TY - JOUR A1 - Schrader, Nikolas A1 - Riese, Thorsten A1 - Kurlbaum, Max A1 - Meybohm, Patrick A1 - Kredel, Markus A1 - Surat, Güzin A1 - Scherf-Clavel, Oliver A1 - Strate, Alexander A1 - Pospiech, Andreas A1 - Hoppe, Kerstin T1 - Personalized antibiotic therapy for the critically ill: Implementation strategies and effects on clinical outcome of piperacillin therapeutic drug monitoring — a descriptive retrospective analysis JF - Antibiotics N2 - Therapeutic drug monitoring (TDM) is increasingly relevant for an individualized antibiotic therapy and subsequently a necessary tool to reduce multidrug-resistant pathogens, especially in light of diminishing antimicrobial capabilities. Critical illness is associated with profound pharmacokinetic and pharmacodynamic alterations, which challenge dose finding and the application of particularly hydrophilic drugs such as β-lactam antibiotics. Methods: Implementation strategy, potential benefit, and practicability of the developed standard operating procedures were retrospectively analyzed from January to December 2020. Furthermore, the efficacy of the proposed dosing target of piperacillin in critically ill patients was evaluated. Results: In total, 160 patients received piperacillin/tazobactam therapy and were subsequently included in the study. Of them, 114 patients received piperacillin/tazobactam by continuous infusion and had at least one measurement of piperacillin serum level according to the standard operating procedure. In total, 271 measurements were performed with an average level of 79.0 ± 46.0 mg/L. Seventy-one piperacillin levels exceeded 100 mg/L and six levels were lower than 22.5 mg/L. The high-level and the low-level group differed significantly in infection laboratory parameters (CRP (mg/dL) 20.18 ± 11.71 vs. 5.75 ± 5.33) and renal function [glomerular filtration rate (mL/min/1.75 m2) 40.85 ± 26.74 vs. 120.50 ± 70.48]. Conclusions: Piperacillin levels are unpredictable in critically ill patients. TDM during piperacillin/tazobactam therapy is highly recommended for all patients. Although our implementation strategy was effective, further strategies implemented into the daily clinical workflow might support the health care staff and increase the clinicians' alertness. KW - therapeutic drug monitoring KW - piperacillin/tazobactam KW - personalized antimicrobial therapy KW - antimicrobial stewardship Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-250052 SN - 2079-6382 VL - 10 IS - 12 ER - TY - THES A1 - Riese, Thorsten T1 - Analysen zur potentiellen Gentoxizität von Terahertzstrahlung in vitro T1 - Analyses concerning potential genotoxicity of terahertz radiation in vitro N2 - Im Rahmen dieser Arbeit wurden immortalisierte humane Keratinozyten (HaCaT-Zelllinie) über eine Dauer von 24 Stunden mit Terahertzstrahlung der Frequenz 0,106 THz und einer Leistungsflussdichte von 2 mW/cm² behandelt und anschließend mittels „cytokinesis-block micronucleus cytome assay“ ausgewertet. Ferner wurden Proben der gleichen Zelllinie über einen Zeitraum von 24 Stunden Temperaturen zwischen 37 °C und 42 °C ausgesetzt und zum einen auf Hinweise für Gentoxizität mit Hilfe des Mikrokerntests untersucht und zum anderen mittels Western Blot die Expressionsrate von Hitzeschockproteinen der 70 kDa Familie bestimmt. Die der Terahertzstrahlung ausgesetzten Zellen zeigten gegenüber den Kontrollen keine signifikanten Veränderungen der Marker für chromosomale Aberrationen oder der Zellteilung. Die der erhöhten Temperatur ausgesetzten Zellen zeigten einen signifikanten Anstieg der Mikrokernraten und weiterer Marker für Gentoxizität sowie eine damit korrelierende Zunahme der synthetisierten Proteinmenge der Hsp70 Proteine im Rahmen der Hitzeschockreaktion. N2 - In this dissertation HaCaT human keratinocytes were exposed to terahertz radiation (0.106 THz) and to different temperatures from 37 °C to 42 °C for 24 hours. Using the “cytokinesis-block micronucleus cytome assay” the appearance of different markers of genomic damage was analysed and compared to negative controls. Furthermore the heat-induced expression rate of the heat shock protein 70 was determined between 37 °C and 42 °C. The cells exposed to terahertz radiation showed no statistically significant elevation of genomic damage markers or change of proliferation compared to the controls. The hyperthermia-treated cells showed significantly increased micronucleus frequencies and an elevated heat-shock protein expression for temperatures above 37 °C. KW - Terahertzbereich KW - Gentoxizität KW - Nichtionisierende Strahlung KW - Terahertzstrahlung KW - Gentoxizität KW - Nichtionisierende Strahlung KW - terahertz radiation KW - genotoxicity KW - non-ionizing radiation Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-116469 ER -