RESUMEN
Haemodialysis patients are at risk of gram-positive bacteraemia and commonly require intravenous vancomycin. Intravenously administered vancomycin is primarily excreted by the kidney and exhibits complex pharmacokinetics in haemodialysis patients; achieving therapeutic levels can be challenging. An audit in our unit showed current practises of vancomycin administration resulted in a high proportion of sub-therapeutic levels. A new protocol was developed with fixed weight-based loading and subsequent dosing guided by pre-dialysis levels, target levels were 10-20mg/L. Its effectiveness was prospectively evaluated between 24th September 2012, and 8th February 2013. During this period 25 patients commenced vancomycin, 15 were included. In total, 112 vancomycin levels were taken, 94 (84%) were therapeutic, this was a significant improvement compared to previous practise (odds ratio 5.4, CI 3.1-9.4, p<0.0001). In conclusion, our study shows this protocol can consistently and reliably achieve therapeutic vancomycin levels.
Asunto(s)
Antibacterianos/administración & dosificación , Bacteriemia/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Diálisis Renal/efectos adversos , Vancomicina/administración & dosificación , Administración Intravenosa , Antibacterianos/farmacocinética , Bacteriemia/metabolismo , Bacteriemia/microbiología , Cálculo de Dosificación de Drogas , Infecciones por Bacterias Grampositivas/metabolismo , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Estudios Prospectivos , Vancomicina/farmacocinéticaRESUMEN
In June 2005, a pilot program was implemented in Canadian laboratories to monitor the performance of the Abbott human immunodeficiency virus types 1 and 2 (HIV-1/2) gO enzyme immunoassay (EIA). Two different external quality control (QC) reagents and a "real-time" software analysis program were evaluated. In November 2005, higher-than-expected calibrator rate values in these kits were first reported at the Ontario Ministry of Health (Etobicoke), followed by the Alberta Provincial Public Health Laboratory (Edmonton and Calgary) and others. These aberrations were easily and readily tracked in "real time" using the external QC reagents and the software program. These high calibrator values were confirmed in Delkenheim, Germany, by Abbott, and a manufacturing change was initiated beginning with lot 38299LU00, which was distributed to laboratories in Canada in April 2006. However, widespread reports of calibrator failure by laboratories outside Canada were made in March 2006. In April 2006, Abbott Diagnostics initiated a level III investigation to identify the root cause, which was prolonged storage, under uncontrolled storage conditions, of the raw material used in the manufacture of the matrix cells. To the best of our knowledge, this is the first example of a program in Canada for serological testing that combines a common external QC reagent and a "real-time" software program to allow laboratories to monitor kit performance. In this case, external QC monitoring helped identify and confirm performance problems in the Abbott HIV-1/2 gO EIA kit, further highlighting the benefit of implementing such a program in a national or multilaboratory setting for laboratories performing diagnostic and clinical monitoring testing.
Asunto(s)
Técnicas de Laboratorio Clínico/normas , Infecciones por VIH/diagnóstico , Técnicas para Inmunoenzimas/métodos , Técnicas para Inmunoenzimas/normas , Control de Calidad , Estadística como Asunto/métodos , Estadística como Asunto/normas , Canadá , Técnicas de Laboratorio Clínico/métodos , Humanos , Estándares de ReferenciaRESUMEN
219 stools were examined by direct electron microscopy (EM), culture and 'combined' commercial enzyme-linked immunosorbent assay kits (CELISA). The specificity of the combined ELISA for rotavirus was 100% as compared with EM, and 100% for adenovirus when both culture in addition to EM were carried out. ELISA appeared to be more sensitive than EM for both viruses. There was no cross-reaction between the 2 'combined' antisera. This technique may be useful for automation of viral diagnosis with ELISA using a 'panel' of selected viruses for a variety of specimens.
Asunto(s)
Adenoviridae/aislamiento & purificación , Autoanálisis , Ensayo de Inmunoadsorción Enzimática , Heces/microbiología , Rotavirus/aislamiento & purificación , Adenoviridae/ultraestructura , Animales , Estudios de Evaluación como Asunto , Femenino , Masculino , Rotavirus/ultraestructura , Células Vero/microbiologíaRESUMEN
A total of 115 stools were examined for Rotavirus, using direct electron microscopy (EM) and Rotazyme. The overall agreement was 88.7%. Of the negative results, there was 91.95% agreement. Rotazyme reactions of three-plus or more gave a 100% agreement with EM. The Rotazyme test is a useful diagnostic aid in laboratories not capable of performing EM.