Introduction: According to clinical guidelines, there are no differences in early infection rates when utilizing antimicrobial prophylaxis regimens beyond 24 hours. We shortened the prophylaxis regimen from 72 to 24 hours in liver transplant recipients due to rising rates of resistance. The objective of this study is to evaluate the difference in posttransplant outcomes, following the protocol change. Design: We reviewed adult patients undergoing orthotopic liver transplantation between June 2013 and December 2015. Patients were stratified into 2 cohorts: 24 and 72 hours. Patients were excluded if donor cultures were positive. The primary objective of this study is to evaluate the incidence and time to posttransplant infections. The secondary objectives included analysis of total and intensive care unit length of stay and rates of Clostridioides difficile infection. Results: Forty-four patients were included, 20 in the 72-hour and 24 in the 24-hour cohorts. The incidence of post-OLT infection (30% vs 8%, P = .115, 95% CI: −1% to 45%) was higher in the 72-hour cohort. Total (21 vs 14, P = .332, 95% CI: −4% to 28%) and intensive care unit LOS (11 vs 6, P = .201, 95% CI, −5% to 31%) were longer in the 72-hour group. No difference was observed in the incidence of CDI (15% vs 13%, P = 1.000). Discussion: There was no increase in posttransplant infections in the 24-hour cohort. Shorter antibiotic exposure may be associated with a reduction in length of stay and be favorable in this patient population.
BackgroundAdvancements in the development of antiretrovirals (ARVs) have led to reduced HIV-related morbidity and mortality and improved patient adherence. Despite the simplicity of current ARV regimens, medication errors still frequently occur. This study evaluated the impact of an antimicrobial stewardship (ASP) team in identifying and reducing ARV medication errors.MethodsA retrospective study was conducted to evaluate ARV medication errors pre -and post-implementation of an ASP initiative in HIV-positive patients admitted between July 2016 and December 2017. The ASP team consisted of a PGY2 infectious diseases (ID) pharmacy resident and an ID clinical specialist. The ASP intervention occurred upon admission and consisted of a comprehensive ARV review to assess for dosing, drug–drug interaction, and completeness of regimen. The following endpoints were assessed: incidence of errors, classification of errors, and the number of errors detected/corrected.ResultsThree hundred and fifty-six patients were included in the analysis; 153 patients in the pre-intervention group and 203 patients in the post-intervention group. A total of 243 errors were identified in 175 patients; 119 errors (n = 78) in the pre-intervention group and 124 (n = 97) in the post-intervention group. The overall number of errors were stratified by classification: dosing (42/243; 17%), drug–drug interaction (159/243; 66%), and completeness of regimen (42/243; 17%). Drug–drug interactions involving integrase inhibitors and cations were the most frequently occurring medication error in both cohorts. There was a statistically significant difference in errors detected, and subsequently corrected in the pre-intervention group compared with the post-intervention group (12/119 vs. 85/124, P < 0.001). Of the 39 errors that were missed by the ASP team, six were not detected, 12 occurred post-review, and 21 were not accepted by the primary team.ConclusionPharmacists play a vital role in mitigating errors in HIV-infected patients upon hospital admission. However, continuous review throughout the hospital course and at discharge, as well as education of all practitioners, is critical to preventing propagation of errors.Disclosures All authors: No reported disclosures.
Purpose Vancomycin-resistant Enterococcus (VRE) infections are designated a serious threat. Recently, the Clinical and Laboratory Standards Institute revised daptomycin breakpoints for Enterococcus faecium infections to reflect a minimum inhibitory concentration (MIC) of less than 4 mg/L as susceptible dose dependent and 8 mg/L or greater as resistant. The objective was to compare clinical outcomes for patients who had a VRE bloodstream infection (BSI) and a daptomycin MIC of 2 mg/L or greater (low MIC group) versus a daptomycin MIC of 3 to 4 mg/L (high MIC group). Methods This was a single-center, retrospective study of adult patients receiving 48 hours or more of daptomycin therapy. The following primary and secondary outcomes were assessed: microbiological cure, clinical cure, and 30-day all-cause mortality. Results Sixty-five patients were included in this analysis: 16 patients in the low MIC group and 49 in the high MIC group. Patients in the high MIC group received a longer duration of therapy (14.0 vs 7.5 days, P = 0.047), had a larger percentage of patients receiving concomitant antimicrobials (85.7% vs. 56.2%, P = 0.013), and were more likely to be infected with E. faecium (98.0% vs 56.2%, P < 0.001) compared with the low MIC group. Patients in the low MIC group had a significantly higher clinical cure rate (69.0% vs 31.0%, P = 0.009), microbiological cure rate (100.0% vs. 73.0%, P = 0.027), and a comparable 30-day all-cause mortality rate (19.0% vs 41.0%, P = 0.139) compared with the high MIC group. Conclusions High daptomycin MICs were associated with worse outcomes in our patient cohort with VRE BSIs.
BackgroundInfections caused by carbapenem-resistant Enterobacteriaceae (CRE) have been designated an urgent level threat to public health. With the advent of novel β lactam/β-lactamase inhibitor combinations, the armamentarium against CRE is expanding. Our study aims to evaluate clinical outcomes in patients with CRE infections.MethodsA retrospective study was conducted to compare clinical outcomes in adult patients with documented CRE infections between January 2009 and December 2017 and received either ceftazidime–avibactam (CAZ-AVI) or best available therapy (BAT). Best available therapy was defined as antimicrobials with susceptibility to the causative pathogen according to CLSI breakpoints. The following clinical outcomes were assessed: clinical cure, total length of stay (LOS), 30-day mortality, and infection-related mortality.ResultsOne hundred and fifty patients met criteria for inclusion; 25 in the CAZ-AVI group and 125 in the BAT group. The median Charlson Comorbidity Index (CCI) was 6 in both cohorts, indicating a low baseline probability for survival. The most common primary sites of infection for the CAZ-AVI and BAT cohorts, respectively, were the following: blood (24% vs. 18%, P = 0.580), urine (36% vs. 23%, P = 0.209), intraabdominal (16% vs. 14%, P = 0.754), and lung (12% vs. 27%, P = 0.132). Combination therapy was utilized in 8% of patients in the CAZ-AVI group compared with 42% in the BAT group. Combinations in the BAT group consisted of colistin-based (68%), tigecycline-based (13%), and aminoglycoside-based (13%) regimens. Although clinical cure rates were similar between both groups (80% vs. 72%, P = 0.469), there was a statistically significant difference in both all-cause mortality (24% vs. 73%, P = 0.006) and infection related mortality (4% vs. 26%, P = 0.017) in the CAZ-AVI and BAT groups, respectively. There was a trend toward a lower overall length of stay favoring the CAZ-AVI cohort as opposed to the BAT cohort (16 days vs. 30 days, P = 0.082).ConclusionCAZ-AVI therapy was associated with lower mortality rates for CRE infections and have a high attributable mortality, especially with concomitant bacteremia. Future studies are warranted to confirm these results.Disclosures All authors: No reported disclosures.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.