Effectiveness of piperacillin/tazobactam loading dose for extended infusion dosing among patients with Gram-negative bacteraemia.

Objective: To examine the effect of a loading dose (LD) for extended infusion piperacillin/tazobactam on clinical outcomes.

Methods: This single-centre, retrospective cohort study evaluated adult patients with Gram-negative bacteraemia who received extended infusion piperacillin/tazobactam for ≥48 hours between 2015 and 2022. In December 2019, the study institution developed a policy that automatically ordered a piperacillin/tazobactam LD whenever piperacillin/tazobactam was prescribed.

Activity of ampicillin-sulbactam, sulbactam-durlobactam, and comparators against complex strains isolated from respiratory and bloodstream sources: results from ACNBio study.

Infections caused by carbapenem-resistant complex (ABC) are associated with high mortality rates and limited treatment options. This study aims to evaluate the activity of clinically utilized antimicrobials against a contemporary collection of ABC isolates with a predominant carbapenem-resistant phenotype. Geographically dispersed US medical centers ( = 22) provided non-duplicate respiratory and bloodstream ABC isolates for surveillance testing.

Urinary tract infection in adults: gaps in current guidelines - opinions from an international multidisciplinary panel and relevance to clinical practice.

Purpose: Although urinary tract infections (UTIs) are one of the most common infections encountered in clinical practice, many challenges remain with respect to classification and management. The purpose of this report is to discuss key issues in the management of UTIs and identify gaps in current knowledge and guidelines, as well as future research needs.

Design: A multidisciplinary panel of 13 experts from 6 European countries and the United States met on April 27, 2024.

The association between undetected heteroresistance and antibiotic treatment failure in complicated urinary tract infection.

Background: Antibiotic resistance is a worsening public health threat. One poorly understood aspect of this problem is unexpected antibiotic treatment failure; when an infecting isolate is deemed susceptible to a given antibiotic, yet treatment with that drug fails. It has been proposed that heteroresistance may be an explanation for at least some unexplained treatment failures.

Effectiveness of oral vancomycin as prophylaxis against infection in hematopoietic stem cell transplant patients.

Objective: Patients receiving hematopoietic stem cell transplants (HSCT) are at increased risk for infection (CDI). The purpose of this study was to assess the effectiveness of oral vancomycin prophylaxis (OVP) for CDI in HSCT patients.

Design: Single-center, retrospective cohort.

Association between Socioeconomic Status and Vaccination Hesitancy, Reluctancy and Confidence among Asian-Americans Living in the State of New Jersey.

Backgroud: Socioeconomic status (SES) plays a vital role in determining vaccination uptake and attitudes. Vaccine hesitancy varies among different communities, yet knowledge of vaccine attitudes among Asian-Americans is limited.

Objective: This study aims to investigate the relationship between SES and vaccine attitudes among Asian-Americans in the State of New Jersey (NJ).

Amoxicillin-Clavulanate Breakpoints Against Enterobacterales: Rationale for Revision by the Clinical and Laboratory Standards Institute.

Amoxicillin-clavulanate (AMC) is among the most frequently prescribed antibiotics globally. It has broad antibacterial activity against gram-positive, gram-negative, and anaerobic bacteria and has been used to treat infections caused by a broad range of pathogens. AMC breakpoints against Enterobacterales were initially set in the 1980s.

Simplified urine-based method to detect rifampin underexposure in adults with tuberculosis: a prospective diagnostic accuracy study.

Variable pharmacokinetics of rifampin in tuberculosis (TB) treatment can lead to poor outcomes. Urine spectrophotometry is simpler and more accessible than recommended serum-based drug monitoring, but its optimal efficacy in predicting serum rifampin underexposure in adults with TB remains uncertain. Adult TB patients in New Jersey and Virginia receiving rifampin-containing regimens were enrolled.

Principles and Practice of Antimicrobial Stewardship Program Resource Allocation.

Antimicrobial Stewardship Programs (ASP) improve individual patient outcomes and clinical care processes while reducing antimicrobial-associated adverse events, optimizing operational priorities, and providing institutional cost savings. ASP composition, resources required, and priority focuses are influenced by myriad factors. Despite robust evidence and broad national support, individual ASPs still face challenges in obtaining appropriate resources.

Rapid diagnostics to enhance therapy selection for the treatment of bacterial infections.

Purpose Of Review: Rapid diagnostic tests (RDTs) may reduce morbidity and mortality related to bacterial infections by reducing time to identification of pathogens and antibiotic resistance mechanisms. There has been a significant increase in the breadth and depth of available technology utilized by RDTs.

Recent Findings: There are numerous Food and Drug Administration (FDA)-cleared assays for rapid detection of bacteria from various specimen types from sites including blood, stool, central nervous system and respiratory tract.

Utility of triazole antifungal therapeutic drug monitoring: Insights from the Society of Infectious Diseases Pharmacists: Endorsed by the Mycoses Study Group Education and Research Consortium.

Triazole antifungals (i.e., fluconazole, itraconazole, voriconazole, posaconazole, and isavuconazole) are commonly used in clinical practice to prevent or treat invasive fungal infections.

Challenges and Opportunities in Antimicrobial Stewardship among Hematopoietic Stem Cell Transplant and Oncology Patients.

Antimicrobial stewardship programs play a critical role in optimizing the use of antimicrobials against pathogens in the era of growing multi-drug resistance. However, implementation of antimicrobial stewardship programs among the hematopoietic stem cell transplant and oncology populations has posed challenges due to multiple risk factors in the host populations and the infections that affect them. The consideration of underlying immunosuppression and a higher risk for poor outcomes have shaped therapeutic decisions for these patients.

Impact of phenotypic rapid diagnostic assay on duration of empiric antibiotics for gram-negative bacteremia.

Objective: Rapid diagnostic tests (RDTs) are increasingly being implemented as antimicrobial stewardship tools to facilitate antibiotic modification and reduce complications related to their overutilization. We measured the clinical impact of a phenotypic RDT with antimicrobial stewardship (AMS) in the setting of gram-negative bacteremia.

Setting And Participants: In this single-center retrospective cohort study, we evaluated adult patients with gram-negative bacteremia who received at least 72 hours of an antibiotic.

Pharmacogenetic variability and the probability of site of action target attainment during tuberculosis meningitis treatment: A physiologically based pharmacokinetic modeling and simulations study.

Objective And Methods: Our objective was to investigate the role of patient pharmacogenetic variability in determining site of action target attainment during tuberculous meningitis (TBM) treatment. Rifampin and isoniazid PBPK model that included SLCO1B1 and NAT2 effects on exposures respectively were obtained from literature, modified, and validated using available cerebrospinal-fluid (CSF) concentrations. Population simulations of isoniazid and rifampin concentrations in brain interstitial fluid and probability of target attainment according to genotypes and M.

Safety and Effectiveness of High-Dose Cefazolin in Patients With High Body Weight: A Retrospective Cohort Study.

Background: Cefazolin is a commonly used antibiotic for the treatment of mild to severe infections. Despite the use of higher dose of cefazolin (3 g/dose) for surgical prophylaxis in patients with obesity, there is currently a paucity of data identifying the optimal dose to treat infections in this specific patient population.

Methods: This was a multicenter, retrospective cohort study of patients who received cefazolin at weight-based (up to 9 g/day) or standard doses (up to 6 g/day) for the treatment of bacteremia or skin and soft tissue infection (SSTI).

Effectiveness of an Electronic Automated Antibiotic Time Out Alert in the Setting of Gram-Negative Bacteremia.

To minimize complications associated with over-utilization of antibiotics, many antimicrobial stewardship programs have incorporated an antibiotic time out (ATO); however, limited data are available to support its effectiveness. This was a single-center retrospective cohort study assessing the impact of the automated electronic ATO in the setting of Gram-negative bacteremia. The primary outcome was the proportion of patients who received a modification of therapy within 24 h of final culture results.

Pharmacists' Perceptions and Drivers of Immunization Practices for COVID-19 Vaccines: Results of a Nationwide Survey Prior to COVID-19 Vaccine Emergency Use Authorization.

Background: Pharmacists play a vital role in recommending and providing vaccines to improve public health and are on the front line of mass immunization efforts.

Aim: The objective of this study is to evaluate pharmacists' perceptions on COVID-19 vaccines prior to emergency use authorization (EUA) amid a global pandemic.

Methods: A voluntary, anonymous, cross-sectional survey was conducted between September and November 2020.

Comparing mortality in patients with carbapenemase-producing carbapenem resistant Enterobacterales and non-carbapenemase-producing carbapenem resistant Enterobacterales bacteremia.

Carbapenem-resistant Enterobacterales (CRE) are classified as either carbapenemase-producing CRE (CP-CRE) or non-carbapenemase-producing CRE (non-CP-CRE) based on their mechanism of carbapenem resistance. Few studies have compared outcomes associated with each type of infection. We attempted to determine if either CRE subset is associated with increased mortality.

Relationship Between Multidrug-Resistant Enterobacterales and Obesity in Older Adults.

Purpose: The objective of our study was to determine if obesity is associated with the presence of multidrug-resistant (MDR) bacteria among Enterobacterales.

Patients And Methods: This two-center cohort study included adult hospitalized patients with at least one specimen sampled from any site for bacterial culture yielding an Enterobacterales bacterial species from November 2016 to May 2017. Study groups were stratified by obesity status based on body mass index <30 kg/m (non-obese) and ≥30 kg/m (obese).

Prevention of infection and optimizing vaccination in the solid organ transplant candidate and recipient.

Purpose Of Review: Infections can result in serious complications in solid organ transplant (SOT) patients. The need to remain up to date on recommendations on screening, vaccinations, and chemoprophylaxis is paramount in the management of SOT patients. The goal of this review is to provide an overview of current recommendations for the prevention of infections and optimization of vaccinations from the pretransplant through posttransplant periods.

Montelukast in hospitalized patients diagnosed with COVID-19.

Objective: Several therapeutic agents have been assessed for the treatment of COVID-19, but few approaches have been proven efficacious. Because leukotriene receptor antagonists, such as montelukast have been shown to reduce both cytokine release and lung inflammation in preclinical models of viral influenza and acute respiratory distress syndrome, we hypothesized that therapy with montelukast could be used to treat COVID-19. The objective of this study was to determine if montelukast treatment would reduce the rate of clinical deterioration as measured by the COVID-19 Ordinal Scale.