As compared with the use of other broad-spectrum oral antibiotics, including other fluoroquinolones, the use of gatifloxacin among outpatients is associated with an increased risk of in-hospital treatment for both hypoglycemia and hyperglycemia.
Oritavancin (LY333328) is a novel glycopeptide with activity against Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium. We compared the effects of pH and growth phase on the activity of oritavancin and vancomycin against methicillin-resistant S. aureus and vancomycin-susceptible and -resistant E. faecium. Killing curve methods were used to evaluate the effect of growth phase (stationary versus exponential) and pH (6.4, 7.4 and 8.0). An inoculum of 10(6) cfu/mL was used for all experiments. Growth phase of S. aureus and vancomycin-susceptible E. faecium did not influence the rate and killing activity of oritavancin. The rate of killing by oritavancin against the vancomycin-resistant E. faecium strain was significantly faster and the reduction in cfu/mL at 24 h was significantly greater when the organism was in exponential compared with stationary growth phase (P < 0.05). In exponential growth phase, time to 99.9% killing was achieved in 0.6 +/- 0.01 h for the vancomycin-resistant strain, whereas in stationary growth phase, oritavancin did not decrease the inoculum by 99.9% within 24 h. Oritavancin's activity against S. aureus and vancomycin-susceptible E. faecium was not influenced by the pH conditions tested. Oritivancin's killing activity against the vancomycin-resistant E. faecium strain was significantly enhanced when tested at pH 7.4 and 8.0 (P < 0.05). Our study has demonstrated that oritavancin's activity does not seem to be influenced by the growth phase of the organisms or the pH of the environment when tested against sensitive strains of S. aureus and E. faecium. However, oritavancin's activity might be reduced against vancomycin-resistant E. faecium strains in stationary growth phase, as seen in infective endocarditis or when organisms are exposed to an acidic environment.
The antimicrobial stewardship program in this community hospital was associated with significant decreases in antimicrobial costs and in utilization of antipseudomonal antimicrobial agents and a nonsignificant decrease in the rate of C. difficile infection. Knowledge exchange, peer-to-peer communication, and decision support, key factors in this success, will be applied in implementing the antimicrobial stewardship program throughout the hospital.
Our results suggest that in Canada, prophylactic fondaparinux compared with enoxaparin avoids VTEs and is associated with lower costs in patients who undergo major hip or knee surgery.
Background:
Medication safety along the continuum of care is dependent on the quality of medication information at each point of transfer. The purpose of our study was to assess the impact of integrating a community-based medication history (MedsCheck) into perioperative medication reconciliation for elective orthopedic surgery patients by assessing postoperative unintentional medication discrepancies. Secondary objectives were to evaluate community pharmacist participation and patient satisfaction.
Methods:
Patients scheduled for elective hip or knee surgery between April and September 2008 were identified as the study population. Patients and community pharmacies were contacted to coordinate the MedsCheck prior to the pre-admission clinic visit. At the visit, the Meds Check document was used to prepare a best possible medication history, which was documented in the patient chart. Medications were reconciled postoperatively. Participants were surveyed for feedback on the process.
Results:
Eighty-two patients were included in the study. A MedsCheck was completed for 73.8% (31/42) of eligible patients who were contacted prior to their pre-admission clinic visit. The average number of medications per patient was 8.4. The percentage of patients with at least 1 unintentional medication discrepancy decreased from 68.4% (13/19) to 47.6% (39/82) post-intervention. Total unintentional medication discrepancies decreased from 25.6% to 10.6%.
Discussion:
Integrating MedsCheck into the perioperative medication reconciliation process resulted in positive outcomes. The main challenge was coordination of the MedsCheck service prior to the patient's pre-admission clinic visit.
Conclusion:
Integrating MedsCheck into routine perioperative care for orthopedic patients is a feasible way to facilitate pharmacist medication reconciliation and increase patient satisfaction.
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.