Detroit Receiving Hospital

About: Detroit Receiving Hospital is a healthcare organization based out in Detroit, Michigan, United States. It is known for research contribution in the topics: Vancomycin & Population. The organization has 877 authors who have published 850 publications receiving 37202 citations. The organization is also known as: Detroit General.

Pharmacologic and bacteriologic properties of SCH-27899 (Ziracin), an investigational antibiotic from the everninomicin family

Abstract: SCH-27899 is an investigational antibiotic from the everninomicin family, a group of oligosaccharide antibiotics produced by Micromonospora carbonacea. Information regarding the pharmacology, pharmacodynamics, pharmacokinetics, efficacy, and toxicity of this agent was obtained from a MEDLINE search and a review of abstracts presented at recent scientific meetings. SCH-27899 has in vitro bacteriostatic activity against a wide variety of gram-positive organisms, including highly resistant organisms such as methicillin-resistant Staphylococcus aureus, vancomycin-intermediate-sensitivity S. aureus, Streptococcus pneumoniae (both penicillin-susceptible and -nonsusceptible), and vancomycin-resistant enterococci. In vitro data, animal studies, and preliminary human studies indicate that it is effective and fairly well tolerated. Its place in therapy remains to be determined, and clinical trials continue.

Evaluation of vancomycin and daptomycin against methicillin-resistant Staphylococcus aureus and heterogeneously vancomycin-intermediate S. aureus in an in vitro pharmacokinetic/pharmacodynamic model with simulated endocardial vegetations

Abstract: Objectives: Glycopeptides have historically been the drugs of choice for the treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). However, the continued selective pressure has led to the emergence of non-susceptible strains including heterogeneously vancomycin-intermediate S. aureus (hVISA). Infections with hVISA have been associated with poor outcomes including vancomycin treatment failures. The objective of this study was to evaluate vancomycin and daptomycin against vancomycin-susceptible MRSA and hVISA in a pharmacokinetic/pharmacodynamic (PK/PD) model with simulated endocardial vegetations. Methods: Six clinical isolates obtained from patients at the Detroit Medical Center were used: MRSA 494, MRSA 67, hVISA R1720, hVISS R2295, hVISA R3640 and hVISA R1629. All heteroresistant strains were confirmed by a population analysis profile ratio, with Mu3 as a control strain. Vancomycin regimens of 1 g every 12 h and 2 g every 12 h and daptomycin regimens of 6, 10 and 12 mg/kg daily were utilized in a PK/PD model over 72 h. Results: Against MRSA isolates, vancomycin displayed minimal activity and minimal-to-no activity against hVISA. In general, the use of high dose vancomycin over standard dose vancomycin did not improve activity except against one of six isolates (MRSA 494). Daptomycin was bactericidal against both MRSA and hVISA isolates, although the rate of kill was slower against hVISA. Conclusions: Overall, daptomycin achieved rapid and effective kill against both MRSA and hVISA while vancomycin displayed slow and minimal kill against MRSA and minimal-to-no activity against hVISA, regardless of high dose exposure.

Cost-effectiveness of enoxaparin versus low-dose heparin for prophylaxis against venous thrombosis after major trauma

Abstract: We attempted to determine health and economic outcomes from the perspective of an integrated health system of administering enoxaparin 30 mg twice/day versus heparin 5000 U twice/day for prophylaxis against venous thrombosis after major trauma. A decision-analytic model was developed from best literature evidence, institutional data, and expert opinion. We assumed that 40% of proximal deep vein thromboses (DVTs) and 5% of distal DVTs are diagnosed and confirmed with initial or repeat duplex scanning; 50% of undiagnosed proximal DVTs result in pulmonary embolism; 2% and 1% of undiagnosed proximal DVTs will lead to readmission for DVT and pulmonary embolism, respectively, and pulmonary embolism-related mortality rates range from 8-30%. Length of hospital stay data and 1996 institutional drug use and acquisition cost data were used to estimate the cost of enoxaparin and heparin therapy. Diagnosis and treatment costs for DVT and pulmonary embolism were derived from institutional charge data using cost:charge ratios. A second analysis of patients with lower extremity fractures was completed. One-way and multiway sensitivity analyses were performed. For 1000 mixed trauma patients receiving enoxaparin versus heparin, our model showed that 62.2 (95% CI -113 to -12) DVTs or pulmonary emboli would be avoided, resulting in 67.6 (8 to 130) life-years saved at a net cost increase of $104,764 (-$329,300 to $159,600). Enoxaparin versus heparin resulted in a cost of $1684 (-$3600 to $9800) for each DVT or pulmonary embolus avoided and a discounted cost/life-year saved of $2303 (-$8100 to $19,000). For 1000 patients with lower extremity fractures, enoxaparin versus heparin resulted in a cost of $751 (-$4200 to $3300) for each DVT or pulmonary embolus avoided and a discounted cost/life-year saved of $1017 (-$10,200 to $6300). Although enoxaparin increases overall health care costs, it is associated with a cost/additional life-year saved of only $2300, which is generally lower than the commonly used hurdle rate of $30,000/life-year saved. The cost-effectiveness ratio is more favorable in patients with lower extremity fractures than in the general mixed trauma population.

Labetalol: Response and Safety in Critically Ill Hemorrhagic Stroke Patients:

Abstract: ObjectiveTo observe and characterize the blood pressure (BP)-lowering and adverse hemodynamic and/or central nervous system effects of intravenous bolus doses of labetalol in hemorrhagic stroke patients.DesignObservational, prospective, pilot survey conducted over an eight-week period.SettingSurgical intensive care unit.ParticipantsPatients admitted with an intracerebral or subarachnoid hemorrhage.Main Outcome ParametersAbsolute decline in systolic BP (SBP) and diastolic BP (DBP), time to peak reduction in SBP and DBP, and adverse hemodynamic and mental status changes.ResultsLabetalol at doses between 5 and 25 mg lowered SBP by 6–19 percent (baseline 152–184 mm Hg) and DBP by 3–26 percent (baseline 50–99 mm Hg). Adverse hemodynamic or mental status changes were not detected following labetalol administration.ConclusionsSmall (≤25 mg) intravenous bolus doses of labetalol produce mild decreases in BP in hemorrhagic stroke patients.