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Prolonged Infusion Beta-lactam Therapy in Patients with Ventilator Associated Pneumonia: Pilot Study
정치량,박승용,김유지,김소리,박성주,이용철,이흥범 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-
Although intermittent bolus antibiotic therapy is currently the standard of practice for pneumonia, β-lactams exhibit time-dependent bacterial killing. Use of a prolonged infusion has been advocated for maximizing the time above the MIC compared with intermittent bolus dosing. To examine the clinical properties of the β-lactam antibiotics and the rationale for their prolonged infusion, and to validate reasons that this mode of administration may be replaced intermittent infusion as the standard of practice in ventilator associated pneumonia (VAP). 17 patients, who were diagnosed VAP with gram negative pathogens were examined by chart review observational retrospective study in academic medical intensive care unit in Chonbuk national university hospital. Each received β-lactams by prolonged infusion over 3 hours q8h were assigned. 12 patients have changed to cefepime prolonged infusion, another 5 patient treated with ceftazidime. Negative microbial conversion identified in 4 patients (4/12, 33%). Radiologic improvement disclosed in 10 patients (10/17, 59%). Laboratory findings improved as fol-lows; white blood cell count (12/17, 71%), high sensitive C-reactive protein level (12/17, 71%), procalcitonin level (7/15, 47%). Renal impairment reported in 4 patients (5/17, 29%). Prolonged infusion β-lactam antibiotics may have value in VAP subsets of patients, such as those with highly-resistant Gram-negative infections. The safety profile were acceptable, therefore further enrollment should be scheduled.
정치량 ( Chi Ryang Chung ),홍윤경 ( Yun Kyung Hong ),김소영 ( So Young Kim ),최영훈 ( Yung Hun Choi ),나영균 ( Young Gyun Na ),박승용 ( Seung Yong Park ),황정환 ( Heong Hwan Hwang ),문희 ( Hee Moon ),오호준 ( Ho Jun Oh ),이석 ( 전북대학교 의과학연구소 2005 全北醫大論文集 Vol.29 No.2
Background: An alteration in the balance between a T-helper type 2 cell (Th2) response and a T-helper type 1 cell (Th1) response may predispose to the development of bronchial asthma. IL-18 has an ability to promote both Th1 and Th2 responses depending on the surrounding cytokine environment. Reactive oxygen species (ROS) play a crucial role in the pathogenesis of airway inflammation and hyperresponsiveness. Objective: An aim of the present study was to determine the effect of ROS on the regulation of IL-18 expression. Methods: We used a C57BL/6 mouse model of allergic asthma to examine effects of antioxidants on the regulation of IL-18 expression. Our present study with ovalbumin (OVA)- induced murine model of asthma revealed that ROS production in cells from bronchoalveolar lavage (BAL) fluids was increased, and that administration of L-2-oxothiazolidine-4-carboxylic acid (OTC) or α-lipoic acid reduced the increased levels of ROS, the increased expression of IL-18 protein and mRNA, airway inflammation, and bronchial hyperresponsiveness. Our results also showed that antioxidants down-regulated a transcription factor, nuclear factor-kB (NF-kB) activity. Conclusion: These results indicate that antioxidants may inhibit LL-18 expression in asthma by inhibiting activity of NF-kB, and suggest that ROS regulate the LL-18 expression.