Full text loading...
Chapter 21 : Fluoroquinolones in Intensive Care Unit Infections
Patients with life-threatening severe community-acquired infections or infections that compromise vital organ functions are often treated in intensive care units (ICUs). The ICU is the "meeting point" for severe community-acquired infections and nosocomial infections. Among resistant gram-negative pathogens, the most common sources in the ICU are infections of the respiratory tract and urinary tract. A recent article found an association in an ICU setting between the amount of intravenous fluoroquinolones prescribed and the incidence of endemic infection with Acinetobacter baumanii and Escherichia coli strains resistant to fluoroquinolones. The chapter discusses pharmacokinetic factors that are likely to differ in ICU patients. Fluoroquinolones have been used frequently to treat nosocomial infections in the ICU because of their pronounced activity against resistant gram-negative bacteria, their lack of association with Clostridium difficile colitis, and their lack of promo¬tion of vancomycin-resistant enterococci. Among the fluoroquinolones, clinafloxacin was most active, whereas ciprofloxacin and fleroxacin were the least active. At present, the newer fluoroquinolones (levofloxacin, moxifloxacin, and gatifloxacin) with their improved activity against gram-positive pathogens do not seem to add much to present therapeutic options for nosocomial infections. However, in vitro data of some of the more advanced fluoroquinolones, like gemifloxacin, garenoxacin and clinafloxacin, might make them useful alternatives for treatment of nosocomial gram-positive infections in ICUs.