Results of A Local Combination Therapy Antibiogram For \u3cem\u3ePseudomonas Aeruginosa\u3c/em\u3e Isolates: Is Double Worth The Trouble?

Purpose: To determine the frequency at which fluoroquinolones and aminoglycosides demonstrate in vitro activity against non-urinary, non-skin/skin structure Pseudomonas aeruginosa isolates exhibiting decreased susceptibilities to one or more β-lactam agents. Methods: β-lactam-non-susceptible P. aeruginosa isolates recovered from blood, bone, lower respiratory tract, pleural fluid, cerebrospinal fluid, or peritoneal fluid cultures between October 2010 and October 2014 were reviewed from four community hospitals within a single health-system. Only the first isolate per patient was included for analysis. The likelihood that each isolate was susceptible to a non-β-lactam antimicrobial was then determined and summarized within a combination antibiogram. Results: In total, 179 P. aeruginosa isolates with decreased susceptibilities to one or more β-lactam agents were assessed. Because no appreciable differences in antimicrobial susceptibility profile were observed between hospitals, the isolates were evaluated in aggregate. Susceptibility rates for β-lactam monotherapy ranged from 34% to 75%. Aminoglycosides possessed increased antibacterial activity compared to fluoroquinolones. Tobramycin was the non-β-lactam most likely to expand antimicrobial coverage against β-lactam-non-susceptible P. aeruginosa with activity against 64%, 66%, and 65% of cefepime-, piperacillin-tazobactam-, and meropenem-non-susceptible isolates, respectively (p \u3c 0.001 for all). Conclusions: The results of this study support the use of aminoglycosides over fluoroquinolones for achieving optimal, empiric antimicrobial combination therapy for P. aeruginosa when dual antimicrobial therapy is clinically necessary. Future efforts aimed at optimizing combination therapy for P. aeruginosa should focus on systemic interventions that limit the selection of fluoroquinolones in combination with β-lactams to expand coverage based on local susceptibility rates

A Retrospective Analysis of Treatment and Clinical Outsomes among Patients with Methicillin-Susceptible \u3cem\u3eStaphlococcus aureus\u3c/em\u3e Bloodstream Isolates Possessing detecable mecA by a Commercial PCR Assay Compared to Patients with Methicillin-Resistant \u3cem\u3eStaphylococcus aureus\u3c/em\u3e Bloodstream Isolates

mecA-positive Staphylococcus aureus isolates phenotypically susceptible to cefoxitin (mecA-methicillin-sensitive S. aureus[MSSA]) have been identified. We describe the treatment and outcomes among patients with mecA-MSSA bloodstream infections (BSI) and MRSA BSI matched 1:1 for age, BSI origin, and BSI type (n = 17 per group). Compared to MRSA BSI patients, mecA-MSSA BSI patients more often experienced clinical failure (58.8% and 11.8%, P = 0.010), driven largely by persistent bacteremia (35.3% and 11.8%). mecA-MSSA BSI patients may be at higher risk for poor clinical outcomes

MHD Peristaltic Flow of a Couple Stress Fluids with Heat and Mass Transfer through a Porous Medium

In the present article, we have studied the effects of heat and mass transfer on the MHD flow of an incompressible, electrically conducting couple stress fluid through a porous medium in an asymmetric flexible channel over which a traveling wave of contraction and expansion is produced, resulting in a peristaltic motion. The flow is examined in a wave frame of reference moving with the velocity of the wave. Formulas of dimensionless velocity, temperature and concentration are obtained analytically under assumptions of long wavelength and low Reynolds number. The effects of various parameters of interest such as the couple stress fluid parameter, Darcy number, Hartmann number and Schmidt number on these formulas were discussed and illustrated graphically through a set of figures. Key words: peristalsis,  Couple stress fluid,  Porous medium,  MHD flow, Heat transfer,  Mass transfer

Pharmacist-Driven Management of Chemotherapy Induced Nausea and Vomiting in Hospitalized Adult Oncology Patients. A Retrospective Comparative Study

Chemotherapy-induced nausea and vomiting (CINV) is a major adverse event associated with cancer treatments. There are clinical practice guidelines that assist practitioners in managing CINV. Many cancer centers develop protocols for physicians and pharmacists to guide prophylaxis and breakthrough treatments of CINV based on published guidelines. The purpose of this study was to evaluate the outcome differences between pharmacist and physician -driven management of CINV in adult hospitalized cancer patients in a large academic medical center. This is a single center retrospective chart review study. The primary outcome of the study was the number of breakthrough antiemetic doses needed throughout the hospitalization. A total of 106 adult patients receiving inpatient chemotherapy were reviewed for CINV management. Fifty-five patients (52%) were managed according to the pharmacist-driven protocol, and fifty-one patients (48%) were managed by the physician. There was no difference between the two groups in the primary outcome. Patients in the pharmacist-managed group needed 6.4 breakthrough antiemetic doses; whereas, patients in the physician managed group needed 5.9 doses throughout the hospital stay (P-value = 0.7). No difference was seen when results were adjusted for length of hospitalization. There was a difference in adherence to the institution CINV guidelines favoring the pharmacist-driven approach (85% versus 33%, P < 0.0001). In conclusion, pharmacist-run protocol for CINV management was as effective as the standard of care. Protocols that are based on practice guidelines may offer the advantage of care standardization and potential cost savings.   Type: Student Projec

Pharmacist-Driven Management of Chemotherapy Induced Nausea and Vomiting in Hospitalized Adult Oncology Patients. A Retrospective Comparative Study

Chemotherapy-induced nausea and vomiting (CINV) is a major adverse event associated with cancer treatments. There are clinical practice guidelines that assist practitioners in managing CINV. Many cancer centers develop protocols for physicians and pharmacists to guide prophylaxis and breakthrough treatments of CINV based on published guidelines. The purpose of this study was to evaluate the outcome differences between pharmacist and physician -driven management of CINV in adult hospitalized cancer patients in a large academic medical center. This is a single center retrospective chart review study. The primary outcome of the study was the number of breakthrough antiemetic doses needed throughout the hospitalization. A total of 106 adult patients receiving inpatient chemotherapy were reviewed for CINV management. Fifty-five patients (52%) were managed according to the pharmacist-driven protocol, and fifty-one patients (48%) were managed by the physician. There was no difference between the two groups in the primary outcome. Patients in the pharmacist-managed group needed 6.4 breakthrough antiemetic doses; whereas, patients in the physician managed group needed 5.9 doses throughout the hospital stay (P-value = 0.7). No difference was seen when results were adjusted for length of hospitalization. There was a difference in adherence to the institution CINV guidelines favoring the pharmacist-driven approach (85% versus 33%, P < 0.0001). In conclusion, pharmacist-run protocol for CINV management was as effective as the standard of care. Protocols that are based on practice guidelines may offer the advantage of care standardization and potential cost savings.   Type: Student Projec

Multisociety Statement on COVID-19 Vaccination as a Condition of Employment for Healthcare Personnel

This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and The Society for Post-Acute and Long-Term Care Medicine (AMDA), The Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP), recommends that COVID-19 vaccination should be a condition of employment for all healthcare personnel. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of non-employees functioning at a healthcare facility (for example, students, contract workers, volunteers, etc.)

Multisociety statement on coronavirus disease 2019 (COVID-19) vaccination as a condition of employment for healthcare personnel

This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) recommends that coronavirus disease 2019 (COVID-19) vaccination should be a condition of employment for all healthcare personnel in facilities in the United States. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of nonemployees functioning at a healthcare facility (eg, students, contract workers, volunteers, etc)