Traditional antibiograms use local resistance patterns and susceptibility data to guide empiric antimicrobial therapy selection. However, antibiograms are rarely unit-specific and do not account for patient-specific risk factors. The objective was to develop an Emergency Department (ED)-specific antibiogram and evaluate the impact of risk factors on antimicrobial susceptibility. This retrospective, single-center descriptive study used culture and susceptibility data from January 1 to December 31, 2016 to create an ED-specific antibiogram for the most commonly isolated organisms. Susceptibilities were then compared with the hospital antibiogram. All ED isolates were further stratified by the following risk factors: age, disposition from ED, previous antimicrobial use and/or hospitalization within 30 days, and presenting location. Descriptive statistics, Pearson Chi-Square/Fisher’s Exact Tests, and logistic regression were performed. A two-tailed p-value of <0.05 was considered statistically significant. A total of 2158 isolates from the ED were included: Escherichia coli (EC) (n = 1244), Klebsiella pneumoniae (KP) (n = 232), Proteus mirabilis (PM) (n = 131), Pseudomonas aeruginosa (PA) (n = 103), Staphylococcus aureus (SA) (n = 303), and Enterococcus faecalis (EF) (n = 145). The majority of patients were <65 years old (n = 1088) and presented from the community (n = 1800) with no antimicrobial exposure (n = 1628) nor hospitalization (n = 1895) within 30 days. There were no statistically significant differences between the ED and hospital antibiogram (n = 5739) for KP, PM, PA, SA, and EF. The hospital antibiogram overestimated EC resistance rates for cefazolin (20% vs. 15.6%, P = 0.049), ceftriaxone (9.6% vs. 6.4%, P < 0.033), and ciprofloxacin (23.7% vs. 15.4%, P < 0.006). There were significantly more risk factors present in patients discharged from the ED vs. those admitted (P < 0.0001). Healthcare facility residence had the greatest impact on susceptibility, especially EC (81.8% vs. 34.9%, P < 0.0001) and PM (75.3% vs. 33%, P < 0.0001) ciprofloxacin susceptibility. Development of an ED-specific antibiogram can aid physicians in prescribing appropriate empiric therapy when risk factors are included. All authors: No reported disclosures.
Purpose. The adverse events associated with bevacizumab therapy are characterized, and the underlying pathophysiology, risk factors, frequency, and management of these events are described. Summary. The adverse events associated with bevacizumab include hypertension, proteinuria, thromboembolism, impaired wound healing, bleeding, perforation, reversible leukoencephalopathy syndrome, skin rash, and infusion-related hypersensitivity reactions. Patients should be monitored for these events throughout the course of bevacizumab therapy. Hypertension is by far the most common adverse event associated with bevacizumab. Blood pressure should be routinely monitored, and hypertension should be medically managed with antihypertensive drugs as deemed appropriate during bevacizumab therapy. Patients should be monitored for proteinuria every three to four weeks, and bevacizumab should be discontinued with persistent proteinuria of >2+. Thromboembolic events, impaired wound healing, bowel and nasal septum perforation, and bleeding share similar pathophysiology. Thromboembolic events should be managed in accordance with guidelines established by the American College of Chest Physicians, and bevacizumab should be discontinued for new life-threatening venous or arterial thromboembolism. To minimize the risk of bleeding or impaired wound healing, bevacizumab should be started at least four weeks after surgery or discontinued for at least six to eight weeks before elective surgery. The management of other adverse events is more anecdotal, with relatively few reports of their occurrence with bevacizumab. Conclusion. Many of the potential serious complications of bevacizumab can be averted by close monitoring of patient- specific variables, which should be measured at baseline and then at predetermined intervals throughout the course of therapy to maximize patient safety.
