Black Lives Matter.

Recent Black deaths at the hands of law enforcement officers has heightened awareness of racism within the United States. The consequences of this racism are not only differential policing practices toward Black people, but also inequities related to numerous other sectors, including housing, education, economics, and overt health care disparities between White and non-White Americans. Health care practitioners, including pharmacists, are extremely well positioned to be leaders in addressing long-standing inequities, thereby saving lives and improving access to and quality of care.

Treatment of Achromobacter Ventilator-Associated Pneumonia in Critically Ill Trauma Patients.

Background: Achromobacter sp are nonfermenting Gram-negative bacilli (NFGNB) that rarely cause severe infections, including ventilator-associated pneumonia (VAP). Data on the treatment of Achromobacter pneumonia are very limited, and the organism has been associated with a high mortality rate. Thus, more data are needed on treating this organism.

The Use of Topical Hemostatic Agents in Cardiothoracic Surgery.

Topical hemostatic agents are used in conjunction with conventional procedures to reduce blood loss. They are often used in cardiothoracic surgery, which is particularly prone to bleeding risks. Variation in their use exists because detailed policy and practice guidelines reflecting the current medical evidence have not been developed to promote best surgical practice in this setting.

Pharmacokinetics of Imipenem/Cilastatin Burn Intensive Care Unit Patients Undergoing High-Dose Continuous Venovenous Hemofiltration.

Study Objective: High-dose continuous venovenous hemofiltration (CVVH) is a continuous renal replacement therapy (CRRT) used frequently in patients with burns. However, antibiotic dosing is based on inference from studies assessing substantially different methods of CRRT. To address this knowledge gap for imipenem/cilastatin (I/C), we evaluated the systemic and extracorporeal clearances (CLs) of I/C in patients with burns undergoing high-dose CVVH.

Short-duration treatment for catheter-associated urinary tract infections in critically ill trauma patients.

Background: The optimal treatment duration for catheter-associated urinary tract infection (CA-UTI) in critically ill patients is unclear. The Infectious Diseases Society of America recommends up to 14 days of therapy; however, short-duration therapy (SDT) for 3 days to 5 days is often used in trauma intensive care unit (ICU) patients at our center. The efficacy of SDT for CA-UTI has not been studied in this population.

Adjunctive intraventricular antibiotic therapy for bacterial central nervous system infections in critically ill patients with traumatic brain injury.

Background: Limited data exist on the role of adjunctive intraventricular (IVT) antibiotics for the treatment of central nervous system (CNS) infections in traumatic brain injury (TBI) patients.

Objective: To evaluate differences in CNS infection cure rates for TBI patients who received adjunctive IVT antibiotics compared with intravenous (IV) antibiotics alone.

Methods: We retrospectively identified patients with TBI and bacterial CNS infections admitted to the trauma intensive care unit (ICU) from 1997 to 2013.

Treatment of Chryseobacterium indologenes ventilator-associated pneumonia in a critically ill trauma patient.

Objective: To report a case of Chryseobacterium indologenes ventilator-associated pneumonia (VAP) in a critically ill trauma patient.

Case Summary: This report describes a 66-year-old critically ill trauma patient who developed VAP, which was caused by C indologenes. The patient was injured in a riding lawn mower accident that trapped him underwater in a pond.

Treatment of Rhizobium radiobacter bacteremia in a critically ill trauma patient.

Objective: To report the first case of Rhizobium radiobacter bacteremia in a critically ill trauma patient.

Case Summary: A 36-year-old female trauma patient hospitalized at The Regional Medical Center at Memphis developed bacteremia due to Rhizobium radiobacter on hospital day 9. The central line catheter tip culture from the same hospital day was negative.

Effectiveness of pseudoephedrine as adjunctive therapy for neurogenic shock after acute spinal cord injury: a case series.

Study Objective: To evaluate the effectiveness of pseudoephedrine as adjunctive therapy for neurogenic shock in patients with acute spinal cord injury (SCI).

Design: Case series.

Setting: Academic medical center.

Nonvolatile salt-free stabilizer for the quantification of polar imipenem and cilastatin in human plasma using hydrophilic interaction chromatography/quadrupole mass spectrometry with contamination sensitive off-axis electrospray.

A hydrophilic interaction chromatography/mass spectrometry (HILIC-MS)-based assay for imipenem (IMP) and cilastatin (CIL) was recently reported. This orthogonal electrospray ion source-based (ORS) assay utilized nonvolatile salt (unremovable) to stabilize IMI in plasma. Unfortunately, this method was not applicable to conventional MS with off-axis spray (OAS-MS) because MS sensitivity was rapidly deteriorated by the nonvolatile salt.

An essential primer for understanding the role of topical hemostats, surgical sealants, and adhesives for maintaining hemostasis.

A wide variety of topical hemostats are approved as adjunctive therapies in the maintenance of hemostasis during surgical procedures in which conventional methods are insufficient or not practical. A multidisciplinary approach to the selection and application of these agents requires input from all members of the surgical team including surgeons, perioperative nurses, blood bank specialists, and pharmacists. However, pharmacist knowledge regarding topical hemostats may be limited based on lack of formal education within college of pharmacy curricula as well as their use being predominantly in the operating room setting.

The relationship between serum sodium and intracranial pressure when using hypertonic saline to target mild hypernatremia in patients with head trauma.

Introduction: Limited data suggest mild hypernatremia may be related to lower intracranial pressure (ICP) in patients with traumatic brain injury (TBI). The practice at the study center has been to use hypertonic saline (HTS) to generate a targeted serum sodium of 145 to 155 mEq/l in patients with TBI. The purpose of this study was to determine the relationship between serum sodium values and ICP, and to evaluate the acute effect of HTS on ICP.

Treatment of methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia with high-dose vancomycin or linezolid.

Background: The purpose of this study was to determine the clinical cure rate of high-dose vancomycin for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia (VAP) in critically ill trauma patients. Recent trials suggest that a traditional dose of 1 g q12 hours results in unacceptable cure rates for MRSA VAP. Thus, more aggressive vancomycin dosing has the potential to improve efficacy.

Clinical and microbiologic outcomes in trauma patients treated for Stenotrophomonas maltophilia ventilator-associated pneumonia.

Study Objectives: To determine clinical and microbiologic plus clinical success rates in critically ill trauma patients who received treatment for Stenotrophomonas maltophilia ventilator-associated pneumonia (VAP).

Design: Retrospective medical record review.

Setting: Level I trauma intensive care unit of a large academic medical center.

Intravenous to oral conversion of antihypertensives: a toolkit for guideline development.

Objective: To provide a toolkit of information for hospitals to use in developing intravenous to oral conversion protocols for antihypertensives.

Data Sources: Articles describing intravenous to oral conversion protocols for any therapeutic category were identified in an English-language MEDLINE search (1990-April 2010) using a wide variety of MeSH terms. References from selected articles were reviewed for additional material.

Formulary decisions: then and now.

An institution's formulary is a constantly evolving entity with a myriad of considerations that must be taken into account when any agent or chemical entity is being evaluated for formulary inclusion or is under review to continue as a therapeutic option. Originally a simple list of available agents, the formulary has developed into a required part of the hospital's administrative structure and an authoritative source for cost-effective management of drug use within the institution. In recent years, closer evaluations of internal processes surrounding drugs with black-box warnings, safety protocols, and the development of programs such as the risk evaluation and mitigation strategies (REMS) have added to the costs of using some therapeutic agents.

The use of extended-interval aminoglycoside dosing strategies for the treatment of moderate-to-severe infections encountered in critically ill surgical patients.

Background: Extended-interval dosing strategies have been developed to exploit the concentration-dependent bactericidal activity and time-dependent host toxicity associated with aminoglycoside the therapy. The ability of published extended-interval dosing nomograms to achieve optimal pharmacodynamic endpoints may be limited in certain critically ill surgical patients.

Methods: Review of pertinent English language literature.

Changes in pulmonary cytokines during antibiotic therapy for ventilator-associated pneumonia.

Background: A major unanswered question in ventilator-associated pneumonia (VAP) management relates to patient response to therapy. We investigated the use of pulmonary cytokines as biomarkers for response to antibiotic therapy for VAP.

Methods: Prospective, observational pilot study of 12 critically ill trauma patients with VAP using a bronchoscopic bronchoalveolar lavage (BAL) (> or =100,000 colony-forming units [cfu]/mL).

Adjunctive aerosolized antibiotics for treatment of ventilator-associated pneumonia.

Study Objective: To determine clinical and microbiologic success in patients receiving adjunctive aerosolized antibiotics for the treatment of ventilator-associated pneumonia (VAP).

Design: Retrospective medical record review.

Setting: Level I trauma intensive care unit of a large academic medical center.

Achieving hemostasis in the surgical field.

Hemostatic mechanisms are an integral part of the human physiology. Traditionally divided into intrinsic and extrinsic arms, the coagulation cascade converges, through the interactions of many different factors, at a common element-thrombin. As a consequence, a number of different agents have been developed to supplement this common, critical step to aid surgical hemostasis.

Utility of preliminary bronchoalveolar lavage results in suspected ventilator-associated pneumonia.

Background: More than one half of lower respiratory cultures are negative for ventilator-associated pneumonia (VAP) and final reporting requires 72 hours to 96 hours. A previous retrospective study concluded that preliminary bronchoalveolar lavage (BAL) culture results (pBAL), reported at approximately 24 hours, accurately predicted final BAL culture results (fBAL). Our objective was to verify the predictive value of pBALs for fBALs, and evaluate the use of insignificant (1-99,999 cfu/mL) pBALs for rapid discontinuation of empirical antibiotics.