scholarly journals Outcomes from an inpatient beta-lactam allergy guideline across a large US health system

2019 ◽  
Vol 40 (05) ◽  
pp. 528-535 ◽  
Author(s):  
Kimberly G. Blumenthal ◽  
Yu Li ◽  
Joyce T. Hsu ◽  
Anna R. Wolfson ◽  
David N. Berkowitz ◽  
...  
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Test Dose ◽  
Drug Discontinuation ◽  
Beta Lactam ◽  
Multivariable Logistic Regression Model ◽  
Model Modification ◽  
Increased Risk ◽  
Lactam Antibiotic ◽  
Dose Step

AbstractObjective:To assess the safety of, and subsequent allergy documentation associated with, an antimicrobial stewardship intervention consisting of test-dose challenge procedures prompted by an electronic guideline for hospitalized patients with reported β-lactam allergies.Design:Retrospective cohort study.Setting:Large healthcare system consisting of 2 academic and 3 community acute-care hospitals between April 2016 and December 2017.Methods:We evaluated β-lactam antibiotic test-dose outcomes, including adverse drug reactions (ADRs), hypersensitivity reactions (HSRs), and electronic health record (EHR) allergy record updates. HSR predictors were examined using a multivariable logistic regression model. Modification of the EHR allergy record after test doses considered relevant allergy entries added, deleted, and/or specified.Results:We identified 1,046 test-doses: 809 (77%) to cephalosporins, 148 (14%) to penicillins, and 89 (9%) to carbapenems. Overall, 78 patients (7.5%; 95% confidence interval [CI], 5.9%–9.2%) had signs or symptoms of an ADR, and 40 (3.8%; 95% CI, 2.8%–5.2%) had confirmed HSRs. Most HSRs occurred at the second (ie, full-dose) step (68%) and required no treatment beyond drug discontinuation (58%); 3 HSR patients were treated with intramuscular epinephrine. Reported cephalosporin allergy history was associated with an increased odds of HSR (odds ratio [OR], 2.96; 95% CI, 1.34–6.58). Allergies were updated for 474 patients (45%), with records specified (82%), deleted (16%), and added (8%).Conclusion:This antimicrobial stewardship intervention using β-lactam test-dose procedures was safe. Overall, 3.8% of patients with β-lactam allergy histories had an HSR; cephalosporin allergy histories conferred a 3-fold increased risk. Encouraging EHR documentation might improve this safe, effective, and practical acute-care antibiotic stewardship tool.

scholarly journals Systematic Review and Meta-analysis of the Association of Acute Kidney Injury with the Concomitant Use of Vancomycin and Piperacillin-Tazobactam in Children

2019 ◽  
Vol 63 (12) ◽  
Author(s):  
Markos Kalligeros ◽  
Spyridon A. Karageorgos ◽  
Fadi Shehadeh ◽  
Ioannis M. Zacharioudakis ◽  
Eleftherios Mylonakis
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Publication Bias ◽  
Pediatric Population ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Beta Lactam ◽  
Beta Lactam Antibiotic ◽  
Increased Risk ◽  
Lactam Antibiotic

ABSTRACT Concomitant use of vancomycin plus piperacillin-tazobactam (TZP) has been associated with increased risk of acute kidney injury (AKI) in hospitalized adults. In this systematic review and meta-analysis, we searched PubMed and EMBASE for pediatric studies examining this hypothesis, with reference to vancomycin monotherapy or in combination with another beta-lactam antibiotic. Of 1,381 nonduplicate studies, 10 met our inclusion criteria. We performed a random-effects meta-analysis, based on crude odds ratios (ORs), and we accounted for both quality of included studies and publication bias. In primary analysis, concomitant vancomycin and TZP use yielded a statistically significant association with the development of AKI. More specifically, children with AKI had higher odds of having been exposed to vancomycin plus TZP than to vancomycin monotherapy (OR, 8.15; 95% confidence interval [CI], 3.49 to 18.99) or to vancomycin plus any other beta-lactam antibiotic (OR, 3.48; 95% CI, 2.71 to 4.46). On the basis of the results of the Newcastle-Ottawa scale quality assessment, a secondary analysis that included only higher-quality studies (6 of 10 studies) again yielded higher odds of exposure to vancomycin plus TZP than to vancomycin plus another beta-lactam antibiotic (OR, 3.76; 95% CI, 2.56 to 5.51). Notably, even after controlling for possible publication bias, our results remained statistically significant (OR, 3.09; 95% CI, 2.30 to 4.14). In conclusion, the concomitant use of vancomycin and TZP could be associated with AKI development and the clinical significance of this potential association needs to be studied further in the pediatric population.

scholarly journals 137. Risk Factors of B-lactams Associated Cytopenias during Outpatient Parenteral Antimicrobial Therapy: Results from a Large National Sample

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S84-S84
Author(s):  
Yasir Hamad ◽  
Katelin B Nickel ◽  
Ige George ◽  
Yvonne J Burnett ◽  
Margaret A Olsen
Keyword(s):  
Risk Factors ◽  
Antimicrobial Therapy ◽  
Lower Risk ◽  
Univariate Analysis ◽  
National Sample ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Multivariable Logistic Regression Model ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Increased Risk

Abstract Background Cytopenias are rare complications of prolonged beta-lactam use; however, incidence and associated risk factors are not well described. Methods Patients aged 18-64 years in the 2010-2016 IBM MarketScan Commercial Database discharged from the hospital on cephalosporin, penicillin, or carbapenem outpatient Parenteral Antimicrobial Therapy (OPAT) were included. The primary endpoint was hospital admission coded for neutropenia, leukopenia, or thrombocytopenia within the first 6 weeks post index discharge and within 7 days of beta-lactam discontinuation. Patients with history of malignancy and those who are on chemotherapy were excluded. Significant factors in univariate analysis were incorporated into a multivariable logistic regression model with sequential exclusion of variables with p > 0.1. Results A total of 35,102 patients received beta-lactam OPAT; median age was 52 years and 53.6% were male. The primary outcome occurred in 150 (0.43%) patients at a median of 19 days (IQR 10-28 days after index discharge), which included 63 (0.18%) neutropenia, 85 (0.24%) thrombocytopenia, and 23 (0.07%) leukopenia admissions. Factors independently associated with readmission cytopenias included chronic liver disease (OR 4.61 [CI 2.93-7.25]), valvular heart disease (2.69 [1.71-4.24]), receipt of vancomycin (2.10 [1.42-3.12]), or antifungal therapy (4.42 [2.01-9.68]); lower risk was associated with carbapenem therapy (0.49 [0.32-0.75]) and diabetes (0.48 [0.31-0.74]) (Table 1). Conclusion Readmissions with cytopenias during beta-lactam OPAT were rare and carbapenem use was associated with lower risk compared to other classes of beta-lactams. Combination of beta-lactam with vancomycin was associated with an increased risk of cytopenias, and those patients might benefit from closer monitoring. Table 1. Factors Associated with Cytopenias during Beta-Lactams Outpatient Parenteral Antimicrobial Therapy (OPAT) Disclosures Margaret A. Olsen, PhD, MPH, Pfizer (Consultant, Research Grant or Support)

scholarly journals Outcomes of beta-lactam antibiotic test dose procedures for patients with reported beta-lactam allergy performed in a large US healthcare system

2019 ◽  
Vol 143 (2) ◽  
pp. AB25 ◽  
Author(s):  
Kimberly G. Blumenthal ◽  
Anna R. Wolfson ◽  
Joyce T. Hsu ◽  
Erica S. Shenoy ◽  
Yu Li ◽  
...  
Keyword(s):  
Healthcare System ◽  
Test Dose ◽  
Beta Lactam ◽  
Beta Lactam Antibiotic ◽  
Lactam Antibiotic

scholarly journals Impact of Diagnosed and Undiagnosed Respiratory Pseudomonas on VAP and VAE During Long-Term Acute Care

2020 ◽  
Vol 41 (S1) ◽  
pp. s258-s259
Author(s):  
James Harrigan ◽  
Ebbing Lautenbach ◽  
Emily Reesey ◽  
Magda Wernovsky ◽  
Pam Tolomeo ◽  
...  
Keyword(s):  
Bacterial Community ◽  
Acute Care ◽  
Statistical Significance ◽  
Rrna Gene ◽  
Care Hospital ◽  
16S Sequencing ◽  
Increased Risk ◽  
Wide Range ◽  
The Impact

Background: Clinically diagnosed ventilator-associated pneumonia (VAP) is common in the long-term acute-care hospital (LTACH) setting and may contribute to adverse ventilator-associated events (VAEs). Pseudomonas aeruginosa is a common causative organism of VAP. We evaluated the impact of respiratory P. aeruginosa colonization and bacterial community dominance, both diagnosed and undiagnosed, on subsequent P. aeruginosa VAP and VAE events during long-term acute care. Methods: We enrolled 83 patients on LTACH admission for ventilator weaning, performed longitudinal sampling of endotracheal aspirates followed by 16S rRNA gene sequencing (Illumina HiSeq), and bacterial community profiling (QIIME2). Statistical analysis was performed with R and Stan; mixed-effects models were fit to relate the abundance of respiratory Psa on admission to clinically diagnosed VAP and VAE events. Results: Of the 83 patients included, 12 were diagnosed with P. aeruginosa pneumonia during the 14 days prior to LTACH admission (known P. aeruginosa), and 22 additional patients received anti–P. aeruginosa antibiotics within 48 hours of admission (suspected P. aeruginosa); 49 patients had no known or suspected P. aeruginosa (unknown P. aeruginosa). Among the known P. aeruginosa group, all 12 patients had P. aeruginosa detectable by 16S sequencing, with elevated admission P. aeruginosa proportional abundance (median, 0.97; IQR, 0.33–1). Among the suspected P. aeruginosa group, all 22 patients had P. aeruginosa detectable by 16S sequencing, with a wide range of admission P. aeruginosa proportional abundance (median, 0.0088; IQR, 0.00012–0.31). Of the 49 patients in the unknown group, 47 also had detectable respiratory Psa, and many had high P. aeruginosa proportional abundance at admission (median, 0.014; IQR, 0.00025–0.52). Incident P. aeruginosa VAP was observed within 30 days in 4 of the known P. aeruginosa patients (33.3%), 5 of the suspected P. aeruginosa patients (22.7%), and 8 of the unknown P. aeruginosa patients (16.3%). VAE was observed within 30 days in 1 of the known P. aeruginosa patients (8.3%), 2 of the suspected P. aeruginosa patients (9.1%), and 1 of the unknown P. aeruginosa patients (2%). Admission P. aeruginosa abundance was positively associated with VAP and VAE risk in all groups, but the association only achieved statistical significance in the unknown group (type S error <0.002 for 30-day VAP and <0.011 for 30-day VAE). Conclusions: We identified a high prevalence of unrecognized respiratory P. aeruginosa colonization among patients admitted to LTACH for weaning from mechanical ventilation. The admission P. aeruginosa proportional abundance was strongly associated with increased risk of incident P. aeruginosa VAP among these patients.Funding: NoneDisclosures: None

scholarly journals Focus on Function in Hospitalized Persons With Dementia: The Impact of Hospital-Acquired Complications

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 762-762
Author(s):  
Marie Boltz ◽  
Lorraine Mion
Keyword(s):  
Acute Care ◽  
Goal Attainment ◽  
Functional Decline ◽  
Policy And Practice ◽  
Increased Risk ◽  
Research Findings ◽  
Pharmacologic Management ◽  
Hospitalized Older Adults ◽  
Hospital Acquired ◽  
The Impact

Abstract Persons with dementia (PWD) are two-three times more likely to be hospitalized as persons without dementia and comprise one fourth of hospitalized older adults. Hospitalization often has a dramatic impact upon the health and disposition of the older PWD. They are at increased risk for hospital acquired complications (HAC) such as functional decline, behavioral symptoms of distress, and delirium, all of which contribute to increased disability, mortality, and long-term nursing home stays. Despite the unprecedented number of PWD admitted to acute care, little attention has focused on their specialized needs and HAC, and how they impact functional recovery. The purpose of this symposium is to describe the incidence of common HACs, and factors that influence their occurrence and presentation in PWD. Utilizing baseline findings from the Family-centered Function-focused Care (Fam-FFC) trial, the presentations will address this objective and discuss the ramifications for functional and cognitive post-acute recovery in PWD. The first presentation will describe the incidence and pharmacologic management of pain in PWD, and its association with common HACs. The second presentation will describe physical activity in PWD on medical units and the validity of the Motionwatch8 actigraphy. The third session will describe differences in common HACs between white and black PWD. The final presentation will examine function-focused goals developed in collaboration with family caregivers and patients, and the functional outcomes associated with goal attainment. Our discussant, Dr. Lorraine Mion, will synthesize the research findings and lead a discussion of future directions for policy and practice in dementia-capable acute care.

Diagnostic and antimicrobial stewardship with molecular respiratory testing across the SHEA Research Network

2020 ◽  
pp. 1-4
Author(s):  
Kimberly C. Claeys ◽  
Daniel J. Morgan ◽  
Surbhi Leekha ◽  
Kaede V. Sullivan
Keyword(s):  
Respiratory Tract ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Real World ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Research Network ◽  
Lower Respiratory Tract Infections ◽  
Panel Testing ◽  
Tract Infections

This survey investigated diagnostic and antimicrobial stewardship practices related to molecular respiratory panel testing in adults with lower respiratory tract infections at acute care hospitals. Most respondents reported use of rapid respiratory panels, but related stewardship practices were uncommon and the real-world impact of respiratory panels were difficult to quantify.

scholarly journals Effect of a bacterial lipopolysaccharide on biliary excretion of a beta- lactam antibiotic, cefoperazone, in rats

1995 ◽  
Vol 39 (10) ◽  
pp. 2258-2261 ◽  
Author(s):  
S. Haghgoo ◽  
T. Hasegawa ◽  
M. Nadai ◽  
L. Wang ◽  
T. Nabeshima ◽  
...  
Keyword(s):  
Biliary Excretion ◽  
Bacterial Lipopolysaccharide ◽  
Beta Lactam ◽  
Beta Lactam Antibiotic ◽  
Lactam Antibiotic

scholarly journals Clinical Impact of Antimicrobial Stewardship Programs in Colombian Acute Care Hospitals

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S486-S487 ◽  
Author(s):  
Cristhian Hernández-Gómez ◽  
Christian Pallares ◽  
Sergio Reyes ◽  
Max Feinstein ◽  
Sergio Gutiérrez ◽  
...  
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospitals ◽  
Clinical Impact
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