BackgroundMultidrug-resistant Pseudomonas aeruginosa infections remain common in hospitals worldwide. We investigated the outcomes associated with the use of ceftolozane-tazobactam for the treatment of these infections.MethodsData were collected retrospectively from 20 hospitals across the United States about adults who received ceftolozane-tazobactam for the treatment of multidrug-resistant P aeruginosa infections of any source for at least 24 hours. The primary outcome was a composite of 30-day and inpatient mortality, and secondary outcomes were clinical success and microbiological cure. Multivariable regression analysis was conducted to determine factors associated with outcomes.ResultsTwo-hundred five patients were included in the study. Severe illness and high degrees of comorbidity were common, with median Acute Physiology and Chronic Health Evaluation (APACHE) II scores of 19 (interquartile range [IQR], 11–24) and median Charlson Comorbidity Indexes of 4 (IQR, 3–6). Delayed initiation of ceftolozane-tazobactam was common with therapy started a median of 9 days after culture collection. Fifty-nine percent of patients had pneumonia. On susceptibility testing, 125 of 139 (89.9%) isolates were susceptible to ceftolozane-tazobactam. Mortality occurred in 39 patients (19%); clinical success and microbiological cure were 151 (73.7%) and 145 (70.7%), respectively. On multivariable regression analysis, starting ceftolozane-tazobactam within 4 days of culture collection was associated with survival (adjusted odds ratio [OR], 5.55; 95% confidence interval [CI], 2.14–14.40), clinical success (adjusted OR, 2.93; 95% CI, 1.40–6.10), and microbiological cure (adjusted OR, 2.59; 95% CI, 1.24–5.38).ConclusionsCeftolozane-tazobactam appeared to be effective in the treatment of multidrug-resistant P aeruginosa infections, particularly when initiated early after the onset of infection.

Ceftazidime-avibactam is a novel cephalosporin-beta-lactamase inhibitor combination that is active against many carbapenem-resistant Enterobacteriaceae (CRE). We describe a retrospective chart review for 60 patients who received ceftazidimeavibactam for a CRE infection. In-hospital mortality was 32%, 53% of patients had microbiological cure, and 65% had clinical success. In this severely ill population with CRE infections, ceftazidime-avibactam was an appropriate option.

Despite the clinically proven benefits of the human papillomavirus (HPV) vaccine in preventing cervical and other HPV-associated cancers, vaccination coverage has been suboptimal among adolescents and young adults in the United States (US), particularly among racial and ethnic minority adolescents. Historical legacies, combined with current racial/ethnic disparities in healthcare, may contribute to suboptimal uptake and completion of the HPV vaccine in part through differing levels of trust in doctors and healthcare institutions. The purpose of this narrative review was to characterize trust and its role in decision making about HPV vaccine uptake among US racial and ethnic minorities. We conducted a literature search using the PubMed database, and our search terms yielded 1176 articles. We reviewed 41 full-text articles for eligibility and included 20 articles in this review. These studies used varied measures of trust or mistrust and assessed trust in not only doctors/healthcare providers, but also other sources including pharmaceutical companies, media, and clergy. Our review findings revealed generally high levels of trust in doctors and healthcare providers, but less so in pharmaceutical companies. Mistrust of either healthcare providers, government agencies or pharmaceutical companies was consistently associated with less favorable attitudes and lower vaccine uptake. The downstream effects of mistrust may occur through selected health beliefs regarding the perceived efficacy and safety of the vaccine. Minority groups were more likely to report trust in family members, religious organizations, and media sources compared to their white counterparts. Decision making about vaccine uptake is a multilayered process that involves comparing the perceived benefits of the vaccine against its perceived risks. Understanding how trusted sources can effectively harness the tools of social and traditional media to increase knowledge and awareness may help combat misinformation about the HPV vaccine and improve engagement with diverse communities.

Purpose: To understand the ability of trigger tools to detect preventable adverse events (pAEs) in the primary care outpatient setting using the Institute for Healthcare Improvement's (IHI) Outpatient Adverse Event Trigger Tool (IHI Tool).Methods: The OVID MEDLINE and OVID MEDLINE In-process and non-Indexed citations databases were queried using controlled vocabulary and Medical Subject Headings related to the concepts "primary care" and "adverse events." Included articles were conducted in the outpatient setting, used at least 1 of the triggers identified in the IHI Tool, and identified pAEs of any type. Articles were selected for inclusion based first on assessment of titles then abstracts by 2 trained reviewers independently, followed by full text review by 2 authors.Results: Our search identified 6435 unique articles, and we included 15 in our review. The most common studied trigger was laboratory abnormalities. The most common pAEs were medication errors followed by unplanned hospitalizations. The effectiveness of triggers in identifying AEs varied widely.

BackgroundAs antimicrobial exposure represents a major risk factor in the development of Clostridium difficile infection (CDI), optimization of antimicrobial selection is critical. While a number of antibiotics have been associated with increased risk of CDI, doxycycline may be considered protective. The combination of ceftriaxone and doxycycline (CTX-D) is supported by the Infectious Diseases Society of America (IDSA) for the management of community acquired pneumonia (CAP). The primary objective of this study was to evaluate if CTX-D is associated with a reduced incidence of CDI compared with ceftriaxone and azithromycin (CTX-A) among nonintensive care unit (ICU) patients with CAP at Christiana Care Health System.MethodsA retrospective cohort study was conducted to evaluate patients who received CTX-D or CTX-A admitted to Christiana Care between June 1, 2015 and December 31, 2017. Non-ICU patients, aged 18 years or older, receiving at least one dose of CTX-D or CTX-A were included. The primary outcome of our study was the incidence of CDI within 30 days from initial dose of CTX-D or CTX-A. The secondary outcome was the time to onset of CDI from initial dose of CTX-D or CTX-A.ResultsOne thousand sixty-four unique patients were included in this study. Overall, 778 patients received CTX-D and 286 received CTX-A. Among patients who received CTX-D, 2 patients developed CDI, compared with five patients who received CTX-A (relative risk, 0.15; 95% confidence interval, 0.03–0.75; P = 0.02). The mean time to onset of CDI from initiation of CTX-D was 22 days compared with 9.2 days from initiation of CTX-A.ConclusionIn this cohort of non-ICU patients with CAP, CTX-D was associated with a reduced incidence of CDI. Further studies are necessary to confirm these preliminary findings to optimize clinical practice, while minimizing potential adverse outcomes associated with antimicrobial use.Disclosures All authors: No reported disclosures.

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Objective To implement a collaborative statewide antibiotic stewardship initiative in both the ambulatory and inpatient settings. Methods Five participating Delaware health systems each convened internal team(s) to translate the vision set forth by the eBrightHealth LLC Choosing Wisely Work Group into clinical action through process improvement efforts at their institutions. The teams focused on implementing antibiotic time-outs, and on improving antibiotic prescribing for upper respiratory infections in ambulatory settings. The learning network utilized an “all teach, all learn” methodology via monthly conference calls and quarterly face-to-face meetings. Results All inpatient teams implemented antibiotic time-outs for at least 1 unit. Other interventions included commitment posters; submitting antibiotic utilization data nationally; provider/patient surveys; local stewardship champions; and provider prescribing data feedback. Barriers to implementation included competing priorities, lack of reliable utilization data, and suboptimal provider engagement. Overall antibiotic utilization decreased by 9%, compared to the pre-intervention period. Conclusions This initiative has demonstrated the value of multidisciplinary teams, from varying healthcare systems, coming together to work on a single project. While each team’s interventions and specific goals differed slightly, all teams implemented new initiatives to promote appropriate use of antibiotics. Policy Implications Antibiotic stewardship is a national priority. Acute care hospitals are required to have antibiotic stewardship programs; similar programs are proposed for ambulatory settings.

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