Changes in essential care in individuals with spinal cord injury during the COVID-19 pandemic.

Study Design: Cross-sectional, observational study.

Objectives: To determine whether changes in essential care during the COVID-19 pandemic impacted satisfaction with activities, participation, and relationships among individuals with spinal cord injury (SCI).

Setting: Data were collected online between December 31, 2020 and February 14, 2021 among community dwelling adults with SCI (N = 123).

Three-Year Results of a Medicare Advantage Cancer Management Program.

Purpose: Reform of cancer care delivery seeks to control costs while improving quality. Texas Oncology collaborated with Aetna to conduct a payer-sponsored program that used evidence-based treatment pathways, a disease management call center, and an introduction to advance care planning to improve patient care and reduce total costs.

Methods: From June 1, 2013, to May 31, 2016, 746 Medicare Advantage patients with nine common cancer diagnoses were enrolled.

Pseudomonas aeruginosa is not just in the intensive care unit any more: implications for empirical therapy.

Objective: To improve empirical therapy for Pseudomonas aeruginosa using susceptibility surveillance by unit type (intensive care unit vs. nonintensive care unit) and to optimize antibacterial dosing using pharmacodynamic profiling.

Design: Prospective multicentered surveillance study.

Selection of prophylactic antimicrobial agent may affect incidence of infection in small bowel and colorectal surgery.

Background: Antibiotic prophylaxis guidelines suggest single-dose regimens are adequate, but comparisons of multiple agents are lacking. We compared post-operative infection rates retrospectively among six common prophylactic agents given as a single dose to colorectal surgery patients.

Methods: A commercial database supplied demographics, All-Patient Refined Diagnosis-Related Groups (APR DRGs), International Classification of Disease (ICD)-9 codes, and drug utilization information for patients discharged from 303 hospitals from January 2007-December 2008 whose charts had been sampled for reporting Surgical Care Improvement Project (SCIP) measures.

Change in antipseudomonal carbapenem susceptibility in 25 hospitals across 9 years is not associated with the use of ertapenem.

Background: Concern remains that ertapenem use may promote cross-resistance in Pseudomonas aeruginosa to antipseudomonal carbapenems (APCs). This study extends our earlier multicentre investigation of this relationship by an additional 3 years.

Methods: Use density ratios (UDRs) for ertapenem, APCs, aminoglycosides, fluoroquinolones and non-carbapenem β-lactams were derived from purchase data for 3 years pre-adoption and up to 6 years post-adoption of ertapenem at 25 hospitals.

Fluoroquinolone use is not associated with the change in imipenem susceptibility of Pseudomonas aeruginosa in 25 hospitals.

Introduction: Evidence suggests use of fluoroquinolones is associated with carbapenem resistance in Pseudomonas aeruginosa, and fluoroquinolone use has been identified as a risk factor for clinical acquisition of imipenem-resistant P. aeruginosa in single-center studies. Imipenem susceptibility and fluoroquinolone use was evaluated within 25 hospitals over 9 years.

Length of stay and hospital costs associated with a pharmacodynamic-based clinical pathway for empiric antibiotic choice for ventilator-associated pneumonia.

Study Objective: To determine hospital costs associated with the use of a clinical pathway implemented in our intensive care units (ICUs) to optimize antibiotic regimen selection for patients with ventilator-associated pneumonia (VAP) compared with costs in a historical control group treated according to prescriber preference.

Design: Retrospective cost analysis from the hospital perspective.

Setting: Single, tertiary-care medical center.

Absence of association between use of ertapenem and change in antipseudomonal carbapenem susceptibility rates in 25 hospitals.

Objective: Ertapenem exposure has been reported to select for cross-resistance to other carbapenems in Pseudomonas aeruginosa in vitro. Single-center investigations report conflicting results. We evaluated ertapenem use and antipseudomonal carbapenem susceptibility for 6 years spanning the time of ertapenem adoption at each of 25 US hospitals.

In vitro activity and pharmacodynamics of commonly used antibiotics against adult systemic isolates of Escherichia coli and Pseudomonas aeruginosa at Forty US Hospitals.

Background: Treatment of infections caused by gram-negative bacilli is increasingly challenging because of emerging resistance. Current surveillance data are informative, but may not discern differences by infection site and clinical setting, and do not incorporate pharmacodynamic (PD) characteristics when determining susceptibility.

Objectives: This study explored the differences in infection site and clinical setting and evaluated dose-optimization strategies using PD principles.

Surgical site infections: does inadequate antibiotic therapy affect patient outcomes?

Background: Complicated skin/skin structure infections involve deeper soft tissues and include surgical site infections (SSIs). Inadequate antibiotic therapy (IAT) has been associated with adverse outcomes in respiratory and blood stream infections, but is seldom evaluated in SSIs. This study assessed the impact of IAT on primary outcomes of length of stay (LOS) and costs in complicated SSIs; identifying risk factors associated with receiving IAT was a secondary objective.

Risk factors and outcomes associated with isolation of meropenem high-level-resistant Pseudomonas aeruginosa.

Objective: To determine risk factors and outcomes for patients with meropenem high-level-resistant Pseudomonas aeruginosa (MRPA) (minimum inhibitory concentration [MIC] > or = 32 microg/mL).

Design: Case-control-control.

Setting: An 867-bed urban, teaching hospital.

Pharmacodynamic-based clinical pathway for empiric antibiotic choice in patients with ventilator-associated pneumonia.

Background: Because of the high frequency of multidrug resistant bacteria in our intensive care units (ICUs), we implemented a ventilator-associated pneumonia (VAP) clinical pathway based on unit-specific minimum inhibitory concentration (MIC) distributions and pharmacodynamic modeling in 3 of our ICUs.

Methods: This was a prospective, observational evaluation with a historical control group in adult patients (n = 168) who met clinical and radiologic criteria for VAP. Monte Carlo simulation was used to determine antibiotic regimens having the greatest likelihood of achieving bactericidal exposures against Pseudomonas aeruginosa.

Deep and organ/space infections in patients undergoing elective colorectal surgery: incidence and impact on hospital length of stay and costs.

Background: The reported incidence of infection complicating elective colorectal surgery (ECS) is 11% to 26%. We evaluated length of stay (LOS) and expense associated with such infections, which heretofore remain unexplored.

Methods: We reviewed 1127 ECS procedures from October 2005 to may 2007 to identify infected case subjects (n = 46).

Impact of superinfection on hospital length of stay and costs in patients with ventilator-associated pneumonia.

Ventilator-associated pneumonia (VAP) increases length of stay (LOS) in VAP versus non-VAP patients, but LOS differences among VAP patients remain unexplained. We explored the economic impact of developing a respiratory superinfection while being treated for VAP. This was a retrospective, observational cohort study conducted in 74 patients discharged between January 2004 and July 2005 identified as having VAP.

A pharmacodynamic analysis of resistance trends in pathogens from patients with infection in intensive care units in the United States between 1993 and 2004.

Background: Increasing nosocomial pathogen resistance to available antimicrobial agents is of growing concern. While higher MICs can diminish antimicrobial effectiveness, dose adjustments often mitigate this effect. This study's objective was to ascertain whether MICs among major pathogens in the ICU to several commonly used agents have increased enough to significantly impact their ability to achieve bactericidal effect.

Empiric therapy for secondary peritonitis: a pharmacodynamic analysis of cefepime, ceftazidime, ceftriaxone, imipenem, levofloxacin, piperacillin/tazobactam, and tigecycline using Monte Carlo simulation.

Background: Inappropriate antibiotic therapy (ie, the selection of an empiric agent without activity against the responsible pathogen) of secondary peritonitis may result in poor patient outcomes. The selection of an appropriate agent can be challenging because of the emerging resistance of target organisms to commonly prescribed antibiotics.

Objective: The aim of this study was to perform a pharmacodynamic analysis, using recent global surveillance data, of commonly prescribed antibiotic agents and a newer agent, tigecycline, indicated in 2005 for the treatment of complicated intra-abdominal infections, to determine their probability for achieving microbiologic success against aerobic bacteria associated with secondary peritonitis.

Evaluating empiric treatment options for secondary peritonitis using pharmacodynamic profiling.

Background: Selecting an appropriate agent for empiric antibiotic therapy for secondary peritonitis is challenging. The pathogens responsible, aerobic gram-negative bacilli in particular, are becoming more resistant to antibiotics. The purpose of this study was to predict the ability of common antimicrobial regimens to achieve optimal pharmacodynamic exposure against aerobic bacteria implicated in secondary peritonitis, while considering current national resistance trends.

Pharmacodynamic profiling of imipenem, meropenem and ertapenem against clinical isolates of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. from Brazil.

The pharmacodynamic potency of imipenem, meropenem and ertapenem against extended-spectrum beta-lactamase (ESBL)-producing isolates was investigated. Minimal inhibitory concentration (MIC) determination, confirmation of ESBLs by Etest and the disk approximation test were performed for 133 ESBL-producing isolates of Escherichia coli and Klebsiella spp. Pharmacodynamic exposure, measured as percent of the dosing interval during which free drug was above the MIC (% fT>MIC), was modelled via a 5000-subject Monte Carlo simulation.