s a period of time after ischemic stroke when damaged cerebral blood vessels are susceptible to bleeding. Anticoagulation during this vulnerable period could result in so-called hemorrhagic transformation, worsening b…

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Should platelets be transfused in thrombocytopenic patients before central line placement?

PulmCCM

Jun 16

Central venous catheterization (CVC or central lines), when placed with ultrasound guidance, have a low rate of severe bleeding complications, even in patients with significant thrombocytopenia. Nevertheless, platelets are frequently transfused prior to CVC placement in patients with platelet counts 20,000-50,000/mcL. Is this justified?

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In The News

FDA approved the new intravenous antibiotic sulbactam-durlobactam (Xacduro) for healthcare-associated pneumonia caused by Acinetobacter baumannii-calcoaceticus complex (A. baumannii). Sulbactam is a beta-lactam and durlobactam a beta-lactamase inhibitor. Carbapenem-resistant Acinetobacter infections increased by almost 80% between 2019 and 20…

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