Recovery rates of combination antibiotic therapy using in vitro microdialysis simulating in vivo conditions

Microdialysis is a technique used to measure the unbound antibiotic concentration in the interstitial spaces, the target site of action. In vitro recovery studies are essential to calibrating the microdialysis system for in vivo studies. The effect of a combination of antibiotics on recovery into microdialysate requires investigation. In vitro microdialysis recovery studies were conducted on a combination of vancomycin and tobramycin, in a simulated in vivo model. Comparison was made between recoveries for three different concentrations and three different perfusate flow rates. The overall relative recovery for vancomycin was lower than that of tobramycin. For tobramycin, a concentration of 20μg/mL and flow rate of 1.0μL/min had the best recovery. A concentration of 5.0μg/mL and flow rate of 1.0μL/min yielded maximal recovery for vancomycin. Large molecular size and higher protein binding resulted in lower relative recoveries for vancomycin. Perfusate flow rates and drug concentrations affected the relative recovery when a combination of vancomycin and tobramycin was tested. Low perfusate flow rates were associated with higher recovery rates. For combination antibiotic measurement which includes agents that are highly protein bound, in vitro studies performed prior to in vivo studies may ensure the reliable measurement of unbound concentrations.

Impact of hospital type on risk-adjusted,traffic-related 30-day mortality:a population-based registry study

Background:Traffic incidents are still a major contributor to hospital admissions and trauma-related mortality.The aim of this nationwide study was to examine risk-adjusted traffic injury mortality to determine whether hospital type was an independent survival factor.Methods:Data on all patients admitted to Swedish hospitals with traffic-related injuries,based on International Classification of Diseases codes,between 2001 and 2011 were extracted from the Swedish inpatient and cause of death registries.Using the binary outcome measure of death or survival,data were analysed using logistic regression,adjusting for age,sex,comorbidity,severity of injury and hospital type.The severity of injury was established using the International Classification of Diseases Injury Severity Score(ICISS).Results:The final study population consisted of 152,693 hospital admissions.Young individuals(0–25 years of age)were overrepresented,accounting for 41%of traffic-related injuries.Men were overrepresented in all age categories.Fatalities at university hospitals had the lowest mean(SD)ICISS 0.68(0.19).Regional and county hospitals had mean ICISS 0.75(0.15)and 0.77(0.15),respectively,for fatal traffic incidents.The crude overall mortality in the study population was 1193,with a mean ICISS 0.72(0.17).Fatalities at university hospitals had the lowest mean ICISS 0.68(0.19).Regional and county hospitals had mean ICISS 0.75(0.15)and 0.77(0.15),respectively,for fatal traffic incidents.When regional and county hospitals were merged into one group and its risk-adjusted mortality compared with university hospitals,no significant difference was found.A comparison between hospital groups with the most severely injured patients(ICISS0.85)also did not show a significant difference(odds ratio,1.13;95%confidence interval,0.97–1.32).Conclusions:This study shows that,in Sweden,the type of hospital does not influence risk adjusted traffic related mortality,where the most severely injured patients are transported to the university hospitals and centralization of treatment is common.