Abstract Background Infectious Diseases (ID) consult services, typically led by ID physicians, benefit significantly from the support of ID pharmacists. These pharmacists, with specialized training in ID pharmacotherapy through post-graduate residencies or fellowships, play a crucial role in advising on the selection, dosing, duration, and monitoring of antimicrobials. While the contribution of ID pharmacists to antimicrobial stewardship programs is well described, their impact in supporting ID consult services remains underdocumented. This report explores the clinical inquiries made by ID physicians and advanced practice providers (APP) to ID pharmacists on consult services, detailing how these interactions influence patient treatment and monitoring plans.Figure 1ID Pharmacist Curbside Question Categories (Categories with 2+ Submissions) Methods Ten ID residency- or fellowship-trained clinical pharmacists practicing in various practice settings documented questions they received from ID providers (attendings, fellows, and APPs) for patients on their respective ID consult service over a 6-month period. The impact of the conversations was documented if the pharmacist recommending a new drug, dose, duration, or monitoring plan which resulted in a change in care. Additional information was captured on the time spent answering questions, category of question, and pertinent microbiology or organism phenotype to describe areas of highest need for ID pharmacist support.Figure 2Questions Leading to Therapeutic Change Results Over the first three months of documentation, 782 questions were asked by ID providers to ID pharmacists. Total direct time spent answering questions was 8,937 minutes. The top three question categories were gram-negative resistance, antifungal therapy, and antimicrobial allergies. Seven hundred and three (89.8%) questions resulted in a clinical change in management as recommended by the ID pharmacist. The most common clinical change category was recommending a new dose which occurred in 57.4% of questions followed by new antimicrobial 50.4%, new monitoring plan 24.2% and new duration of therapy 8.8%. Conclusion ID pharmacists offer critical support that frequently changes management on ID consult services. Integrating their expertise into a multidisciplinary ID team is essential for achieving optimal patient safety and treatment outcomes. Disclosures Wesley D. Kufel, Pharm.D., BCPS, BCIDP, Merck & Co.: Grant/Research Support|Shionogi, Inc: Grant/Research Support Jennifer Ross, PharmD, BCIDP, Shionogi Inc.: Advisor/Consultant Frank Tverdek, PharmD, Merck: Advisor/Consultant
OBJECTIVE: To describe outcomes associated with monoclonal antibody use in pregnant persons with mild-to-moderate coronavirus disease 2019 (COVID-19). METHODS: We present a retrospective case series of pregnant patients who received anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) monoclonal antibody infusions at a single center from April 1, 2021, through October 16, 2021. Pregnant patients who had a positive SARS-CoV-2 polymerase chain reaction (PCR) test result and mild-to-moderate COVID-19 symptoms were eligible for monoclonal antibody infusion. Exclusion criteria for administration included need for supplemental oxygen, hospitalization due to COVID-19, and positive SARS-CoV-2 PCR test result more than 7 days before screening. All patients received either bamlanivimab plus etesevimab or casirivimab plus imdevimab based on availability and dosing instructions of the product and emerging resistance patterns in the community. RESULTS: During the study period, monoclonal antibody infusions were administered to 450 individuals at our institution, of whom 15 were pregnant. Of the 15 pregnant persons receiving monoclonal antibody, six (40%) had full-vaccination status at the time of infusion. Two individuals (13%, CI 0–31%) experienced systemic reactions during the infusion, both resulting in temporary changes in the fetal heart rate tracing that recovered with maternal and intrauterine resuscitative efforts. One patient delivered after infusion for worsening maternal and fetal status; the remainder of the patients did not require admission for COVID-19. CONCLUSION: In this case series, pregnant persons who received anti–SARS-CoV-2 monoclonal antibody infusions had generally favorable outcomes.
A bench-scale dose-response study evaluated the efficacy of a commercially available copper-based molluscicide known as EarthTec QZ for controlling quagga veligers collected from three Southern California sites impacted by quagga mussels.A variety of concentrations were tested (0, 3, 16.7, 33.4, and 50.1 µL/L of EarthTec QZ or 0, 0.18, 1.0, 2.0, 3.0 mg/L as copper (Cu), respectively) for different durations (0.5, 2, 5, and 24 hours) on quagga mussel veligers.Water from each study site was also used in non-target 96-hour acute toxicity testing of three other species.A suite of water quality parameters was measured to characterize the differences between the study sites.The federal and California secondary maximum contaminant level and action level for copper in drinking water are 1.0 and 1.3 mg/L as Cu, respectively; therefore, results for the 16.7 µL/L EarthTec QZ (1.0 mg/L as Cu) test condition were the main reference point for assessing the efficacy of EarthTec QZ as a feasible treatment strategy.Under this condition, veliger mortality at two study sites, Lake Mathews, and a downstream water treatment plant, was found to be greater than 60% and 85% after 5 hours, and 95% and 100% after 24 hours, respectively.Lower efficacy was observed for the Lake Piru study site, with approximately 30% veliger mortality after 24 hours.Alkalinity, dissolved organic carbon, and chemical oxygen demand were found to be significant variables for veliger mortality in these hard water locations based on linear regression modeling.The three non-target indicator species were adversely affected by EarthTec QZ at concentrations tested.These results indicate that this product has potential as an effective chemical control agent against quagga veligers at low doses, but the aforementioned water quality parameters must be considered with full-scale application to optimize target efficacy, while minimizing exposure to non-target species and costs.
Abstract Objective: To describe the real-world clinical impact of a commercially available plasma cell-free DNA metagenomic next-generation sequencing assay, the Karius test (KT). Methods: We retrospectively evaluated the clinical impact of KT by clinical panel adjudication. Descriptive statistics were used to study associations of diagnostic indications, host characteristics, and KT-generated microbiologic patterns with the clinical impact of KT. Multivariable logistic regression modeling was used to further characterize predictors of higher positive clinical impact. Results: We evaluated 1000 unique clinical cases of KT from 941 patients between January 1, 2017–August 31, 2023. The cohort included adult (70%) and pediatric (30%) patients. The overall clinical impact of KT was positive in 16%, negative in 2%, and no clinical impact in 82% of the cases. Among adult patients, multivariable logistic regression modeling showed that culture-negative endocarditis (OR 2.3; 95% CI, 1.11–4.53; P .022) and concern for fastidious/zoonotic/vector-borne pathogens (OR 2.1; 95% CI, 1.11–3.76; P .019) were associated with positive clinical impact of KT. Host immunocompromised status was not reliably associated with a positive clinical impact of KT (OR 1.03; 95% CI, 0.83–1.29; P .7806). No significant predictors of KT clinical impact were found in pediatric patients. Microbiologic result pattern was also a significant predictor of impact. Conclusions: Our study highlights that despite the positive clinical impact of KT in select situations, most testing results had no clinical impact. We also confirm diagnostic indications where KT may have the highest yield, thereby generating tools for diagnostic stewardship.
