51
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Mota ANB, Turrini RNT. Avaliação de usabilidade de aplicativo móvel para pacientes com cateter central de inserção periférica. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5817.3667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Resumo Objetivo: avaliar a usabilidade do aplicativo Meu PICC para o acompanhamento extra-hospitalar de pacientes em uso de cateter central de inserção periférica por meio do instrumento validado System Usability Scale. Método: estudo transversal que aplicou o System Usability Scale a 30 pacientes em uso de cateter central de inserção periférica, dez enfermeiros e oito profissionais de tecnologia da informação para avaliar a usabilidade do aplicativo. Resultados: observou-se diferença estatística entre idade e usabilidade (p=0,006), bem como correlação negativa entre o tempo de utilização do aplicativo e usabilidade (p=0,002). Pela classificação adjetiva do System Usability Scale, 40,0% dos pacientes consideraram o aplicativo como o melhor imaginável e 33,3% como excelente. Com relação aos enfermeiros, 70,0% consideraram o aplicativo como o melhor imaginável e 20,0% como excelente; dos profissionais de tecnologia da informação, 50,0% consideraram o aplicativo como o melhor imaginável e 50,0% excelente. Conclusão: a avaliação de usabilidade mostrou que pacientes, enfermeiros e profissionais de TIC consideraram o aplicativo útil para o acompanhamento de pacientes em uso de PICC e o avaliaram como adequado, atribuindo-lhe a qualificação de melhor imaginável ou excelente. Estes resultados corroboram para o uso do aplicativo Meu PICC no acompanhamento de pacientes em uso extra-hospitalar de PICC.
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Eckmann C, Tulkens PM. Current and future options for treating complicated skin and soft tissue infections: focus on fluoroquinolones and long-acting lipoglycopeptide antibiotics. J Antimicrob Chemother 2021; 76:iv9-iv22. [PMID: 34849999 PMCID: PMC8632788 DOI: 10.1093/jac/dkab351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bacterial skin and soft tissue infections are among the most common bacterial infections and constitute a major burden for patients and healthcare systems. Care is complicated by the variety of potential pathogens, some with resistance to previously effective antimicrobial agents, the wide spectrum of clinical presentations and the risk of progression to life-threatening forms. More-efficient care pathways are needed that can reduce hospital admissions and length of stay, while maintaining a high quality of care and adhering to antimicrobial stewardship principles. Several agents approved recently for treating acute bacterial skin and skin structure infections have characteristics that meet these requirements. We address the clinical and pharmacological characteristics of the fourth-generation fluoroquinolone delafloxacin, and the long-acting lipoglycopeptide agents dalbavancin and oritavancin.
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Affiliation(s)
- Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Goettingen University, Germany
| | - Paul M Tulkens
- Cellular and Molecular Pharmacology, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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53
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Huskey M, Lewis P, Brown SD. Stability of Ampicillin in Normal Saline Following Refrigerated Storage and 24-Hour Pump Recirculation. Hosp Pharm 2021; 56:507-512. [PMID: 34720153 DOI: 10.1177/0018578720925389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Use of ampicillin in outpatient parenteral antimicrobial therapy (OPAT) has historically been complicated by frequent dosing and limited stability. The purpose of this study was to evaluate stability of ampicillin using high-pressure liquid chromatography (HPLC) in an OPAT dosing model using continuous infusion at room temperature over 24 hours immediately following preparation compared with batches stored under refrigeration for 24 hours, 72 hours, and 7 days. Methods An HPLC method was developed and validated as stability indicating using guidance in USP general Chapter <1225>. Four ampicillin batches were prepared for each experimental condition (immediate use and refrigerated storage for 24 hours, 72 hours, and 7 days). A pump was used to recirculate the solutions through medical-grade tubing for 24 hours. Triplicate 1-mL aliquots were removed from each batch at time 0, 4, 8, 12, and 24 hours and analyzed for ampicillin concentration. Results Each batch was assayed for initial concentration (20.34-21.50 mg/mL), and percent recovery compared with that concentration thereafter. For the duration of infusion, the average recoveries were 96.4%, 95.8%, 94.6%, and 90.3% for immediate use, 24-hour storage, 72-hour storage, and 7-day storage, respectively. The recovery remained above 90% for all batches and time points, except for 7-day storage, which fell below 90% after 4 hours of circulation. Conclusion Ampicillin can be prepared and stored in a refrigerator for up to 72 hours prior to continuously infusing at room temperature over 24 hours with less than a 10% loss of potency over the dosing period. This model supports twice weekly OPAT delivery of ampicillin.
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van de Peppel RJ, Schauwvlieghe A, Van Daele R, Spriet I, Van't Wout JW, Brüggemann RJ, Rijnders BJA, Hendriks BJC, de Boer MGJ. Outpatient parenteral antifungal therapy (OPAT) for invasive fungal infections with intermittent dosing of liposomal amphotericin B. Med Mycol 2021; 58:874-880. [PMID: 31965178 PMCID: PMC7527269 DOI: 10.1093/mmy/myz134] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 12/27/2022] Open
Abstract
Triazole resistant A. fumigatus has been documented in many parts of the world. In the Netherlands, incidence is now above 10% and results in the need for long-term parenteral therapy with liposomal amphotericin B (LAmB). The long terminal half-life of LAmB suggests that intermittent dosing could be effective, making the application of outpatient antifungal therapy (OPAT) possible. Here, we report our experience with the use of OPAT for Invasive Fungal Infections (IFI). All adult patients treated with LAmB with a 2 or 3 times weekly administration via the outpatient departments in four academic tertiary care centers in the Netherlands and Belgium since January 2010 were included in our analysis. Patient characteristics were collected, as well as information about diagnostics, therapy dose and duration, toxicity, treatment history and outcome of the IFI. In total, 18 patients were included. The most frequently used regimen (67%) was 5 mg/kg 3 times weekly. A partial response to the daily treatment prior to discharge was confirmed by CT-scan in 17 (94%) of patients. A favorable outcome was achieved in 13 (72%) patients. Decrease in renal function occurred in 10 (56%) cases but was reversible in all and was treatment limiting in one patient only. The 100-day mortality and 1-year mortality after initiation of OPAT were 0% and 6%, respectively. In a selected population, and after confirmation of initial response to treatment, our data support the use of OPAT with LAmB for treatment of IFI in an intermittent dosing regimen.
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Affiliation(s)
- Robert J van de Peppel
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander Schauwvlieghe
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam
| | - Ruth Van Daele
- Pharmacy Department, University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Belgium
| | - Jan W Van't Wout
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Roger J Brüggemann
- Department of Pharmacy and Radboud Institute for Health Sciences, Radboud University Medical Center; Center of Expertise in Mycology Radboud / CWZ, Radboud University Medical Center Nijmegen, The Netherlands
| | - Bart J A Rijnders
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC, University Medical Center Rotterdam
| | - Bart J C Hendriks
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center
| | - Mark G J de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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55
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Pennington KM, Vu A, Challener D, Rivera CG, Shweta FNU, Zeuli JD, Temesgen Z. Approach to the diagnosis and treatment of non-tuberculous mycobacterial disease. J Clin Tuberc Other Mycobact Dis 2021; 24:100244. [PMID: 34036184 PMCID: PMC8135042 DOI: 10.1016/j.jctube.2021.100244] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) is a collective name given to a group of more than 190 species of Mycobacterium. The clinical presentation for most NTM infections is non-specific, often resulting in delayed diagnosis. Further complicating matters is that NTM organisms can be difficult to isolate. Medications used to treat NTM infection can be difficult for patients to tolerate, and prolonged courses of anti-mycobacterial therapy are often required for adequate suppression or eradication. Herein, we review different NTM syndromes, appropriate diagnostic tests, and treatment regimens.
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Key Words
- ADR, adverse drug reactions
- AFB, acid fast bacilli
- AST, antimicrobial-susceptibility testing
- ATS, American Thoracic Society
- BCG, Bacille Calmette-Guerin
- CLSI, Clinical and Laboratory Standards Institute
- COPD, chronic obstructive pulmonary disease
- ECG, electrocardiogram
- EMB, ethambutol
- Erm, erythromycin ribosomal methylase
- FDA, Food and Drug Administration
- HIV, human immunodeficiency virus
- HRCT, high resolution computed tomography
- IDSA, Infectious Disease Society of America
- INF-γ, interferon- γ
- INH, isoniazid
- MAC, Mycobacterium avium complex
- MALDI-TOF, matrix-assisted laser desorption ionization time-of-flight mass spectrometry
- MGIT, mycobacteria growth indicator tube
- MIC, minimum inhibitory concentrations
- Mycobacterium abscessus
- Mycobacterium avium
- NTM, non-tuberculous mycobacteria
- Non-tuberculous mycobacteria
- PCR, polymerase chain reaction
- PFT, pulmonary function test
- TB, tuberculosis
- TDM, therapeutic drug monitoring
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Affiliation(s)
- Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - Ann Vu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - Douglas Challener
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | | | - F N U Shweta
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - John D Zeuli
- Department of Pharmacy, Mayo Clinic Rochester, MN, USA
| | - Zelalem Temesgen
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Rochester, MN, USA
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Bianchini ML, Kenney RM, Lentz R, Zervos M, Malhotra M, Davis SL. Discharge Delays and Costs Associated With Outpatient Parenteral Antimicrobial Therapy for High-Priced Antibiotics. Clin Infect Dis 2021; 71:e88-e93. [PMID: 31665269 DOI: 10.1093/cid/ciz1076] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 10/25/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Outpatient parenteral antimicrobial therapy (OPAT) is a widely used, safe, and cost-effective treatment. Most public and private insurance providers require prior authorization (PA) for OPAT, yet the impact of the inpatient PA process is not known. Our aim was to characterize discharge barriers and PA delays associated with high-priced OPAT antibiotics. METHODS This was an institutional review board-approved study of adult patients discharged with daptomycin, ceftaroline, ertapenem, and novel beta-lactam-beta-lactamase inhibitor combinations from January 2017 to December 2017. Patients with an OPAT PA delay were compared with patients without a delay. The primary endpoint was total direct hospital costs from the start of treatment. RESULTS Two-hundred patients were included: 141 (71%) no OPAT delay vs 59 (30%) OPAT delay. More patients with a PA delay were discharged to a subacute care facility compared with an outpatient setting: 37 (63%) vs 52 (37%), P = .001. Discharge delays and median total direct hospital costs were higher for patients with OPAT delays: 31 (53%) vs 21 (15%), P < .001 and $19 576 (interquartile range [IQR], 10 056-37 038) vs $7770 (IQR, 3031-13 974), P < .001. In multiple variable regression, discharge to a subacute care facility was associated with an increased odds of discharge delay, age >64 years was associated with a decreased odds of discharge delay. CONCLUSIONS OPAT with high-priced antibiotics requires significant care coordination. PA delays are common and contribute to discharge delays. OPAT transitions of care represent an opportunity to improve patient care and address access barriers.
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Affiliation(s)
- Monica L Bianchini
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan, USA
| | - Rachel M Kenney
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan, USA
| | - Robyn Lentz
- Department of Case Management and Social Work, Henry Ford Macomb Hospital, Macomb, Michigan, USA
| | - Marcus Zervos
- Department of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA
| | - Manu Malhotra
- Hospital Administration, Henry Ford Hospital West Bloomfield, West Bloomfield, Michigan, USA
| | - Susan L Davis
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Pharmacy Practice, Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, Michigan
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57
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Ingram PR, Kilgarriff S, Grzelak M, Jackson G, Carr P, Boan P, Italiano C, Dyer J, Raby E. Risk factors for catheter related thrombosis during outpatient parenteral antimicrobial therapy. J Vasc Access 2021; 23:738-742. [PMID: 33845663 DOI: 10.1177/11297298211009361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Outpatient parenteral antimicrobial therapy (OPAT) delivery using peripherally inserted central catheters is associated with a risk of catheter related thrombosis (CRT). Individualised preventative interventions may reduce this occurrence, however patient selection is hampered by a lack of understanding of risk factors. We aimed to identify patient, infection or treatment related risk factors for CRT in the OPAT setting. METHODS Retrospective case control study (1:3 matching) within OPAT services at two tertiary hospitals within Australia. RESULTS Over a 2 year period, encompassing OPAT delivery to 1803 patients, there were 19 cases of CRT, giving a prevalence of 1.1% and incidence of 0.58/1000 catheter days. Amongst the cases of CRT, there were nine (47%) unplanned readmissions and two (11%) pulmonary emboli. Compared to controls, cases had a higher frequency of malposition of the catheter tip (4/19 (21%) vs 0/57 (0%), p = 0.003) and complicated catheter insertion (3/19 (16%) vs 1/57 (2%), p = 0.046). CONCLUSIONS Although CRTs during OPAT are infrequent, they often have clinically significant sequelae. Identification of modifiable vascular access related predictors of CRT should assist with patient risk stratification and guide risk reduction strategies.
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Affiliation(s)
- Paul R Ingram
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia.,Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia.,Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Sinead Kilgarriff
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
| | | | - Gavin Jackson
- Peripherally Inserted Central Catheter service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland.,Menzies Health Institute, Griffith University, Queensland, Australia
| | - Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Claire Italiano
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia
| | - John Dyer
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Edward Raby
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia.,Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
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58
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Beigel JH, Hayden FG. Influenza Therapeutics in Clinical Practice-Challenges and Recent Advances. Cold Spring Harb Perspect Med 2021; 11:a038463. [PMID: 32041763 PMCID: PMC8015700 DOI: 10.1101/cshperspect.a038463] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the last few years, several new direct-acting influenza antivirals have been licensed, and others have advanced in clinical development. The increasing diversity of antiviral classes should allow an adequate public health response should a resistant virus to one agent or class widely circulate. One new antiviral, baloxavir marboxil, has been approved in the United States for treatment of influenza in those at high risk of developing influenza-related complications. Except for intravenous zanamivir in European Union countries, no antivirals have been licensed specifically for the indication of severe influenza or hospitalized influenza. This review addresses recent clinical developments involving selected polymerase inhibitors, neuraminidase inhibitors, antibody-based therapeutics, and host-directed therapies. There are many knowledge gaps for most of these agents because some data are not published and multiple pivotal studies are in progress at present. This review also considers important clinical research issues, including regulatory pathways, study designs, endpoints, and target populations encountered during the clinical development of novel therapeutics.
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Affiliation(s)
- John H Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland 20892-9826, USA
| | - Frederick G Hayden
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
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Wrapping Our Heads Around Outpatient Parenteral Antimicrobial Therapy for Central Nervous System Infections. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Farmer ECW, Seaton RA. Recent innovations and new applications of outpatient parenteral antimicrobial therapy. Expert Rev Anti Infect Ther 2020; 19:55-64. [PMID: 32799577 DOI: 10.1080/14787210.2020.1810566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Outpatient parenteral antimicrobial therapy (OPAT) is safe and effective for selected patients managed within an organized clinical service. Service configurations however are evolving, patient populations are changing and new evidence is emerging which challenges traditional OPAT practice. AREAS COVERED This review will discuss evolving OPAT service delivery from the traditional model of infusion center toward nonspecialist, community and remotely delivered OPAT and the challenges this represents. We consider new patient populations including those with incurable infection or infections at the end of life and difficult to reach populations including people who inject drugs. The evidence base that underpins the multi-disciplinary approach to OPAT delivery will be examined and particularly the role of the antimicrobial pharmacist and specialist nurse. Evidence for new treatment options which challenge established OPAT practice including complex oral antibiotic regimens, long acting parenteral agents and drug stability in continuous infusion antibiotics will be considered. Finally we emphasize the central importance of antimicrobial stewardship and good clinical governance which should underpin OPAT practice. EXPERT OPINION Changing patient populations, service structures and team roles coupled with a growing infection management evidence base means that OPAT services and practice must evolve. Challenging traditional practice is essential to ensure best patient outcomes and cost-efficiency.
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Affiliation(s)
| | - Ronald Andrew Seaton
- Infectious Disease Department, Queen Elizabeth University Hospital , Glasgow, UK
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61
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Salles TCG, Cerrato SG, Santana TF, Medeiros EA. Factors associated with successful completion of outpatient parenteral antibiotic therapy in an area with a high prevalence of multidrug-resistant bacteria: 30-day hospital admission and mortality rates. PLoS One 2020; 15:e0241595. [PMID: 33206669 PMCID: PMC7673565 DOI: 10.1371/journal.pone.0241595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives To identify factors associated with hospital admission and mortality within the first 30 days after enrolment in an outpatient parenteral antimicrobial therapy (OPAT) program, also analysing adequacy of the treatment regimen and clinical outcomes. Patients and methods This was a retrospective cohort study conducted between October 2016 and June 2017 in the state of São Paulo, Brazil. Variables related to hospital admission and mortality were subjected to bivariate analysis, and those with a P<0.05 were subjected to multivariate analysis as risk factors. Results We evaluated 276 patients, of whom 80.5% were ≥60 years of age and 69.9% had more than one comorbidity. Of the patients evaluated, 41.3% had pneumonia and 35.1% had a urinary tract infection. The most common etiological agent, isolated in 18 (31.6%) cases, was Klebsiella pneumoniae, and 13 (72,2%) strains were carbapenem resistant. The OPAT was in accordance with the culture results in 76.6% of the cases and with the institutional protocols in 76.4%. The majority (64.5%) of the patients were not admitted, and a cure or clinical improvement was achieved in 78.6%. Multivariate analysis showed that, within the first 30 days after enrolment, the absence of a physician office visit was a predictor of hospital admission (P<0.001) and mortality (P = 0.006). Conclusions This study demonstrated the viability of OPAT in elderly patients with pulmonary or urinary tract infections in an area with a high prevalence of multidrug-resistant bacteria and that a post-discharge physician office visit is protective against hospital admission and mortality.
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Affiliation(s)
- Thais Cristina Garbelini Salles
- Division of Infectious Diseases, Department of Internal Medicine, Paulista School of Medicine, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Hospital Santa Helena, Santo André, São Paulo, Brazil
- * E-mail:
| | | | | | - Eduardo Alexandrino Medeiros
- Division of Infectious Diseases, Department of Internal Medicine, Paulista School of Medicine, Federal University of São Paulo, São Paulo, São Paulo, Brazil
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Patel P, Laurich VM, Smith S, Sturm J. Point-of-Care Influenza Testing in the Pediatric Emergency Department. Pediatr Emerg Care 2020; 36:515-518. [PMID: 33065674 DOI: 10.1097/pec.0000000000002250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To see what the impact of introducing a rapid polymerase chain reaction-based influenza test has on length of stay (LOS) in emergency department, use of imaging, serum or urine testing, antibiotic use, and antiviral use. METHODS Audit of electronic medical health records was performed for all emergency department visits from 2014 to 2018 between November and March, which was defined as peak flu season. Patients were included if they were between 3 months and 18 years of age, presented during peak flu season, and were tested for influenza. The pre-point of care (POC) period was defined as November through March of 2014 to 2017 which was compared with the post-POC group which was defined as November through March of 2017 to 2018. RESULTS Patients tested for influenza in the pre-POC period were more likely to have complete blood count testing (44.7% vs 25.6% P < 0.01), more likely to have blood cultures performed (30% vs 16.3%, P < 0.01), more likely to have urine testing performed (21.5% vs 12.2%, P < 0.01), and more likely to have a chest radiograph completed (47.5% vs 34.4%, P < 0.01). There was no significant difference in rates of antibiotics used. There was increased rates of oseltamivir used in the post-POC period (21.2% vs 13.3%, P < 0.05. The median LOS decreased from 239 minutes in the pre-POC period to 232 minutes in the post-POC period (P < 0.05). CONCLUSIONS With the introduction of a polymerase chain reaction-based point-of-care influenza test, there were overall decreased rates of invasive blood work, urine studies, and imaging, and median LOS. There was also increased antiviral administration.
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Affiliation(s)
- Prina Patel
- From the Department of Pediatric Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT
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Escudero-Sánchez R, Mendoza Lizardo SS, Batlle López E, Campelo Gutierrez C, Losa García JE, Velasco Arribas M. [Impact of surgery on the mortality of infective endocarditis in a hospital without cardiac surgery]. REVISTA ESPANOLA DE QUIMIOTERAPIA 2020; 33:436-443. [PMID: 33045817 PMCID: PMC7712346 DOI: 10.37201/req/005.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Infective endocarditis has a high morbidity and mortality and requires a coordinated medical-surgical management. The objective was to analyse the impact of surgery on mortality in a hospital without cardiac surgery. METHODS Evaluation of a prospective cohort of patients with infective endocarditis diagnosed between August 2011 and January 2016 according to modified Duke's criteria. RESULTS Sixty-four patients were included, of whom seventeen patients were operated (26.6%). Mortality was 32.8% and it was associated with chronic obstructive pulmonary disease history, staphylococci coagulase-negative and the appearance of complications, as valvular insufficiency and embolisms in the central nervous system; cardiac surgery was not associated with mortality. Four patients (6,6%) were not operated despite indication of cardiac surgery. The main reason for not been intervened was the poor presurgical prognosis (44.7%). CONCLUSIONS Mortality due to infective endocarditis in a hospital without cardiac surgery is high. The need for interhospital teams is strengthened.
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Affiliation(s)
- R Escudero-Sánchez
- Rosa Escudero Sánchez, Servicio Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Ctra Colmenar Viejo, Km 9,1 (28034) Madrid (Spain).
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Vaughn VM, O’Malley M, Flanders SA, Gandhi TN, Petty LA, Malani AN, Weinmann A, Horowitz JK, Chopra V. Association of Infectious Disease Physician Approval of Peripherally Inserted Central Catheter With Appropriateness and Complications. JAMA Netw Open 2020; 3:e2017659. [PMID: 33084898 PMCID: PMC7578772 DOI: 10.1001/jamanetworkopen.2020.17659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous antimicrobial therapy. However, inappropriate PICC use may lead to patient harm. OBJECTIVE To evaluate whether infectious disease physician approval prior to PICC placement for intravenous antimicrobials is associated with more appropriate device use and fewer complications. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 21 653 PICCs placed for a primary indication of intravenous antimicrobial therapy between January 1, 2015, and July 26, 2019, was conducted in 42 hospitals participating in a quality collaborative across Michigan among hospitalized medical patients. MAIN OUTCOMES AND MEASURES Appropriateness of PICCs was defined according to the Michigan Appropriateness Guide for Intravenous Catheters as a composite measure of (1) single-lumen catheter use, (2) avoiding use of PICCs for 5 days or less, and (3) avoiding use of PICCs for patients with chronic kidney disease (defined as an estimated glomerular filtration rate <45 mL/min/1.73 m2). Complications related to PICCs included catheter occlusion, deep vein thrombosis, and central line-associated bloodstream infection. The association between infectious disease physician approval, device appropriateness, and catheter complications was assessed using multivariable models, adjusted for patient comorbidities and hospital clustering. Results were expressed as odds ratios with 95% CIs. RESULTS A total of 21 653 PICCs were placed for intravenous antimicrobials (11 960 PICCs were placed in men [55.2%]; median age, 64.5 years [interquartile range, 53.4-75.4 years]); 10 238 PICCs (47.3%) were approved by an infectious disease physician prior to placement. Compared with PICCs with no documented approval, PICCs with approval by an infectious disease physician were more likely to be appropriately used (72.7% [7446 of 10 238] appropriate with approval vs 45.4% [5180 of 11 415] appropriate without approval; odds ratio, 3.53; 95% CI, 3.29-3.79; P < .001). Furthermore, approval was associated with lower odds of a PICC-related complication (6.5% [665 of 10 238] with approval vs 11.3% [1292 of 11 415] without approval; odds ratio, 0.55; 95% CI, 0.50-0.61). CONCLUSIONS AND RELEVANCE This cohort study suggests that, when PICCs were placed for intravenous antimicrobial therapy, infectious disease physician approval of PICC insertion was associated with more appropriate device use and fewer complications. Policies aimed at ensuring infectious disease physician approval prior to PICC placement for antimicrobials may improve patient safety.
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Affiliation(s)
- Valerie M. Vaughn
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Patient Safety Enhancement Program, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Megan O’Malley
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Patient Safety Enhancement Program, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Scott A. Flanders
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Patient Safety Enhancement Program, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Tejal N. Gandhi
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Lindsay A. Petty
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Anurag N. Malani
- Division of Infectious Diseases, Department of Internal Medicine, St Joseph Mercy Health System, Ann Arbor, Michigan
| | - Allison Weinmann
- Division of Infectious Diseases, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Jennifer K. Horowitz
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Patient Safety Enhancement Program, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Patient Safety Enhancement Program, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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Barnes A, Nunez M. Diabetic Foot Infection and Select Comorbidities Drive Readmissions in Outpatient Parenteral Antimicrobial Therapy. Am J Med Sci 2020; 361:233-237. [PMID: 33097196 DOI: 10.1016/j.amjms.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/22/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Outpatient parenteral antimicrobial therapy (OPAT) facilitates early patient discharge, but readmissions prior to completion of therapy may offset its advantages. The objective of this study was to evaluate unplanned readmissions of patients undergoing OPAT at our institution and to identify risk factors. We hypothesized that host factors were most relevant. METHODS We retrospectively identified all patients discharged to receive OPAT during 2017 who experienced at least one unplanned readmission to the hospital prior to its completion. We determined the proportion of patients readmitted, and the causes for readmission. Using a control group, we identified risk factors through multivariate logistic regression analysis. RESULTS Out of 684 patients, 17% had an unplanned readmission while receiving OPAT. Causes included worsening infection in 18%, venous access problems in 11%, acute events unrelated to infection in 19%, treatment intolerance in 19%, progression of underlying comorbidity in 20%, and social and other problems in 13%. In multivariate analysis diabetic foot infection (OR 3.24; 95%CI 1.38-8.31; p = 0.01), the presence of chronic kidney disease, decubitus ulcer or heart failure (OR 2.65; 95% CI 1.51-4.70; p < 0.001), and narcotics prescribed at discharge (OR 1.93; 95% CI 1.06-3.60; p = 0.049) were independent risk factors for readmission. CONCLUSIONS Unplanned hospital readmissions were frequent and due to very heterogeneous causes. Diabetic foot infection, selected comorbidities, and discharge on opioids were identified as independent risk factors. In the efforts to decrease readmissions among patients receiving outpatient parenteral antimicrobial a focus on these high-risk groups is a priority.
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Affiliation(s)
- Andrew Barnes
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Marina Nunez
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina.
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Evaluation of OPAT in the Age of Antimicrobial Stewardship. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020. [DOI: 10.1007/s40506-020-00217-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Improving Antimicrobial Use in Adult Outpatient Clinics: the New Frontier for Antimicrobial Stewardship Programs. Curr Infect Dis Rep 2020. [DOI: 10.1007/s11908-020-00722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brady SS, Berry A, Camenga DR, Fitzgerald CM, Gahagan S, Hardacker CT, Harlow BL, Hebert-Beirne J, LaCoursiere DY, Lewis JB, Low LK, Lowder JL, Markland AD, McGwin G, Newman DK, Palmer MH, Shoham DA, Smith AL, Stapleton A, Williams BR, Sutcliffe S. Applying concepts of life course theory and life course epidemiology to the study of bladder health and lower urinary tract symptoms among girls and women. Neurourol Urodyn 2020; 39:1185-1202. [PMID: 32119156 PMCID: PMC7659467 DOI: 10.1002/nau.24325] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/23/2020] [Indexed: 01/18/2023]
Abstract
AIMS Although lower urinary tract symptoms (LUTS) may occur at different periods during the life course of women, a little research on LUTS has adopted a life course perspective. The purpose of this conceptual paper is to demonstrate how life course theory and life course epidemiology can be applied to study bladder health and LUTS trajectories. We highlight conceptual work from the Prevention of Lower Urinary Tract Symptoms Research Consortium to enhance the understanding of life course concepts. METHODS Consortium members worked in transdisciplinary teams to generate examples of how life course concepts may be applied to research on bladder health and LUTS in eight prioritized areas: (a) biopsychosocial ecology of stress and brain health; (b) toileting environment, access, habits, and techniques; (c) pregnancy and childbirth; (d) physical health and medical conditions; (e) musculoskeletal health; (f) lifestyle behaviors; (g) infections and microbiome; and (h) hormonal status across the life span. RESULTS Life course concepts guided consortium members' conceptualization of how potential risk and protective factors may influence women's health. For example, intrapartum interventions across multiple pregnancies may influence trajectories of bladder health and LUTS, illustrating the principle of life span development. Consortium members also identified and summarized methodologic and practical considerations in designing life course research. CONCLUSIONS This paper may assist researchers from a variety of disciplines to design and implement research identifying key risk and protective factors for LUTS and bladder health across the life course of women. Results from life course research may inform health promotion programs, policies, and practices.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Amanda Berry
- Department of Surgery, Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deepa R Camenga
- Department of Emergency Medicine and Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Sheila Gahagan
- Department of Pediatrics, Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | | | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - D Yvette LaCoursiere
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, San Diego, California
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Lisa K Low
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Alayne D Markland
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
- Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Diane K Newman
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary H Palmer
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - David A Shoham
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois
| | - Ariana L Smith
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann Stapleton
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington
| | - Beverly R Williams
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
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Ulcerative Proctitis in a Patient With a History of Fecal Microbiota Transplant for Clostridioides difficile Infection. ACG Case Rep J 2020; 7:e00364. [PMID: 32548192 PMCID: PMC7224719 DOI: 10.14309/crj.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/11/2020] [Indexed: 11/17/2022] Open
Abstract
Fecal microbiota transplantation (FMT) effectively treats Clostridioides difficile infection and alters the gut microbiota in the long term, but potential adverse effects are poorly understood. We report a man with a family history of ulcerative colitis who developed ulcerative proctitis within a year of FMT.
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Hase R, Yokoyama Y, Suzuki H, Uno S, Mikawa T, Suzuki D, Muranaka K, Hosokawa N. Review of the first comprehensive outpatient parenteral antimicrobial therapy program in a tertiary care hospital in Japan. Int J Infect Dis 2020; 95:210-215. [PMID: 32205285 DOI: 10.1016/j.ijid.2020.03.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The infectious diseases team at Kameda Medical Center, Japan, implemented a new outpatient parenteral antimicrobial therapy (OPAT) program in July 2012 and expanded the program with the support of home care services. This study reviews the OPAT program after 5.5 years of operation. METHODS We prospectively collected data about the age, sex, diagnoses, causative organisms, types of OPAT, modes of administration, selected antibiotics, treatment durations, bed days saved, outcomes, readmissions, and estimated cost reductions of all patients who were treated in the OPAT program from July 2012 to December 2017. RESULTS Of the 66 patients treated under the OPAT program, 45 (68.2%) were treated using clinic OPAT, and 21 (31.8%) were treated using homecare OPAT. The most commonly targeted organism was methicillin-susceptible Staphylococcus aureus. Continuous infusion with elastomeric pumps was employed in 55 patients (83.3%). Cefazolin was the most frequently used antibiotic (39.4%), followed by penicillin G (24.2%). The median OPAT duration was 13 days (range, 3-51), and the total bed days saved was 923. The estimated medical cost reduction was approximately 87,000 US dollars. CONCLUSIONS Our experience shows that OPAT is a safe and feasible practice not only for efficient bed utilization and medical cost savings but also for better antimicrobial stewardship.
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Affiliation(s)
- Ryota Hase
- Department of Infectious Diseases, Kameda Medical Center, Chiba, Japan; Department of Infectious Diseases, Japanese Red Cross Narita Hospital, Chiba, Japan.
| | | | - Hiroyuki Suzuki
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, IA, USA
| | - Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Mikawa
- Department of Infectious Diseases, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Daisuke Suzuki
- Department of Infectious Diseases, Fujita Health University, Aichi, Japan
| | - Kiyoharu Muranaka
- Department of Internal Medicine, Suwa Central Hospital, Nagano, Japan
| | - Naoto Hosokawa
- Department of Infectious Diseases, Kameda Medical Center, Chiba, Japan
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Com G, Agarwal A, Bai S, Hu Z, Goode G, McCarty H, Berlinski A. Outcomes and Safety of Outpatient Parenteral Antimicrobial Therapy in Select Children with Cystic Fibrosis. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2019; 32:149-154. [PMID: 32140285 PMCID: PMC7057055 DOI: 10.1089/ped.2019.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/29/2019] [Indexed: 11/12/2022]
Abstract
Background: Pulmonary exacerbations (PExs) are common in individuals with cystic fibrosis (CF). Data regarding outcomes of outpatient parenteral antimicrobial therapy (OPAT) in children are sparse. Methods: Retrospective data of PEx episodes treated in the hospital versus OPAT collected. Children ≤18 years were included. Outcome measures included FEV1, FVC, FEF25-75%P, time to the next PEx, and weight gain. Results: Eighty-three subjects with 290 PEx events were eligible. The hospital group had 242 and the OPAT group had 48 PEx events. The median age was 13.1 years for the OPAT and 13.4 years for the hospital group. Medicaid coverage was higher in the hospital group (82.2%) versus OPAT group (48.9%, P < 0.0001). The hospital group had lower FEV1%P on admission [72%P (interquartile range [IQR] = 59.7 and 84) versus 80%P (IQR = 70.7 and 89); P = 0.001] and at the end of treatment [86%P (IQR = 72 and 96.7) versus 92%P (IQR = 82 and 101); P = 0.003] in comparison with OPAT group. FEV1%P improved more in the hospital group, [12%P (IQR = 4 and 20)] versus in the OPAT group [8%P (IQR = 2 and 22.5); (P = 0.41)] but did not quite reach a statistically significant level. The hospital intravenous (IV) group gained more weight (P < 0.0001). There was no difference between the 2 groups in time to the first PEx (P = 0.47) and adverse events. Conclusion: OPAT was safe and comparable with hospital therapy in a select group of children with CF. Hospital IV should be considered for sicker children and families with limited resources.
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Affiliation(s)
- Gulnur Com
- Department of Pediatric Pulmonology, University of Florida, Pensacola, Florida
| | - Amit Agarwal
- Department of Pediatric Pulmonology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Shasha Bai
- Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Zhuopei Hu
- Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Grace Goode
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
- St. Vincent Women's Hospital, Indianapolis, Indiana
| | | | - Ariel Berlinski
- Department of Pediatric Pulmonology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Overcoming stability challenges during continuous intravenous administration of high-dose amoxicillin using portable elastomeric pumps. PLoS One 2019; 14:e0221391. [PMID: 31419268 PMCID: PMC6697341 DOI: 10.1371/journal.pone.0221391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/07/2019] [Indexed: 12/13/2022] Open
Abstract
While treatment of serious infectious diseases may require high-dose amoxicillin, continuous infusion may be limited by lack of knowledge regarding the chemical stability of the drug. Therefore, we have performed a comprehensive study so as to determine the chemical stability of high-dose amoxicillin solutions conducive to safe and effective continuous intravenous administration using portable elastomeric pumps. First, amoxicillin solubility in water was assessed within the range of 25 to 300 mg/mL. Then, amoxicillin solutions were prepared at different concentrations (25, 50, 125, 250 mg/mL) and stored in different conditions (5±2°C, 25±1°C, 30±1°C and 37±1°C) to investigate the influence of concentration and temperature on the chemical stability of amoxicillin. Finally, its stability was assessed under optimized conditions using a fully validated HPLC-UV stability-indicating method. Degradation products of amoxicillin were investigated by accurate mass determination using high-resolution mass spectrometry. Amoxicillin displayed limited water solubility requiring reconstitution at concentrations below or equal to 150 mg/mL. Amoxicillin degradation were time, temperature as well as concentration-dependent, resulting in short-term stability, in particular at high concentrations. Four degradation products of amoxicillin have been identified. Among them, amoxicilloic acid and diketopiperazine amoxicillin are at risk of allergic reaction and may accumulate in the patient. Optimized conditions allowing for continuous infusion of high-dose amoxicillin has been determined: amoxicillin should be reconstituted at 25 mg/mL and stored up to 12 hours at room temperature (22 ± 4°C) or up to 24 hours between 4 and 8°C.
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Highlights From Clinical Practice Guidelines by the Infectious Diseases Society of America for the Diagnosis and Treatment of Seasonal Influenza. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Keller SC, Cosgrove SE, Arbaje AI, Chang RH, Krosche A, Williams D, Gurses AP. It's Complicated: Patient and Informal Caregiver Performance of Outpatient Parenteral Antimicrobial Therapy-Related Tasks. Am J Med Qual 2019; 35:133-146. [PMID: 31161769 PMCID: PMC6917971 DOI: 10.1177/1062860619853345] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) requires patients and caregivers to infuse antimicrobials through venous catheters (VCs) in the home. The objective of this study was to perform a patient-centered goal-directed task analysis to identify what is required for successful completion of OPAT. The authors performed 40 semi-structured patient interviews and 20 observations of patients and caregivers performing OPAT-related tasks. Six overall goals were identified: (1) understanding and developing skills in OPAT, (2) receiving supplies, (3) medication administration and VC maintenance, (4) preventing VC harm while performing activities of daily living, (5) managing when hazards lead to failures, and (6) monitoring status. The authors suggest that patients and caregivers use teach-back, take formal OPAT classes, receive visual and verbal instructions, use cognitive aids, learn how to troubleshoot, and receive clear instructions to address areas of uncertainty. Addressing these goals is essential to ensuring the safety of and positive experiences for our patients.
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Affiliation(s)
- Sara C. Keller
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Alicia I. Arbaje
- Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rachel H. Chang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amanda Krosche
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Ayse P. Gurses
- Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
- Carey School of Business, Baltimore, MD
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Dalbavancin Use in Vulnerable Patients Receiving Outpatient Parenteral Antibiotic Therapy for Invasive Gram-Positive Infections. Infect Dis Ther 2019; 8:171-184. [PMID: 31054088 PMCID: PMC6522607 DOI: 10.1007/s40121-019-0247-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Indexed: 01/12/2023] Open
Abstract
Introduction Dalbavancin is approved for acute bacterial skin and skin structure infections (ABSSSIs) but offers a potential treatment option for complicated invasive gram-positive infections. Importantly, dalbavancin’s real benefits may be in treating complicated infections in vulnerable patient populations, such as persons who inject drugs (PWID). Methods A multicenter retrospective analysis was performed from March 2014 to April 2017 to assess 30- and 90-day clinical cure and adverse drug events (ADEs) in adult patients who received ≥ 1 dose of dalbavancin for a non-ABSSSI indication. Results During the study period, 45 patients received dalbavancin, 28 for a non-ABSSSI indication. The predominant infections treated included osteomyelitis (46%), endovascular infection (25%) and uncomplicated bacteremia (14%). Half of the patients had positive Staphylococcus aureus in cultures, 29% methicillin resistant and 21% methicillin susceptible. Most patients were prescribed dalbavancin as sequential treatment with a median of 13.5 days of prior antibiotic therapy. The most common reason for choosing dalbavancin over standard therapy use was PWID (54%). Seven patients were lost to follow-up at day 30. Of the remaining evaluable patients, 30-day clinical cure was achieved in 15/21 (71%) patients. The most common reason for failure was lack of source control (4/6, 67%). At day 90, relapse occurred in two patients. Three patients had a potential dalbavancin-associated ADE: two patients with renal dysfunction and one patient with pruritus. Conclusions This study demonstrates a possible role for dalbavancin in the treatment of non-ABSSSI invasive gram-positive infections in select vulnerable OPAT patients.
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OPAT for avoidance of hospitalisation in children. THE LANCET. INFECTIOUS DISEASES 2019; 19:450-451. [PMID: 30853251 DOI: 10.1016/s1473-3099(19)30043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/29/2019] [Indexed: 11/21/2022]
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Affiliation(s)
- Helen W Boucher
- From the Tufts Center for Integrated Management of Antimicrobial Resistance and Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center and Tufts University School of Medicine, Boston
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