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Objectives: There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to Enterobacter, Serratia, or Citrobacter species. Methods: This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to Enterobacter, Serratia, or Citrobacter species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection. Results: A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (p = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51–1.72) in multivariable Cox proportional hazards regression analysis. Conclusions: These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to Enterobacter, Serratia, or Citrobacter species compared to other antimicrobial agents.

The results of this evaluation highlight the opportunity for educational intervention and the development of a structured, institution-specific guideline for prescribing and documenting pain management.

Objective. To design and develop a series of technology-enhanced case-based learning activities framed by the Pharmacists' Patient Care Process (PPCP), and to evaluate the impact of these activities on student perceptions and performance. Methods.A mixed methods approach was utilized to generate both quantitative and qualitative data.Survey and focus group interviews were used to analyze student perceptions. Performance on a pre/post case was assessed to measure the impact of the PPCP case-based learning activities.Results. Students demonstrated positive attitudes overall towards the case-based learning activities.Themes emerged during focus group interviews regarding awareness of the PPCP, engagement in learning, and a desire for realistic experiences. Statistically significant changes were observed for the pre/post assessment within the Plan and Follow-up parameters, as well as the total score within each disease state. Conclusion.The use of technology-enhanced case-based modules framed around a standardized patient care process resulted in positive student perceptions and improved scores on a pre/post patient case assessment. The PPCP may be a useful framework for case development to aid students in application of drug therapy knowledge.