438: SAFETY AND EFFICACY OF CEFEPIME INTRAVENOUS PUSH VERSUS PIGGYBACK IN GRAM-NEGATIVE BACTEREMIA

Introduction: Gram-negative infections including bacteremia are a major cause of inpatient mortality. Optimizing management is key to improving outcomes. Beta-lactams exhibit optimal antibacterial effects based on the time free concentrations exceed an organism’s minimum inhibitory concentration. Limited data exists assessing outcomes using beta-lactams as intravenous push (IVP) compared to intravenous piggyback (IVPB) in serious infections. This study’s purpose was to compare safety and efficacy of cefepime administered IVP versus IVPB in gram-negative bacteremia. Methods: This was an IRB-approved, retrospective cohort of patients hospitalized January 2014 to December 2021 and administered cefepime for \u3e48 hours for gram-negative bacteremia involving Pseudomonas aeruginosa or AmpC beta-lactamase producing bacteria. Two groups were included: one of patients who received cefepime IVPB and the second of patients who received cefepime IVP. The primary outcome was a desirability of outcome ranking (DOOR) on a five-point ordinal scale including clinical cure (no recurrent bacteremia of initial pathogen, antibiotic escalation, or 30-day in-hospital mortality) and neurologic adverse effects during cefepime treatment up to 30 days inpatient or at discharge. Secondary outcomes included antibiotic escalation, time to defervescence, vasopressor use, and in-hospital mortality. A sample of 127 patients per group provided 80% power. Data was analyzed using measures of central tendency and variability, chi-square, student’s T test, and Mann-Whitney U. Results: A total 254 patients were included with 127 per group. DOOR with clinical cure was similar between the IVPB and IVP groups (105 (82.7%) vs. 104 (81.9%); P=0.656). Escalation of therapy was the most common reason for clinical failure in both the IVPB and IVP groups (17 (13.4%) vs. 18 (14.2%); P=0.856). More patients in the IVP group required vasopressors (13 (10.2%) vs. 28 (22.0%); P=0.011). No difference was found in time to defervescence or in-hospital mortality. Conclusions: When compared to cefepime IVPB in gram-negative bacteremia, treatment with IVP showed no significant difference in instances of clinical cure or adverse effects. Further research in a more severely ill population is needed to evaluate safety and efficacy of cefepime IVPB versus IVP

Respiratory culture nudge improves antibiotic prescribing for Moraxella catarrhalis and Haemophilus influenzae lower respiratory tract infections

We compared optimal antibiotic prescribing before and after implementing an interpretive β-lactamase microbiology comment for Haemophilus influenzae and Moraxella catarrhalis in lower respiratory-tract infections. The postintervention group was associated with 5-fold increased odds of optimal de-escalation (adjusted odds ratio, 5.03; 95% confidence interval, 2.57-9.87)

Quantitative copper measurement in oxidized p-type silicon wafers using microwave photoconductivity decay

We propose a method to measure trace copper contamination in p-type silicon using the microwave photoconductivity decay (μ-PCD) technique. The method is based on the precipitation of interstitial copper, activated by high-intensity light, which results in enhanced minority carrier recombination activity. We show that there is a quantitative correlation between the enhanced recombination rate and the Cu concentration by comparing μ-PCD measurements with transient ion drift and total reflection x-ray fluorescence measurements. The results indicate that the method is capable of measuring Cu concentrations down to 10exp10cm−3. There are no limitations to wafer storage time if corona charge is used on the oxidized wafer surfaces as the charge prevents copper outdiffusion. We briefly discuss the role of oxide precipitates both in the copperprecipitation and in the charge carrier recombination processes.Peer reviewe

Real-world Multicenter Analysis of Clinical Outcomes and Safety of Meropenem-Vaborbactam in Patients Treated for Serious Gram-Negative Bacterial Infections

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

Preliminary, real-world, multicenter experience with omadacycline for Mycobacterium abscessus infections

Twelve patients were treated with omadacycline (OMC) as part of a multidrug regimen fo

A Multicenter Evaluation of Vancomycin-Associated Acute Kidney Injury in Hospitalized Patients with Acute Bacterial Skin and Skin Structure Infections

BACKGROUND: We sought to determine the real-world incidence of and risk factors for vancomycin-associated acute kidney injury (V-AKI) in hospitalized adults with acute bacterial skin and skin structure infections (ABSSSI). METHODS: Retrospective, observational, cohort study at ten U.S. medical centers between 2015 and 2019. Hospitalized patients treated with vancomycin (≥ 72 h) for ABSSSI and ≥ one baseline AKI risk factor were eligible. Patients with end-stage kidney disease, on renal replacement therapy or AKI at baseline, were excluded. The primary outcome was V-AKI by the vancomycin guidelines criteria. RESULTS: In total, 415 patients were included. V-AKI occurred in 39 (9.4%) patients. Independent risk factors for V-AKI were: chronic alcohol abuse (aOR 4.710, 95% CI 1.929-11.499), no medical insurance (aOR 3.451, 95% CI 1.310-9.090), ICU residence (aOR 4.398, 95% CI 1.676-11.541), Gram-negative coverage (aOR 2.926, 95% CI 1.158-7.392) and vancomycin duration (aOR 1.143, 95% CI 1.037-1.260). Based on infection severity and comorbidities, 34.7% of patients were candidates for oral antibiotics at baseline and 39.3% had non-purulent cellulitis which could have been more appropriately treated with a beta-lactam. Patients with V-AKI had significantly longer hospital lengths of stay (9 vs. 6 days, p = 0.001), higher 30-day readmission rates (30.8 vs. 9.0%, p \u3c 0.001) and increased all-cause 30-day mortality (5.1 vs. 0.3%, p = 0.024) CONCLUSIONS: V-AKI occurred in approximately one in ten ABSSSI patients and may be largely prevented by preferential use of oral antibiotics whenever possible, using beta-lactams for non-purulent cellulitis and limiting durations of vancomycin therapy

Real-world, Multicenter Experience With Meropenem-Vaborbactam for Gram-Negative Bacterial Infections Including Carbapenem-Resistant Enterobacterales and Pseudomonas Aeruginosa

Background: We aimed to describe the clinical characteristics and outcomes of patients treated with meropenem-vaborbactam (MEV) for a variety of gram-negative infections (GNIs), primarily including carbapenem-resistant Enterobacterales (CRE). Methods: This is a real-world, multicenter, retrospective cohort within the United States between 2017 and 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 (NCOs) and was examined by multivariable logistic regression analysis (MLR). Results: Overall, 126 patients were evaluated from 13 medical centers in 10 states. The most common infection sources were respiratory tract (38.1%) and intra-abdominal (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 4 patients: nephrotoxicity (n = 2), hepatoxicity (n = 1), and rash (n = 1). CART-BP between early and delayed treatment was 48 hours (P = .04). MEV initiation within 48 hours was independently associated with reduced NCO following analysis by MLR (adusted odds ratio, 0.277; 95% CI, 0.081-0.941). Conclusions: Our results support current evidence establishing positive clinical and safety outcomes of MEV in GNIs, including CRE. We suggest that delaying appropriate therapy for CRE significantly increases the risk of NCOs

Project #37: Management Guidelines for Patients with COVID-19: Rapid Cycle Improvement

Project’s purpose is to rapidly devise, continually improve, educate, and implement a live and changing COVID-19 management guideline based upon emerging best available evidence. This project also aims to optimize the care of patients with COVID-19 and improve patient outcomes.https://scholarlycommons.henryford.com/qualityexpo2022/1004/thumbnail.jp

Evaluation of HER-2/neu gene amplification and protein expression in non-small cell lung carcinomas

HER-2/neu gene amplification and cell surface overexpression are important factors in breast cancer for prognosis and prediction of sensitivity to anti-HER-2/neu monoclonal antibody therapy. In lung cancer, the clinical significance of HER-2/neu expression is currently under evaluation. We investigated 238 non-small lung carcinomas for HER-2/neu protein overexpression by immunohistochemistry using the HercepTest. We found 2+ or 3+ overexpression in 39 patients (16%), including 35% in adenocarcinomas and 20% in large cell carcinomas, but only 1% of squamous cell carcinomas. Marked (3+) overexpression was uncommon (4%). The association between protein expression and gene copy number per cell, as determined by fluorescence in situ hybridisation assay, was investigated in 51 of these NSCLC tumours. Twenty-seven tumours (53%) were negative by both tests. Marked (3+) protein expression and gene amplification were present in only 4% of samples. In 11 tumours (21%), gene gain was accompanied by chromosomal aneusomy and did not result in high protein levels while in 7 (14%) the score 2+ was associated with maximum number of signals per cell <9. The prognostic implication of HER-2/neu protein expression was studied in 187 surgically resected tumours. No statistical difference in survival was observed comparing patients with positive (2+/3+) and negative tumours (0/1+), although 3+ patients showed a tendency to shorter survival. The therapeutic implications of protein expression and gene amplification in lung cancer need to be examined in prospective clinical trials

Pengaruh persepsi mahasiswa fakultas ekonomi Universitas Kristen Petra Surabaya atas corporate reputation grup Pakuwon sebagai developer terhadap ekspektasi mereka atas Royal Plaza

Penelitian ini bertujuan untuk mengetahui pengaruh persepsi mahasiswa Fakultas Ekonomi Universitas Kristen Petra atas corporate reputation Grup Pakuwon terhadap ekspektasi mereka atas Royal Plaza. Persepsi mahasiswa Fakultas Ekonomi Universitas Kristen Petra ini dapat dilihat dari penilaian berdasarkan shopping center milik Grup Pakuwon yang telah ada, seperti: Tunjungan Plaza, Supermal Pakuwon Indah, dan Pakuwon Trade Center yang diukur dengan bantuan elemen-elemen dari store image. Ekspektasi mahasiswa Fakultas Ekonomi Universitas Kristen Petra terhadap Royal Plaza yang dilihat sebagai salah satu produk dari Grup Pakuwon juga diukur melalui elemen-elemen dari store image. Terdapat 5 elemen dari store image, yaitu: merchandise, employees, the store?s appearance, type of clientele, dan advertising. Hasil penelitian menunjukkan bahwa persepsi mahasiswa Fakultas Ekonomi Universitas Kristen Petra atas corporate reputation Grup Pakuwon berpengaruh secara positif terhadap ekspektasi mereka atas Royal Plaza