A Pharmacist's Role in a Case of Allergy Labeling and Acute Bacterial Rhinosinusitis Treatment

This case report describes a pharmacist's intervention with a 58-year-old female who presented with recurrent rhinosinusitis symptoms and limited treatment options due to a complicated allergy history. Using guidelines for treatment of acute bacterial rhinosinusitis coupled with a thorough antibiotic allergy assessment, the pharmacist developed a treatment plan that was acceptable to both the patient and the provider. Pharmacists can play an essential role in verification of allergies to both medications and non-pharmaceutical products, which further ensures patient safety as well as optimization of appropriate treatment methods.

A Case of Clostridioides difficile: Update on Practice Guidelines

This report describes a case of recurrent Clostridioides difficile infection (CDI) and illustrates that pharmacist's role in selecting appropriate treatment. The report discusses CDI risk factors and reviews the guidelines for the pharmacological management of CDI.

1066. Adjuvant β-Lactam Therapy Combined with Vancomycin for Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia: Does β-Lactam class Matter?

Background

Vancomycin (VAN) combined with a β-lactam (COMBO) expedites MRSA bacteremia clearance compared with VAN alone. However, the impact of COMBO on persistent MRSA bacteremia (PB) using a contemporary definition of ≥5 days is unknown. There is also no consensus on which β-lactam (BL) should be combined with VAN. We sought to assess PB rates among adults who received COMBO or VAN and the impact of BL class on PB.

Methods

This was an analysis of pooled data from two published studies of adults with MRSA bacteremia (Dilworth et al., Antimicrob Agents Chemother. 2014;58(1):102–109; Casapao et al., Pharmacotherapy. 2017;37(11):1347–1356). All patients received intravenous VAN for ≥72 hours. COMBO patients received an intravenous BL for ≥48 hours with VAN, started within 24 hours of VAN. The remaining patients comprised the VAN group. The primary outcome was PB (≥5 days). The impact of BL class on PB was assessed. Acute kidney injury (AKI, serum creatinine increase from baseline by 0.5 mg/dL or 50%) was examined as a secondary outcome. Demographics were compared between groups. Multivariable logistic regression models compared PB between COMBO and VAN.

Results

In total, 156 patients were included (VAN = 66; COMBO = 90). The groups were similar except COMBO patients were more likely to have a pulmonary bacteremia source (12.2% vs. 1.5%, P = 0.014) and a higher median (IQR) vancomycin serum level (mg/L, 17.8 (13.9, 23.6) vs. 15.7 (11.3, 20.6); P = 0.039). PB was less common in COMBO (26.7% vs. 43.9%, P = 0.027). In a multivariable model COMBO was inversely associated with PB (adjusted odds ratio [aOR], 95% confidence intervals [CI], 0.48, 0.24–0.95). AKI was more common in COMBO (18.9% vs. 7.6%, P = 0.062). PB and AKI rates by BL class are shown in the table below, with VAN listed for reference.

Conclusion

COMBO reduced the likelihood of PB but had a higher AKI rate. There were no significant differences in PB by BL class. Clinically, COMBO may reduce PB rates and prevent overuse of salvage antibiotic therapy. BL choice for COMBO warrants further investigation.

Disclosures

All authors: No reported disclosures.

Significant publications on infectious diseases pharmacotherapy in 2012

PURPOSE

The most important articles pertaining to infectious diseases (ID) pharmacotherapy published in 2012, as nominated and ranked by panels of pharmacists and physicians with ID expertise, are summarized.

SUMMARY

Members of the Houston Infectious Diseases Network were asked to nominate articles on ID research published in prominent peer-reviewed journals during the period January 1-December 31, 2012, with a major impact in the field of ID pharmacotherapy. A list of 42 nominated articles on general ID-related topics and 8 articles pertaining to human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) was compiled. In a survey conducted in January 2013, members of the Society of Infectious Diseases Pharmacists (SIDP) were asked to select from the list 10 general ID articles and 1 HIV/AIDS-related article that they considered to be the most important. Of the 180 SIDP members surveyed, 100 (55%) and 44 (24%) participated in ranking the general ID and HIV/AIDS-related articles, respectively. Summaries of the highest-ranked articles in both categories are presented here.

CONCLUSION

With the volume of published ID-related research growing each year, both ID specialists and nonspecialists are challenged to stay current with the literature. Key ID-related publications in 2012 included updated recommendations on management of diabetic foot infections, articles on promising approaches to prevention and early treatment of HIV disease, and reports on developments in research on pharmacotherapies for methicillin-resistant Staphylococcus aureus bacteremia and Klebsiella pneumoniae infections.