Fourty patients were treated with meropenem-vaborbactam (MEV) for serious Gram-negative bacterial (GNB) infections. Carbapenem-resistant Enterobacteriaceae (CRE) comprised 80.0% of all GNB infections. Clinical success occurred in 70.0% of patients. Mortality and recurrence at 30 days were 7.5% and 12.5%, respectively. One patient experienced a probable rash due to MEV.

Obesity and other factors are associated with a higher risk of vancomycin-associated nephrotoxicity.

Background We aimed to describe the clinical characteristics and outcomes of patients treated with meropenem-vaborbactam (MEV) for a variety of Gram-negative infections (GNI), primarily including carbapenem-resistant Enterobacterales (CRE). Methods This is a real-world, multi-center, retrospective cohort within the United States between 2017-2020. Adult patients who received MEV for ≥ 72 hours were eligible for inclusion. The primary outcome was 30-day mortality. Classification and regression tree analysis (CART) was used to identify the time breakpoint (BP) that delineated the risk of negative clinical outcomes (NCO) and was examined by multivariable logistic regression analysis (MLR). Results Overall, 126 patients were evaluated from 13 medical centers within ten states. The most common infection source were respiratory tract (38.1%) and intraabdominal (19.0%) origin, while the most common isolated pathogens were CRE (78.6%). Thirty-day mortality and recurrence occurred in 18.3% and 11.9%, respectively. Adverse events occurred in four patients; nephrotoxicity (n=2), hepatoxicity (n=1), and rash (n=1). CART-BP between early and delayed treatment was 48 hours (P=0.04). MEV initiation within 48 hours was independently associated with reduced NCO following analysis by MLR (aOR=0.277, [0.081 – 0.941]). Conclusion Our results support current evidence establishing positive clinical and safety outcomes of MEV in GNI, including CRE. We suggest that delaying appropriate therapy for CRE significantly increases the risk of NCO.

Summary Background Automatic stop orders (ASOs) for antimicrobials have been recommended as a component of antimicrobial stewardship programs, but may result in unintentional treatment interruption due to failure of providers to re-order an antimicrobial medication. We examined the impact of a multifaceted intervention designed to reduce the potential harms of interrupting antimicrobial treatment due to ASOs. Methods An intervention was implemented that included pharmacist review of expiring antimicrobials as well as provider education to encourage use of a long-term antimicrobial order set for commonly used prophylactic antimicrobials. Pharmacist interventions and antimicrobial re-ordering was recorded. Percent of missed doses of a commonly used prophylactic antimicrobial, single strength co-trimoxazole, was compared pre- and post-intervention using a chi-squared test. Results From November 1, 2015 to November 30, 2016, there were 401 individual pharmacist interventions for antimicrobial ASOs, resulting in 295 instances of antimicrobial re-ordering. The total percent of presumed missed single strength co-trimoxazole doses was reduced from 8.4% to 6.2% post-intervention ( P <0.001). Conclusions This study found that a targeted intervention was associated with a reduction in unintended antimicrobial treatment interruption related to ASOs.

Background Historically, anti-staphylococcal penicillins have been the treatment of choice for methicillin-susceptible Staphylococcus aureus (MSSA) infections. However, cefazolin may have advantages over these agents including convenience and tolerability. Despite several studies finding similar rates of clinical efficacy using cefazolin with fewer adverse drug events, some prescribers remain hesitant to use this agent due to concern for an inoculum effect in deep-seated infections. The purpose of this study was to compare cefazolin and nafcillin for the treatment of MSSA bacteremia with exclusively deep-seated sources. Methods Adult patients who were admitted with MSSA bloodstream infections (BSI) treated with cefazolin or nafcillin between March 2017 and October 2019 were identified. Patients were included if their BSI had a deep-seated source, defined as endocarditis, osteomyelitis, septic arthritis, pneumonia, prosthetic material, mediastinitis, or abscess. Patients were excluded if they had polymicrobial BSI, central nervous system infection, or received less than 7 days of therapy. The primary efficacy outcome (PEO) was a composite of treatment failure, 60-day mortality, and 60-day infection relapse, and was assessed using multivariate logistic regression. The primary safety outcome (PSO) was discontinuation of therapy due to adverse drug events, which was assessed with a chi-square test. Results A total of 164 patients were included in this analysis (141 treated with cefazolin and 23 with nafcillin). There were no significant differences in the baseline characteristics collected (Table 1), and the most common deep-seated sources were prosthetic material and endocarditis. Treatment with nafcillin was not found to be protective against the PEO in multivariate analysis (aOR, 1.19; 95% CI, 0.42 to 3.39; P = 0.75), and the PSO was reached significantly more often among nafcillin recipients compared to those treated with cefazolin (7/23 [30.4%] versus 8/141 [5.7%], P &lt; 0.0001). Conclusion Though the sample size was smaller than desired, cefazolin and nafcillin appeared to have similar efficacy for the treatment of MSSA BSIs with deep-seated sources. Nafcillin was associated with significantly more adverse drug events leading to discontinuation of therapy. Disclosures All Authors: No reported disclosures