Evaluation of the Impact of an Antibiotic Time-out for Transition of IV Vancomycin to Oral Linezolid in Hospitalized Patients

Background: Oral linezolid is a broad-spectrum oxazolidinone antibiotic that offers advantages compared to intravenous (IV) vancomycin including no requirement for therapeutic drug monitoring, no need for home health or peripherally inserted central catheter (PICC) line placement, and opportunities for earlier hospital discharge due to the ease of continuing therapy outpatient. A medication use evaluation investigated if opportunities existed for oral linezolid over IV vancomycin among a randomized cohort of 100 patients initiated on IV vancomycin. Reviewers identified 15 patients who were candidates for transition to oral linezolid and calculated a potential cost avoidance of $125 per day of antibiotic therapy. The purpose of this study is to assess the feasibility of implementing an interdisciplinary approach for transitioning IV vancomycin to oral linezolid based on pharmacist-led transition criteria. Methods: This is an IRB-reviewed, single-center, quasi-experimental study at Baptist Hospital of Miami, a 900-bed tertiary community hospital. Included patients were \u3e18 years old, receiving IV vancomycin for \u3e48 hours, and admitted between January 10, 2023 and March 31, 2023. Patients were excluded if they had an active vasopressor order, were immunocompromised, or if the patient was receiving antibiotics for meningitis, endocarditis, febrile neutropenia, or surgical prophylaxis. A pharmacy resident was on-call to assess for oral linezolid candidates using antibiotic timeout criteria and intervened as appropriate. Continuous and categorical variables were evaluated using the Mann-Whitney U test and Fisher’s exact test, respectively. The primary outcome was total cost avoidance in patients transitioned from IV vancomycin to oral linezolid. Secondary outcomes included median hospital length of stay, median antibiotic treatment days, and incidence of thrombocytopenia and acute kidney injury, and pharmacist intervention acceptance rate. Results: Investigators screened 317 patients for study inclusion and 94 patients met criteria. 66 (70$5,538, with a total of $21 and$70 saved per inpatient and outpatient antibiotic treatment day, respectively. Median length of antibiotic treatment days was 6 days between both groups (p=0.3524). No statistically significant differences were observed between length of stay, length of antibiotic treatment days, or safety outcomes between the 2 groups. Acute kidney injury occurred in 1 patient receiving linezolid and 1 patient receiving IV vancomycin. Thrombocytopenia, defined as a \u3e50% drop in platelet count from baseline, occurred in 1 patient receiving provider-driven linezolid therapy. Conclusion: Pharmacist-driven transition criteria from IV vancomycin to linezolid therapy resulted in a positive cost avoidance strategy, with similar effect on hospital antibiotic treatment days and no difference in incidence of adverse effects. These results demonstrate the practicality of a pharmacist prospective antibiotic timeout and intervention strategy for patients receiving empiric or targeted Methicillin-resistant Staphylococcus aureus (MRSA) therapy

Assessment of a Pharmacist-Led Antibiotic Time-out for Transition of IV Vancomycin to Oral Linezolid

Introduction: Intravenous (IV) vancomycin requires therapeutic drug monitoring and line placement and may prolong hospital stay. Linezolid requires less monitoring, is orally bioavailable, and may expedite transitions of care. This study assessed the impact of a pharmacist-led antibiotic timeout for the transition from IV vancomycin to oral linezolid. Methods: This single-center, quasi-experimental study included admitted adult patients receiving IV vancomycin for over 48 hours. Patients receiving vasopressors, of immunocompromised status, or with specific antibiotic indications were excluded. The primary outcome was the pharmacist intervention acceptance rate. Secondary outcomes included median hospital length of stay, median antibiotic treatment days, and incidence of adverse effects. Results: Of the 317 screened patients, 94 were eligible for the antibiotic time-out assessment, of which 66 met the criteria for oral linezolid. Of those meeting the criteria, 27 interventions were made, of which 20 (74%) were accepted. The median length of antibiotic treatment days was six days between both groups (p = .352). No differences in safety outcomes were observed. Discussion: A pharmacist-led antibiotic timeout for IV vancomycin to oral linezolid resulted in a high intervention acceptance rate and increased oral linezolid use without impacting safety outcomes. These results support the use of this strategy for antimicrobial stewardship. Conclusion: This study illustrates the impact of a pharmacist-led antibiotic timeout for the transition from IV vancomycin to oral linezolid therapy as an antimicrobial stewardship tool

Impact of a pharmacist-driven carbapenem de-escalation algorithm for hospitalized patients with urinary tract infections

Background: Antimicrobial resistance is now a leading cause of death due to infections worldwide. Antimicrobial stewardship can help mitigate antimicrobial resistance by reducing and optimizing broad-spectrum antibiotic use. Urinary tract infections (UTIs) are one of the common indications for use of antibiotics in the hospital setting. Carbapenem use for extended-spectrum β-lactamase producing Enterobacterales (ESBL-PE) UTIs remains controversial with some studies showing benefit while others demonstrating similar efficacy with non-carbapenem beta-lactams or non-beta-lactam agents. National guidelines recommend the utilization of carbapenem sparing strategies for UTIs if there is demonstrated susceptibility to other first line agents such as nitrofurantoin or trimethoprim-sulfamethoxazole (TMP/SMX) for uncomplicated UTIs, and fluoroquinolones or TMP/SMX for complicated UTIs/Pyelonephritis. The purpose of this study is to develop and implement a pharmacist-driven carbapenem de-escalation algorithm for hospitalized patients with UTIs in an effort to reduce further development of antimicrobial resistance. Methods: This is a biphasic, retrospective chart review of patients who received carbapenems with a diagnosis of UTIs in a 900+ bed tertiary community hospital. Patients were included if they were ≥18 years old and receiving carbapenems with a diagnosis of UTI without bacteremia. Patients were excluded if they were receiving carbapenems for other indications, had a urinary stent at baseline, had abnormal genitourinary anatomy, or had a UTI involving renal calculi. Phase I was the pre-intervention period consisting of a chart review from August 2022 to November 2022 prior to the utilization of the carbapenem de-escalation algorithm. Phase II was the post-intervention period, consisting of a chart review of the intervention period from December 2022 to March 2023. During the intervention period, a pharmacist proactively screened for carbapenem de-escalation eligibility using the algorithm and intervened as appropriate. The primary outcome was the percent of eligible patients de-escalated to non-carbapenem agents before and after implementation of the algorithm. Secondary outcomes included intervention acceptance rate post intervention, median duration of carbapenem therapy pre and post intervention and hospital length of stay pre and post intervention. A 95% confidence interval was calculated for the primary outcome and the Mann-Whitney U test was utilized to assess significance of the secondary outcomes. Results: In phase I of the study, 60 patients met inclusion criteria and 40 were eligible for de-escalation to non-carbapenem agents. In phase II, 60 patients were included and 37 were eligible for de-escalation via algorithm. Baseline characteristics were similar in both groups, except the post-intervention period had less females 48% versus 35%. Percent de-escalation before and after implementation of the algorithm was 68% versus 90% (95%Cl [0.03 - 0.38]) respectively. In phase II of the study, pharmacists were responsible for 41% of de-escalations and the intervention acceptance rate was 79%. Median duration of carbapenem therapy pre and post intervention was 3 versus 2.4 days (p=0.4237) respectively. Median hospital length of stay pre and post intervention was 5 versus 7 days (p=0.1615) respectively. Conclusion: A pharmacist-driven carbapenem de-escalation algorithm for patients with ESBL-PE UTIs helped increase carbapenem de-escalation by 22% in the post-intervention period with a 79% intervention acceptance rate

Retrofitted lathe machine

This study focuses on retrofitting the turning and facing processes of the lathe machine. The software part will be composed primarily of G Code commands incorporated into a Visual Basic program. The commands will be relayed to the stepper motor drivers by a micro controller. The stepper motors will be responsible for the movement along the X and Z axis. Thus, automating the lathe to perform the turning and facing processes of the lathe