Students participated were 402. Precourse and postcourse evaluations showed improvement in team participation values, critical event knowledge, and 94 percent of participants reported learning useful skills. Qualitative responses evidenced positive response; most frequent recurring comments concerned value of interprofessional experiences in team communication and desire to incorporate this kind of education earlier in their curriculum. Students demonstrated improvement in both knowledge and attitudes in a critical event response course that includes interprofessional instruction and collaboration. Further study is required to demonstrate sustained improvement as well as benefit to clinical outcomes.

The fluoroquinolones have become the leading class of antimicrobial agents prescribed to adults in the United States. Resistance of key pathogens to fluoroquinolones has developed rapidly in parallel with increased prescribing of these drugs. We describe our pharmacist-led antimicrobial stewardship program that focused on reducing inappropriate prescribing of fluoroquinolones, with the goals of limiting the development of resistance and improving patient outcomes. Core strategies were regular monitoring and reporting of resistance trends observed on institutional antibiograms, performing drug audits and related studies with intervention and feedback to prescribers, implementing an automatic parenteral-to-oral conversion program, establishing and implementing a beta-lactam-based institutional guideline for empiric therapy, and educating prescribers. This successful program reduced empiric prescribing of fluoroquinolones by 30%, improved susceptibility for all antipseudomonal agents against Pseudomonas aeruginosa overall by 10%, and decreased mortality associated with P. aeruginosa infections by 2-fold. Our stewardship program clearly demonstrated that pharmacists can take on leadership roles to positively change antimicrobial prescribing at the institutional level and improve patient outcomes.

Non-albicans Candida species accounted for the majority of IC in caspofungin-treated patients. Improved outcomes were observed for patients initiated with caspofungin within 72 h of positive culture compared with those who received delayed therapy.

The antibiogram is an essential resource for institutions to track changes in antimicrobial resistance and to guide empirical antimicrobial therapy. In this Viewpoint, data and examples from literature are presented that suggest institutions have not completely adopted the standardized approach in developing antibiograms, as variations in the development methodologies of antibiograms exist despite consensus guidelines (M39) published by CLSI. We emphasize developing antibiograms in line with the M39 recommendations will help ensure that they are accurate, reliable and valid, and highlight that understanding the limitations of antibiogram data is critical to ensuring appropriate interpretation and application to clinical decision-making. We also stress the importance of easy accessibility and education on antibiogram use, to allow for prescribers to select the most optimal empirical treatment regimens and propose the creation of an abbreviated antibiogram for frontline users. Multidisciplinary antimicrobial stewardship programmes are vital to accomplishing these goals.

No abstract

Introduction The severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) has infected more than 20 million people worldwide, and the spread is most prevalent in the USA, where California had accounted over 240,000 cases in the initial 5 months of the pandemic. To estimate the number of infected persons in our community, we conducted a cross-sectional study to estimate seroprevalence of SARS-CoV-2 infection. Methods This cross-sectional study evaluated the presence of immunoglobulin G, antibody for SARS-CoV-2 during the time period of July 15, 2020, to July 27, 2020. Testing was done on serum samples from patients who had visited affiliated outpatient clinics or our emergency department. Additionally, we collected age, gender, ethnicity, race, and location of testing. Results Eight hundred sixty-five tests were included in the study. The outpatient clinics cohort accounted for 56% of results and emergency department (ED) contributed 44%. The positive percentage of SARS-CoV-2 test was 9.4% (95% CI: 0.08-0.12). The positivity rates of the outpatient (5.6%) and ED (14.2%) setting differed. The prevalence of SARS-CoV-2 IgG was greatest in those that identified as Hispanic/Latino, 18.1% versus 13.4% in other groups. Specifically compared to the non-Hispanic/Latino population, the prevalence was significantly higher, with a relative risk of 2.73 (95% CI: 1.8-4.1), p < 0.0001. Conclusion The low antibody positivity rate in the community indicates the need for a vaccine. The Hispanic/Latino patient population should be considered for increased education on preventing transmission and acquisition of COVID-19 as well as being considered as a priority for vaccination once a vaccine is available.

Purpose of review Glomerular filtration rate (GFR) is the best index for kidney function and estimated GFR (eGFR) calculated from endogenous filtration markers like serum creatinine and cystatin C is widely used in clinical practice for chronic kidney disease diagnosis and prognostication. We sought to review the evolution of GFR estimating equations, nuances of eGFR interpretation, and utility of eGFR in drug dosing. Recent findings The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) serum creatinine eGFR equation was recently updated to exclude the race variable and the CKD-EPI creatinine–cystatin C equation demonstrated the highest reliability. Although calculated creatinine clearance by Cockcroft Gault has been traditionally used for drug dosing, the use of eGFR is slowly being adapted by the Food and Drug Administration for pharmacokinetic studies. However, the individual-level accuracy of eGFR using the CKD-EPI 2021 equations remained low, with the distribution of measured GFR at a given eGFR value spanning several CKD stages. Summary Although current methods of estimating GFR have improved in population measures of reliability, all have significant individual-level inaccuracies that can be an issue when clinical decision-making is contingent on the actual level of GFR. Modern methods of GFR measurements should be made widely available to enhance individualized patient decision-making.

No abstract