Pneumonia is a leading infectious cause of morbidity and mortality in the United States. The Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) have published treatment guidelines for community-acquired pneumonia (CAP) based upon the site of acquisition and specific pathogen risk. The literature demonstrates improved outcomes with guideline-concordant empiric therapy. A subset of patients with CAP has risk factors for drug-resistant pathogens (DRPs). IDSA/ATS treatment guidelines do not provide clear recommendations for empiric treatment, and clinical studies have not provided descriptive data for this group.A retrospective chart review of all admissions between January 1, 2008 and April 19, 2009 with an International Classification of Diseases-9 code and physician-documented diagnosis of pneumonia at two community hospitals were performed. IDSA pneumonia type and presence of risk factors for DRP were recorded for each patient, and the empiric antibiotic therapy received was evaluated. Admissions were excluded if immunosuppression or pregnancy was present.Of the 400 admissions reviewed, 343 patients were included. A total of 228 patients (71%) had CAP. Forty-three percent of patients with CAP had risk factors for DRP. Only 2% of this group received an antibiotic regimen with coverage of the specific DRP risk factor present. The most common DRPs not receiving coverage in this group were Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. P. aeruginosa and methicillin-resistant S. aureus occurred more commonly in culture-positive patients with CAP with DRP risk factors but did not achieve statistical significance. A larger sample size would be needed to determine whether this difference is significant.Risk factors for DRP occurred commonly in our CAP population. Patients with CAP with risk for DRP may be a distinct group who are without clear guidance on treatment. Future studies are needed to define the risk of DRP and the impact upon empiric therapy for patients with CAP.
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 used to generate both quantitative and qualitative data. Survey and focus group interviews were used to analyze student perceptions. Performance on a pre- and post-assessment was used to measure the impact of 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. Significant changes were observed for the pre- and post-assessment within the plan and follow-up parameters, as well as for 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 patient case assessment. The PPCP may be a useful framework for case development to aid students in application of drug therapy knowledge.
Background: Fluoroquinolones (FQs) are associated with potential tendon injury but comparative risk versus other antibiotic (non-FQ) options for the same indication has rarely been evaluated. Objective Describe the incidence (relative risk) of any tendon injury in patients receiving FQs compared with other (non-FQ) antibiotics for treatment of urinary tract infections (UTIs). Methods A retrospective propensity score-weighted cohort study was performed to evaluate the association between FQ antibiotics and tendon injury at two time points (within one month and within six months of use) compared with non-FQ regimens for treatment of UTI. The evaluation was performed using the Merative™ MarketScan ® Research Databases from 2014 to 2020. Adult patients with International Classification of Diseases (ICD)-9/10 coding for UTI were included. Patients with a history of tendon injury or those who received both FQ and non-FQ regimens during the study period were excluded. Propensity score weighting was used to adjust for selection bias due to contributing risk factors, including demographics (age, sex), comorbidities (diabetes mellitus, chronic kidney disease), and concurrent medications (corticosteroids). Results Both the 1-month and 6-month cohorts were predominately female and less than 50 years of age. At one month, the incidence of tendon injury was 0.2% in the FQ group and 0.1% in the non-FQ group, and the odds of tendon injury were not estimated to be significantly different between groups (odds ratio [OR] = 1.03, 95% confidence interval [CI] 0.93, 1.32). Odds of tendon injury were also not estimated to be significantly different in the 6-month cohort (OR = 0.98, 95% CI 0.84, 1.05). Conclusion and Relevance In this population of predominantly young female patients without high incidence of potentially contributing comorbidities, increased risk of tendon injury was not associated with FQ use. Future research is needed to determine whether demographic differences between this and other previously studied populations account for this discordant result
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.
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