Evaluation of a standardized protocol using lepirudin or argatroban for heparin-induced thrombocytopenia.

Study Objective: To evaluate the effectiveness of our institutions heparin-induced thrombocytopenia (HIT) protocol in achieving a therapeutic activated partial thromboplastin time (aPTT) and to evaluate patient outcomes related to bleeding and thrombotic events before and after protocol implementation.

Design: Retrospective, single-center, pre- and post- assessment of a protocol previously approved at our institution.

Setting: 400-bed community hospital serving surrounding rural populations with emphasis in cardiothoracic surgery.

Continuous versus intermittent infusion of prophylactic cefoxitin after colorectal surgery: a pilot study.

Study Objective: To compare 30-day postoperative surgical site infections (SSIs) and rates of antibiotic discontinuation within 24 hours after surgery in patients receiving continuous-infusion versus intermittent-infusion cefoxitin for postoperative antibiotic prophylaxis.

Design: Retrospective, cohort-matched pilot study.

Setting: Tertiary-care medical center.

Cefazolin tolerance does not predict ceftriaxone hypersensitivity: unique side chains precipitate anaphylaxis.

A 48-year-old woman with a questionable history of an unspecified ceftriaxone allergy was treated with cefazolin for surgical antibiotic prophylaxis. After she tolerated cefazolin therapy for 4 days, the medical staff concluded that her allergy history was inaccurate, and she was treated with intravenous ceftriaxone for suspected nosocomial pneumonia. Approximately 10 minutes after the start of the infusion, the patient experienced anaphylaxis.

Drotrecogin alfa (activated) approved for treatment of severe sepsis.

Drotrecogin alfa (activated) is a recombinant form of human activated protein C that has been shown to reduce mortality in severely septic patients with a high risk of death. Given the complexity of the inclusion and exclusion criteria, the stability and unique duration of infusion, and the cost of treatment, therapy with this agent should be carefully considered to ensure its appropriate use.