Utilizing Monte Carlo Simulations to Optimize Institutional Empiric Antipseudomonal Therapy
AbstractPseudomonas aeruginosa is a common pathogen implicated in nosocomial infections with increasing resistance to a limited arsenal of antibiotics. Monte Carlo simulation provides antimicrobial stewardship teams with an additional tool to guide empiric therapy. We modeled empiric therapies with antipseudomonal β-lactam antibiotic regimens to determine which were most likely to achieve probability of target attainment (PTA) of ≥90%. Microbiological data for P. aeruginosa was reviewed for 2012. Antibiotics modeled for intermittent and prolonged infusion were aztreonam, cefepime, meropenem, and piperacillin/tazobactam. Using minimum inhibitory concentrations (MICs) from institution-specific isolates, and pharmacokinetic and pharmacodynamic parameters from previously published studies, a 10,000-subject Monte Carlo simulation was performed for each regimen to determine PTA. MICs from 272 isolates were included in this analysis. No intermittent infusion regimens achieved PTA ≥90%. Prolonged infusions of cefepime 2000 mg Q8 h, meropenem 1000 mg Q8 h, and meropenem 2000 mg Q8 h demonstrated PTA of 93%, 92%, and 100%, respectively. Prolonged infusions of piperacillin/tazobactam 4.5 g Q6 h and aztreonam 2 g Q8 h failed to achieved PTA ≥90% but demonstrated PTA of 81% and 73%, respectively. Standard doses of β-lactam antibiotics as intermittent infusion did not achieve 90% PTA against P. aeruginosa isolated at our institution; however, some prolonged infusions were able to achieve these targets. View Full-Text
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Tennant, S.J.; Burgess, D.R.; Rybak, J.M.; Martin, C.A.; Burgess, D.S. Utilizing Monte Carlo Simulations to Optimize Institutional Empiric Antipseudomonal Therapy. Antibiotics 2015, 4, 643-652.
Tennant SJ, Burgess DR, Rybak JM, Martin CA, Burgess DS. Utilizing Monte Carlo Simulations to Optimize Institutional Empiric Antipseudomonal Therapy. Antibiotics. 2015; 4(4):643-652.Chicago/Turabian Style
Tennant, Sarah J.; Burgess, Donna R.; Rybak, Jeffrey M.; Martin, Craig A.; Burgess, David S. 2015. "Utilizing Monte Carlo Simulations to Optimize Institutional Empiric Antipseudomonal Therapy." Antibiotics 4, no. 4: 643-652.