Both aerosol AmBd and ABLC appear to be associated with a low rate of invasive pulmonary fungal infection in the early posttransplant period. Patients receiving ABLC were less likely to experience a treatment-related adverse event.

No abstract

Aerosolized delivery of antimicrobial agents is an attractive option for management of pulmonary infections, as this is an ideal method of providing high local drug concentrations while minimizing systemic exposure. With the paucity of consensus regarding the safety, efficacy, and means with which to use aerosolized antimicrobials, a task force was created by the Society of Infectious Diseases Pharmacists to critically review and evaluate the literature on the use of aerosolized antiinfective agents. This article summarizes key findings and statements for preventing or treating a variety of infectious diseases, including cystic fibrosis, bronchiecstasis, hospital-acquired pneumonia, fungal infections, nontuberculosis mycobacterial infection, and Pneumocystis jiroveci pneumonia. Our intention was to provide guidance for clinicians on the use of aerosolized antibiotics through evidence-based pharmacotherapy. Further research with well-designed clinical trials is necessary to elucidate the optimal dosage and duration of therapy and, of equal importance, to appreciate the true risks associated with the use of aerosolized delivery systems.

Positive outcomes of antimicrobial stewardship programs in the inpatient setting have been well documented, but the benefits for patients not admitted to the hospital remain less clear. This report describes a retrospective case-control study of patients discharged from the ED with subsequent positive cultures conducted to determine if integrating antimicrobial stewardship responsibilities into practice of the dedicated emergency medicine clinical pharmacist (EPh) decreased times to positive culture follow-up, patient or primary care provider (PCP) notification, and appropriateness of empiric or final antimicrobial therapy for patients discharged from the emergency department (ED). Pre-and post-implementation groups of an EPh-managed antimicrobial stewardship program were compared. Data were collected from medical records and the ED culture database. Continuous data were analyzed using Wilcoxon Rank Sum test and categorical data using Chi-squared analysis. Positive cultures were identified in 177 patients, 104 and 73 in pre and post-implementation groups, respectively. Median time to culture review in the pre-implementation group was 3 days (range 1–15) and 2 days (range 0–4) in the post-implementation group (p=0.0001). There were positive cultures that required notification in 74 (71.2%) and 36 (49.3%) on pre- and post-implementation groups, respectively. Median time to patient or PCP notification was 3 days (range 1–9) in the pre-implementation group and 2 days(range 0–4) in the Eph managed program (p = 0.01). No difference in appropriate antimicrobial therapy was seen.

Treatment of patients with invasive fungal infections was associated with a significantly higher inpatient hospital cost compared with controls. However, due to new diagnostic techniques and effective antifungal therapy, the relative cost of these infections appears to be at least stable compared with the previous decade. These findings can help assess the utility of cost-avoidance strategies such as antifungal prophylaxis and application of appropriate treatment.