Retrospective Analysis of Adverse Drug Events Between Nafcillin Versus Cefazolin for Treatment of Methicillin-Susceptible Infections.

Nafcillin or cefazolin are drugs of choice for methicillin-susceptible (MSSA) infections. Prior studies indicate a higher incidence of acute kidney injury (AKI) with nafcillin, although AKI classification and time to occurrence is not well described. To characterize the incidence and time to adverse drug events for nafcillin versus cefazolin in the inpatient setting.

Impact of Procalcitonin Guidance on Management of Adults Hospitalized with Chronic Obstructive Pulmonary Disease Exacerbations.

Background: Antibiotics are often prescribed for hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations. The use of procalcitonin (PCT) in the management of pneumonia has safely reduced antibiotic durations, but limited data on the impact of PCT guidance on the management of COPD exacerbations remain.

Objective: To determine the impact of PCT guidance on antibiotic utilization for hospitalized adults with exacerbations of COPD.

Impact of Procalcitonin Guidance with an Educational Program on Management of Adults Hospitalized with Pneumonia.

Background: Community-acquired pneumonia and healthcare-associated pneumonia are often treated with prolonged antibiotic therapy. Procalcitonin (PCT) has effectively and safely reduced antibiotic use for pneumonia in controlled studies. However, limited data exist regarding PCT guidance in real-world settings for management of pneumonia.

Effect of Antimicrobial Stewardship Program Guidance on the Management of Uncomplicated Skin and Soft Tissue Infections in Hospitalized Adults.

Objective: To assess the effect of an antimicrobial stewardship program (ASP)-bundled initiative on the appropriate use of antibiotics for uncomplicated skin and soft tissue infections (uSSTIs) at 2 academic medical centers in Pittsburgh, Pennsylvania.

Patients And Methods: A retrospective preintervention and postintervention study was conducted to compare management of patients admitted with uSSTIs before and after the implementation of the bundled initiative. The preintervention period was from August 1, 2014, through March 31, 2015, and the postintervention period was from August 1, 2015, through March 31, 2016.

Appropriateness of antibiotic management of uncomplicated skin and soft tissue infections in hospitalized adult patients.

Background: Skin and soft tissue infections (SSTIs) are a leading cause for hospitalizations in the United States. Few studies have addressed the appropriateness of antibiotic therapy in the management of SSTIs without complicating factors. We aimed to determine the appropriateness of antibiotic treatment duration for hospitalized adult patients with uncomplicated SSTIs.

High frequency of nonadherence to Clostridium difficile treatment guidelines.

Objectives: The 2010 Infectious Diseases Society of America/Society for Healthcare Epidemiology of America treatment guidelines for Clostridium difficile infections (CDI) recommend oral metronidazole for mild-to-moderate disease and oral vancomycin for severe disease. Given that disease severity is easily determined by the peripheral white blood cell count and serum creatinine level, a computerized decision support (CDS) pathway to guide treatment is inherently appealing. Because providers often override or ignore the computer-based alerts, the proposed CDS pathway should be justified before implementation.

Delays in the administration of antimicrobials in the emergency department and the impact of an educational intervention to improve this administration.

Objectives: The aim of the study was to assess the factors associated with delays in emergency department (ED) antimicrobial administration and to determine whether an educational intervention would reduce the incidence of such delays.

Methods: We carried out a retrospective observational cohort study of patients aged 18-89 years who received intravenous antimicrobial(s) in a single ED and were subsequently admitted (March 2011). Using multivariable logistic regression, we analyzed whether demographic and operational factors were significantly associated with delayed ED antimicrobial administration (> 30 min from physician order to nurse initiation time).

Perceptions of participating emergency nurses regarding an ED seasonal influenza vaccination program.

Introduction: Numerous professional organizations have recommended that emergency departments provide influenza vaccine to patients. However, no study has reported on the perceptions of participating emergency nurses regarding ED influenza vaccination programs.

Methods: We conducted an anonymous Web-based survey to assess the post-participation perceptions of emergency nurses regarding an ED influenza vaccination protocol.

Multidrug-resistant gram-negative infections. Bringing back the old.

Multidrug-resistant (MDR) gram-negative infections have become challenging to treat when there is only a limited armamentarium of anti-infectives that are commercially available. In particular, increasing resistance of gram-negative organisms such as Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacter species have become concerning. Carbapenems have been used to treat extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species infections.

Feasibility of integrating a clinical decision support tool into an existing computerized physician order entry system to increase seasonal influenza vaccination in the emergency department.

While emergency department (ED) seasonal influenza vaccination programs are feasible, reported implementation barriers include added staffing requirements to identify eligible patients and getting busy ED personnel to order and provide vaccination. We present a prospective, observational trial of integrating a clinical decision support tool into an existing ED computerized physician order entry (CPOE) system to increase ED seasonal influenza vaccination without added staffing resources, the operational barriers identified to program implementation, the revenue generated and data on opportunities for future quality improvement. Compared to the comparable pre-protocol period, ED influenza vaccination rose by 17.

Fever of unknown origin: a case of cardiac myxoma infected with Staphylococcus lugdunensis.

Infected cardiac myxoma is a rare entity. It poses a diagnostic challenge as clinical presentation may reflect an underlying infectious, immune, or a neoplastic disease process. To the best of our knowledge, the first case of a cardiac myxoma infected with Staphylococcus lugdunensis is reported in a 54-year-old man with fever of unknown origin for 4 months.

Prescribing trends with daptomycin (cubicin) for the treatment of gram-positive infections.

The injectable agent daptomycin, when prescribed according to approved guidelines, can be a welcome option for treating some multiresistant, gram-positive infections that have become increasingly prevalent.