Background: Catheters provide vascular access for patients requiring intravenous treatments, but frequently are a source of infection and/or thrombosis. Instilling a solution of an antimicrobial agent with an anticoagulant into the catheter lumen may salvage-infected catheters. Objective: The aim is to evaluate the physical compatibility, antibacterial activity, and stability of varying combinations of cefazolin (10 mg/mL), 40% ethanol, 4% sodium citrate with or without gentamicin (1 mg/mL) as a catheter lock solution over 48 h. Methods: Admixtures were prepared using aseptic technique and stored under four conditions with or without light at 25°C or 37°C. Prepared admixtures were assessed for physical compatibility, antimicrobial susceptibility, and chemical stability in triplicate at 0, 24 and 48 h. Admixture physical compatibility was determined by visual clarity, pH, and ultraviolet (UV) spectroscopy. Antibacterial activity was determined using the Kirby-Bauer disk diffusion method. The chemical stability of cefazolin and gentamicin were assessed using high performance liquid chromatography and UV spectroscopy, respectively. Results: All admixtures maintained clarity for 48 h. All admixtures stored at 25°C and the admixture containing 10 mg/mL cefazolin-4% sodium citrate stored at 37°C sustained antimicrobial activity and were chemically stable. A significant change in pH, antimicrobial activity, cefazolin concentration (<95% of baseline), were observed in admixtures containing ethanol stored at 37°C after 24 h. Gentamicin concentrations remained stable throughout the study. Conclusion: The admixture of 10 mg/mL cefazolin-4% sodium citrate sustained antimicrobial activity over 48 h and was chemically stable. However, admixtures containing ethanol stored at 37°C showed incompatibility with decreased antibacterial activity and cefazolin degradation after 24 h.
Background Antimicrobial Stewardship efforts in adult ED settings lead to improved patient outcomes and fewer adverse events. However, there are limited data on incorporation of multiple interventions to assist with empiric and definitive antibiotic therapy selection, particularly in the pediatric ED setting. The purpose of this project was to create an antibiogram and empiric UTI treatment algorithm for use in a pediatric ED. Methods This is a multi-phase program implementation in a pediatric ED. Patients aged 2 months -18 years presenting to the ED between January to December 2018 with an ICD10 code for cystitis or pyelonephritis and collection of urine culture were included. Patients were excluded if they were admitted to an inpatient unit or they had a polymicrobial urine culture result. The antibiogram was prepared by including the first isolate of a species from each patient in the given time frame using Clinical and Laboratory Standards Institute recommendations. Results A total of 145 unique patients with 160 ED encounters were included in phase I of the project. Median patient age was 5 years (IQR 1.4-8). Discharge diagnosis for 75% of the 160 ED encounters was pyelonephritis. Urogenital flora was cultured from 19.4% of cultures and 21.2% of cultures were without any growth. The most common pathogen isolated was E. coli (39.4%). For ages 2 months – 18 years, susceptibility of urinary E. coli isolates was 95.5% for nitrofurantoin, 92.5% each for ceftriaxone and ciprofloxacin, and 85.1% for cefazolin. Cefdinir and cephalexin were the empiric antibiotics prescribed on discharge 76.3% of the time. After consideration of factors such as antimicrobial stewardship and spectrum of activity, cephalexin was chosen as the treatment of choice for the 2 months – 11 years age group. For children ≥ 12 years, nitrofurantoin was selected as preferred treatment for uncomplicated cystitis while cephalexin was selected as preferred treatment for pyelonephritis. M Health Fairview University of Minnesota Masonic Childrens ED 2018 E coli isolate antibiogram Conclusion An empiric UTI treatment algorithm incorporating local antimicrobial susceptibility pattern alongside recommendations from national organizations was created. Phase II of the project will evaluate the implementation of the algorithm to determine its impact on readmission rates and antibiotic/pathogen mismatch. Disclosures Elizabeth B. Hirsch, PharmD, Merck (Grant/Research Support)Nabriva Therapeutics (Advisor or Review Panel member)
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