Evaluating pediatric antimicrobial dosing of β-lactam antibiotics for upper respiratory tract infections in emergency and primary care settings.

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Reprint of: Impact of altered mental status on antibiotic prescribing and outcomes in hospitalized patients presenting with pyuria.

Background: Pyuria is nonspecific and may result in over-treatment of asymptomatic bacteriuria (ASB). The Infectious Diseases Society of America recommends against antibiotic treatment of ASB for most patients including those presenting with altered mental status (AMS). Close observation is recommended over treatment to avoid missing alternative causes of AMS and overuse of antibiotics resulting in adverse events and resistance.

Full-dose challenge of moderate, severe, and unknown beta-lactam allergies in the emergency department.

Objective: This study aims to assess the outcome of challenging documented moderate, severe, or unknown beta-lactam allergies with full dose administration of a beta-lactam antibiotic in emergency department (ED) patients admitted for acute bacterial infection.

Methods: A single-center, retrospective, descriptive study of adult patients challenged with a full dose of beta-lactam in the ED from January 2021 to December 2022 was conducted. Included patients had at least one documented moderate, severe, or unknown beta-lactam allergy in the electronic medical record (EMR) without documentation of prior tolerance.

Impact of altered mental status on antibiotic prescribing and outcomes in hospitalized patients presenting with pyuria.

Background: Pyuria is nonspecific and may result in over-treatment of asymptomatic bacteriuria (ASB). The Infectious Diseases Society of America recommends against antibiotic treatment of ASB for most patients including those presenting with altered mental status (AMS). Close observation is recommended over treatment to avoid missing alternative causes of AMS and overuse of antibiotics resulting in adverse events and resistance.

Evaluation of appropriate transmission-based precautions for non-SARS-CoV-2 respiratory viruses.

Appropriateness of transmission-based precautions after positive result for a non-SARS-CoV-2 virus was evaluated. Most patients (77.2%) lacked appropriate precautions within 3 hours of virus detection; 36.

Perceptions of PGY1 pharmacy resident research, final projects, and associated publication outcomes.

Purpose: To describe the publication rate and the research landscape of postgraduate year 1 (PGY1) pharmacy residency programs within the Great Lakes Pharmacy Resident Conference (GLPRC) region.

Methods: This study was comprised of two elements. The first was a retrospective cohort evaluation of previously presented GLPRC research abstracts and publication rates.

Two Times Versus Four Times Daily Cephalexin Dosing for the Treatment of Uncomplicated Urinary Tract Infections in Females.

Background: The current treatment guidelines of the Infectious Diseases Society of America recommend β-lactam antibiotics as alternative rather than first-line agents for the treatment of uncomplicated urinary tract infection (uUTI). Cephalexin is a commonly prescribed first-generation cephalosporin with excellent bioavailability and urinary penetration; however, little data exist to support optimal dosing for uUTI.

Methods: This retrospective multicenter cohort study included adult female patients who received 5 to 7 days of cephalexin for symptomatic uUTI with a cefazolin-susceptible urine culture.

Outcomes of high-dose oral beta-lactam definitive therapy compared to fluoroquinolone or trimethoprim-sulfamethoxazole oral therapy for bacteremia secondary to a urinary tract infection.

Objective: Compare outcomes of patients receiving high-dose oral beta-lactam versus standard oral therapy for Enterobacterales bacteremia from a urinary tract infection (UTI).

Design: Retrospective, multicenter, observational cohort.

Setting: Three Michigan community teaching hospitals.

HPV vaccination rates in 9- and 10-year-olds following a pharmacist-led intervention.

Background: The American Cancer Society and the American Academy of Pediatrics recommend administering the human papillomavirus (HPV) vaccine to children aged 9 and 10 years to improve on-time vaccination rates as they continue to be below national goal. Pharmacist-led interventions using the electronic health record (EHR) may be an effective way to increase these rates.

Objective: This study aimed to evaluate change in first-dose HPV vaccination rate in 9- and 10-year-olds before and after a multifaceted HPV outreach initiative.

Antimicrobial Stewardship at Transitions of Care.

Antimicrobial stewardship interventions have historically been siloed in different care settings; recently, a need for stewardship interventions at care transitions has arisen as inappropriate prescribing at care transitions may result in patient harm. There are several care areas that should be considered for optimizing antibiotic prescribing. Interventions can be difficult to implement as they often require the efforts of a multidisciplinary team and are resource intensive.

Feasibility evaluation to expand a collaborative practice agreement and discontinue antibiotics after an emergency department or urgent care visit.

Purpose: The impact of pharmacist-led culture follow-up programs for positive cultures is well established. The benefits and feasibility of evaluating negative cultures and deprescribing unnecessary antibiotics after emergency department (ED) and urgent care (UC) visits are unknown; therefore, this evaluation characterized the burden of negative urine cultures and chlamydia tests and estimated how many potential antibiotic days could be saved with deprescribing.

Methods: This retrospective, descriptive study evaluated patients discharged from an ED or UC location with a pharmacist-led culture follow-up program.

Implementation of antimicrobial stewardship weekend coverage within a community hospital with a PGY-2 infectious diseases pharmacy resident.

Objectives: The goal of this study was to describe the impact of expanding inpatient ASP weekend coverage with a newly established infectious diseases postgraduate second-year (ID-PGY-2) pharmacy residency program through quantification of inpatient ASP interventions. Secondary end points included comparing weekend stewardship activities before and after an ID-PGY-2 incorporated staffing model shift based on intervention quantity, type, and impact to weekends.

Methods: This retrospective cohort study was conducted evaluating weekend Antimicrobial stewardship program (ASP) interventions documented within the electronic health record between July 1, 2021, and December 31, 2022.

Three-day ceftriaxone versus longer durations of therapy for inpatient treatment of uncomplicated urinary tract infection.

Current guidelines do not address a recommended duration of parenteral therapy for uncomplicated urinary tract infection (uUTI) treatment in the inpatient setting. We compared a 3-day course of ceftriaxone with longer antibiotic durations for inpatients with a uUTI. Our findings indicate that a 3-day course of ceftriaxone was as efficacious as longer antibiotic courses.

Antipseudomonal Versus Narrow-Spectrum Agents for the Treatment of Community-Onset Intra-abdominal Infections.

Background: Antipseudomonal antibiotics are often used to treat community-acquired intra-abdominal infections (CA-IAIs) despite common causative pathogens being susceptible to more narrow-spectrum agents. The purpose of this study was to compare treatment-associated complications in adult patients treated for CA-IAI with antipseudomonal versus narrow-spectrum regimens.

Methods: This retrospective cohort study included patients 18 years admitted for CA-IAI treated with antibiotics.

Syndromic diagnostic testing: a new way to approach patient care in the treatment of infectious diseases.

Advanced microbiology technologies such as multiplex molecular assays (i.e. syndromic diagnostic tests) are a novel approach to the rapid diagnosis of common infectious diseases.

Impact of a Pharmacist-Driven MRSA Nasal PCR Protocol on Pneumonia Therapy.

Methicillin-resistant (MRSA) nasal polymerase chain reaction (PCR) testing can rapidly detect MRSA colonization via nasopharyngeal swab. With a high negative predictive value for MRSA pneumonia, this test may help minimize the duration of anti-MRSA therapy and associated adverse drug events. This study aimed to evaluate the impact of a pharmacist-initiated MRSA nasal PCR protocol on pneumonia therapy.

Impact of pharmacist-led selective audit and feedback on outpatient antibiotic prescribing for UTIs and SSTIs.

Purpose: An estimated 30% of all outpatient antibiotic prescriptions in the United States are unnecessary. The Joint Commission, in 2016, implemented core elements of performance requiring antimicrobial stewardship programs (ASPs) to expand to outpatient practice settings. A study was conducted to determine whether pharmacist-led audit and feedback would improve antibiotic prescribing for urinary tract infections (UTIs) and skin and soft tissue infection (SSTIs) at 2 primary care practices.

Assessment of Testing and Treatment of Asymptomatic Bacteriuria Initiated in the Emergency Department.

Background: Reducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started in the emergency department (ED). Thus, for hospitalized patients with ASB, we sought to identify patterns of testing and treatment initiated by emergency medicine (EM) clinicians and the association of treatment with outcomes.

Outcomes of an ambulatory care pharmacist-led antimicrobial stewardship program within a family medicine resident clinic.

Objective: To determine whether an ambulatory care pharmacist (AMCP)-led intervention improved outpatient antibiotic prescribing in a family medicine residency clinic (FMRC) for upper respiratory tract infections (URIs), urinary tract infections (UTIs), and skin and soft-tissue infections (SSTIs).

Design: Retrospective, quasi-experimental study comparing guideline-concordant antibiotic prescribing before and after an antimicrobial stewardship program (ASP) intervention.

Setting: Family medicine residency clinic affiliated with a community teaching hospital.

Comparison of diagnosis and prescribing practices between virtual visits and office visits for adults diagnosed with uncomplicated urinary tract infections within a primary care network.

Objectives: Telemedicine visits are an increasingly popular method of care for mild infectious complaints, including uncomplicated urinary tract infections (UTIs), and they are an important target for antimicrobial stewardship programs (ASPs) to evaluate quality of prescribing. In this study, we compared antimicrobial prescribing in a primary care network for uncomplicated UTIs treated through virtual visits and at in-office visits.

Design: Retrospective cohort study comparing guideline-concordant antibiotic prescribing for uncomplicated UTI between virtual visits and office visits.

Comparison of procalcitonin testing to a targeted audit-and-feedback strategy on prescribed durations of therapy for community-acquired pneumonia.

The procalcitonin (PCT) assay is FDA-approved to help guide antimicrobial treatment, however, conflicting data exist regarding its impact on durations of therapy. The purpose of this study was to compare the impact of PCT to a targeted audit-and-feedback (TAF) strategy on antibiotic durations of therapy for community-acquired pneumonia (CAP). A retrospective cohort study was conducted at two community teaching hospitals, one implementing PCT with routine audit-and-feedback and one implementing TAF recommending 5 days of therapy for uncomplicated CAP.

Antibiotic Overuse After Hospital Discharge: A Multi-hospital Cohort Study.

Background: Antibiotics are commonly prescribed to patients as they leave the hospital. We aimed to create a comprehensive metric to characterize antibiotic overuse after discharge among hospitalized patients treated for pneumonia or urinary tract infection (UTI), and to determine whether overuse varied across hospitals and conditions.

Methods: In a retrospective cohort study of hospitalized patients treated for pneumonia or UTI in 46 hospitals between 1 July 2017-30 July 2019, we quantified the proportion of patients discharged with antibiotic overuse, defined as unnecessary antibiotic use, excess antibiotic duration, or suboptimal fluoroquinolone use.