Drug Shortages in Critical Care

How Can We Learn from Incidents?

Reduction of Antimicrobial Resistance in the ICU through Antimicrobial Stewardship

The Emergence of West Nile

SARS as a Paradigm of Emerging Infections

Drug Shortages in Critical Care
1. Stakeholders' meeting by American Medical Association and American Society of Health-System Pharmacists. Provisional observations on drug product shortages: effects, causes, and potential solutions. Am J Health-Syst Pharm 2002; 59:2173-82.

How Can We Learn from Incidents?
1. Reason J. Human Error. Cambidge, England: Cambridge University Press; 1990.

2. Ruben H, Knudsen E, Carugati G. Gastric inflation in relation to airway pressure. Acta Anaesth Scand. 1961;5:107-14.

3. Wenzel V, Idris A, Banner M, Kubilis P, Band R, Williams J et al. Respiratory system compliance decreases after cardiopulmonary resuscitation and stomach inflation:   impact of large and small tidal volumes on calculated peak airway pressure. Resuscitation. 1998;38:113-18.

4. Wenzel V, Idris A, Banner M, Kubilis P, Williams J. The influence of tidal volume on the distribution of gas between the lungs and stomach in the unintubated patient receiving positive pressure ventilation. Crit Care Med. 1998;26:364-68.

5. European Resuscitation Council-Airway and Ventilation Management Working Group. Guidelines for the basic management of the airway and ventilation during resuscitation. 31. 1996;200.

6. Reason, J. Managing the risks of organizational accidents.   2000. Burlington, VT, Ashgate Publishing Company. Ref Type: Serial (Book, Monograph)

7. American Heart Association, International Liaison Committee on Resuscitation (ILCOR). Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care - An international consensus on science. Resuscitation. 2000;46:1-447.

8. Johannigman J, Branson R, Davis K, Hurst J. Techniques of emergency ventilation:   A model to evaluate tidal volume, airway pressure and gastric inflation. J Trauma. 1991;31:93-98.

9. Baskett P, Nolan J, Parr M. Tidal volumes which are perceived to be adequate for resuscitation. Resuscitation. 1996;31:231-34.

10. Wenzel V, Keller C, Idris A, Dorges V, Lindner K, Brimacombe J. Effects of smaller tidal volumes during basic life support ventilation in patients with respiratory arrest:   good ventilation, less risk? Resuscitation. 1999;43:25-29.

11. International Concensus Conference on Science. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2000;102:1-384.

12. ARDS Network. Ventilation with Lower Tidal Volumes as Campared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. N Engl J Med. 2000;342:1301-8.

        Figure 1: JAMES REASON'S SWISS CHEESE MODEL (Reference-6)

          Figure 2: Patient Safety Summary Sheet (PDF)

2. 1. Goldmann DA, Weinstein RA, Wenzel RP, et al. Strategies to prevent and control the emergence and spread of Antimicrobial-resistant microorganisms in hospitals. JAMA 1996;275:234-240.
4. 2. Ferriols-Lisart R, Al?s-Almiñana M. Effectiveness and safety of once-daily aminoglycosides: A meta-analysis. Am J Health-Syst Pharm 1996;53:1141-1150

Table 1: Strategies for detecting, reporting, and preventing transmission of antimicrobial-resistant microorganisms
    1. Develop a system to recognize and promptly report significant changes and trends in Antimicrobial resistance to hospital and physician leaders; medical, nursing, infection control, and pharmacy staffs; and others who need to know.

    2. Develop a system for rapid detection and reporting of resistant microorganisms in individual patients to appropriate personnel (caregivers and infection control staff) and for rapid response by caregivers. 

    3. Increase adherence to policies and procedures, especially hand hygiene, barrier precautions, and environmental control measures. 

    4. Incorporate the detection, prevention, and control of Antimicrobial resistance into institutional strategic goals and provide required resources. 

    5. Develop a plan for identifying, transferring, discharging, and readmitting patients colonized with specified Antimicrobial-resistant microorganisms.

Figure 1: Resistance trend for Enterobacter sp. at Methodist Hospital against piperacillin/tazobactam (P/T), ceftazidime (Ceftaz) and cefepime (Cefep) showing decreased resistance with avoidance of Ceftaz use.

Figure 2: Resistance trend for Pseudomonas aeruginosa at Methodist Hospital against piperacillin/tazobactam (P/T), ceftazidime  (Ceftaz), imipenem-cilistatin (I/P) and Tobramycin (T).  Resistance increased when Cip and I/M use increased, has decreased with  lower use of those agents and has not increased despite prevalent use of P/T.

Figure 3: Average antimicrobial expenditures in dollars per patient day for Methodist Hospital, showing little increase over time, despite the use of agents with a more expensive acquisition cost.      

            
The Emergence of West Nile 

1. 1. www.cdc.gov.
3. 2. Mostashari F, Bunning ML, Kitsutani PT, et al. Epidemic West Nile encephalitis, New York, 1999: results of a household-based seroepidemiological survey. Lancet 2001; 358 (9278) : 261-4.
5. 3. Sejvar JJ, Haddad MB, Tierney BC, et al. Neurologic manifestations and outcome of West Nile virus infection. Jama 2003; 290 (4) : 511-5.
7. 4. Update: Detection of West Nile virus in blood donations--United States, 2003. MMWR Morb Mortal Wkly Rep 2003; 52 (38) : 916-9.
9. 5. Solomon T, Dung NM, Wills B, et al. Interferon alfa-2a in Japanese encephalitis: a randomised double-blind placebo-controlled trial. Lancet 2003; 361 (9360) : 821-6.
11. 6. Rahal JJ. Personal communication. 2002.
13. 7. Hamdan A, Green P, Mendelson E, Kramer MR, Pitlik S, Weinberger M. Possible benefit of intravenous immunoglobulin therapy in a lung transplant recipient with West Nile virus encephalitis. Transpl Infect Dis 2002; 4 (3) : 160-162.
15. 8. Shimoni Z, Niven MJ, Pitlick S, Bulvik S. Treatment of West Nile virus encephalitis with intravenous immunoglobulin. Emerg Infect Dis 2001; 7 (4) : 759.
17. 9. Lanciotti RS, Ebel GD, Deubel V, et al. Complete genome sequences and phylogenetic analysis of West Nile virus strains isolated from the United States, Europe, and the Middle East. Virology 2002; 298 (1) : 96-105.
19. 10. Lanciotti RS, Roehrig JT, Deubel V, et al. Origin of the West Nile virus responsible for an outbreak of encephalitis in the northeastern United States. Science 1999; 286 (5448) : 2333-7.
21. 11. Ben Nathan D. Prophylactic and Therapeutic Efficacy of Human Immunoglobulin (IVIG) on West Nile Virus Infection in Mice. Journal of Infectious Diseases 2003; Accepted for publication.
23. 12. Engle MJ; Diamond MS. Antibody prophylaxis and therapy against West Nile virus infection in wild-type and immunodeficient mice. Journal of Virology 77 (24): 12941-12949 Dec 2003.
25. 13. Butman JA, Gea-Banacloche, JC, Haley MW, Nyquist, PA, Retter AS Progression of West Nile Virus Encephalitis in Deep Gray Nuclei Documentaed by Serial MRI Radiology 2003:226:33A-34A.

SARS as a Paradigm of Emerging Infections

1. 1. Smolinski, M.S., et al., Microbial threats to health : emergence, detection, and response . 2003, Washington, DC: National Academies Press. p.1.
3. 2. WHO issues a global alert about cases of atypical pneumonia . 2003, World Health Organization.
4. Morse, S.S., Factors in the emergence of infectious diseases. Emerg Infect Dis, 1995. 1 (1): p. 7-15.
6. 3. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. 2003, World Health Organization.
8. 4. Stephenson, I., et al., Sialic acid receptor specificity on erythrocytes affects detection of antibody to avian influenza haemagglutinin. J Med Virol, 2003. 70 (3): p. 391-8.
10. 5. Gao, F., et al., Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes. Nature, 1999. 397 (6718): p. 436-41.
12. 6. Hirsch, V.M., et al., Molecular cloning of SIV from sooty mangabey monkeys. J Med Primatol, 1989. 18 (3-4): p. 279-85.
14. 7. Guan, Y., et al., Isolation and characterization of viruses related to the SARS coronavirus from animals in southern China. Science, 2003. 302 (5643): p. 276-8.
16. 8. Update: multistate outbreak of monkeypox--Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep, 2003. 52 (27): p. 642-6.
18. 9. Ksiazek, T.G., et al., A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med, 2003. 348 (20): p. 1953-66.
20. 10. Gao, W., Effects of a SARS-associated coronavirus vaccine in monkeys. Lancet, 2003. 362 : p. 1895-96.
22. 11. Knowles, S.R., et al., Common adverse events associated with the use of ribavirin for severe acute respiratory syndrome in Canada. Clin Infect Dis, 2003. 37 (8): p. 1139-42.
23. Anonymous.