Publications by authors named "Abigail K Kois"

2 Publications

  • Page 1 of 1

Effect of Blood Product Resuscitation on the Pharmacokinetics of Ampicillin-Sulbactam during Orthotopic Liver Transplantation.

Surg Infect (Larchmt) 2021 Nov 24. Epub 2021 Nov 24.

Center for Anti-Infective Research and Development, Hartford Hospital, Harford, Connecticut, USA.

Ampicillin-sulbactam is a piperacillin-tazobactam-sparing alternative antibiotic administered as surgical prophylaxis during orthotopic liver transplant (OLT), but limited data are available describing its pharmacokinetics and impact of blood product resuscitation. The purpose of this study was to determine the intra-operative pharmacokinetics of ampicillin-sulbactam in patients during OLT and evaluate the effects of blood resuscitation on exposure. This was a pharmacokinetic study in 10 OLT patients receiving ampicillin-sulbactam surgical prophylaxis. A 5,000-patient Monte Carlo simulation was conducted to identify optimal ampicillin-sulbactam regimens. Linear regression assessed association between blood product administration and ampicillin exposures. Ampicillin and sulbactam concentrations best fitted two-compartment models. Mean ampicillin pharmacokinetic parameters were central compartment volume (V): 6.9 ± 2.0 L, clearance (CL): 26.6 ± 18.4 L/h, and inter-compartmental rate constants (k and k): 4.8 ± 2.6 and 2.3 ± 1.4 h. Sulbactam pharmacokinetic parameters were V: 8.1 ± 2.7 L, CL: 26.1 ± 7.4 L/h, k and k: 4.9 ± 1.0 and 2.8 ± 1.1 h. Participants received between 500 and 23,642 mL of total blood product. No statistical relations were observed between blood product administration and exposures ( 0.00-0.26). Ampicillin-sulbactam 2/1 g every two hours and 2/1 g bolus followed by 6/3 g continuous infusion provided acceptable probability of target attainment up to minimum inhibitory concentrations (MICs) of 16 and 32 mcg/mL, respectively. High and frequent ampicillin-sulbactam doses are required to maintain 100% T > MIC at relevant MICs during OLT and no impact of blood product resuscitation was observed on ampicillin exposure. These are the first data available to guide ampicillin-sulbactam dosing in patients undergoing OLT.
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http://dx.doi.org/10.1089/sur.2021.218DOI Listing
November 2021

Unresolved issues in the identification and treatment of carbapenem-resistant Gram-negative organisms.

Curr Opin Infect Dis 2020 12;33(6):482-494

Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA.

Purpose Of Review: Carbapenem-resistant organisms (CROs), including Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacterales, are a threat worldwide. This review will cover mechanisms of resistance within CROs and challenges with identification and treatment of these organisms while pointing out unresolved issues and ongoing challenges.

Recent Findings: The treatment of CROs has expanded through newer therapeutic options. Guided utilization through genotypic and phenotypic testing is necessary in order for these drugs to target the appropriate mechanisms of resistance and select optimal antibiotic therapy.

Summary: Identification methods and treatment options need to be precisely understood in order to limit the spread and maximize outcomes of CRO infections.
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http://dx.doi.org/10.1097/QCO.0000000000000682DOI Listing
December 2020
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