Prospective nasal screening for methicillin-resistant Staphylococcus aureus in critically ill patients with suspected pneumonia

We carried out a prospective de-escalation study based on methicillin-resistan

Sepsis prediction for the general ward setting

OBJECTIVE: To develop and evaluate a sepsis prediction model for the general ward setting and extend the evaluation through a novel pseudo-prospective trial design. DESIGN: Retrospective analysis of data extracted from electronic health records (EHR). SETTING: Single, tertiary-care academic medical center in St. Louis, MO, USA. PATIENTS: Adult, non-surgical inpatients admitted between January 1, 2012 and June 1, 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 70,034 included patient encounters, 3.1% were septic based on the Sepsis-3 criteria. Features were generated from the EHR data and were used to develop a machine learning model to predict sepsis 6-h ahead of onset. The best performing model had an Area Under the Receiver Operating Characteristic curve (AUROC or c-statistic) of 0.862 ± 0.011 and Area Under the Precision-Recall Curve (AUPRC) of 0.294 ± 0.021 compared to that of Logistic Regression (0.857 ± 0.008 and 0.256 ± 0.024) and NEWS 2 (0.699 ± 0.012 and 0.092 ± 0.009). In the pseudo-prospective trial, 388 (69.7%) septic patients were alerted on with a specificity of 81.4%. Within 24 h of crossing the alert threshold, 20.9% had a sepsis-related event occur. CONCLUSIONS: A machine learning model capable of predicting sepsis in the general ward setting was developed using the EHR data. The pseudo-prospective trial provided a more realistic estimation of implemented performance and demonstrated a 29.1% Positive Predictive Value (PPV) for sepsis-related intervention or outcome within 48 h

Clinical pharmacist services within intensive care unit recovery clinics: An opinion of the critical care practice and research network of the American College of Clinical Pharmacy

Intensive care unit recovery clinics (ICU- RCs) have been proposed as a potential mechanism to address the multifaceted unmet needs of intensive care unit (ICU) survivors and caregivers. The needs of this population include, but are not limited to, medication optimization, addressing physical function and psychological needs, coordination of care, and other interventions that may help in improving patient recovery and reducing the rate of preventable readmissions. The objective of this opinion paper is to identify and describe clinical pharmacy services for the management of ICU survivors and their caregivers in an ICU- RC. The goals are to guide the establishment and development of clinical pharmacist involvement in ICU- RCs and to highlight ICU recovery research and educational opportunities. Recommendations provided in this paper are based on the following: a review of published data on clinical pharmacist involvement in the ICU- RCs; a consensus of clinical pharmacists who provide direct patient care to ICU survivors and caregivers; and a review of published guidelines and literature focusing on the management of ICU survivors and caregivers. These recommendations define areas of clinical pharmacist involvement in ICU- RCs. Consequently, clinical pharmacists can promote education on Post Intensive Care Syndrome and Post Intensive Care Syndrome- Family; improve medication adherence; facilitate appropriate referrals to primary care providers and specialists; ensure comprehensive medication management and medication reconciliation; provide assessment of inappropriate and appropriate medications after hospitalization; address adverse drug events, medication errors, and drug interactions; promote preventive measures; and facilitate medication acquisition with the goal of improving patient outcomes and reducing health care system costs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163579/2/jac51311.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163579/1/jac51311_am.pd

New perspectives on antimicrobial agents: Ceftolozane-tazobactam

Ceftolozane-tazobactam (C/T) is a new fifth-generation cephalosporin/beta-lactamase inhibitor combination approved by the Food and Drug Administration and the European Medicines Agency for treatment of complicated intraabdominal infections, complicated urinary tract infections, and hospital-acquired pneumonia in adult patients. This review will briefly describe the pharmacology of C/T and focus on the emerging clinical trial and real-world data supporting its current utilization. Additionally, our synthesis of these data over time has set our current usage of C/T at Barnes-Jewish Hospital (BJH). C/T is primarily employed as directed monotherapy at BJH when Pseudomonas aeruginosa isolates are identified with resistance to other beta-lactams. C/T can also be used empirically in specific clinical situations at BJH prior to microbiological detection of an antibiotic-resistant P. aeruginosa isolate. These situations include critically ill patients in the intensive care unit (ICU) setting, where there is a high likelihood of infection with multidrug-resistant (MDR) P. aeruginosa; patients failing therapy with a carbapenem; specific patient populations known to be at high risk for infection with MDR P. aeruginosa (e.g., lung transplant and cystic fibrosis patients); and patients know to have previous infection or colonization with MDR P. aeruginosa