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Komerdelj IA, Buckley MS, D'Alessio PA, Ziadat DS, Kobic E, Rangan P, Agarwal SK, Tinta NC, Yerondopoulos MJ, Kane-Gill SL. Vancomycin With Concomitant Piperacillin/Tazobactam vs. Cefepime or Meropenem Associated Acute Kidney Injury in General Ward Patients: A Multicenter Propensity Score-Matched Study. J Pharm Pract 2024; 37:80-87. [PMID: 36075000 DOI: 10.1177/08971900221125518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Concurrent administration of vancomycin and piperacillin/tazobactam (VAN+PTZ) may increase the risk of acute kidney injury (AKI) in hospitalized patients. Comprehensive characterization of VAN+PTZ associated AKI and recovery patterns remains lacking in previous reports. Objective: To compare the incidence of AKI associated with VAN+PTZ compared to either cefepime (CEF) or meropenem (MER) with VAN in adult general ward patients. Methods: A multicenter, retrospective, propensity score cohort study was conducted in non-critically ill adult patients. Included patients were concurrently administered VAN+PTZ or VAN+CEF/MER. Patients developing AKI ≤48 hours following combination therapy were excluded. The primary endpoint was to compare the incidence of AKI between study groups. Multivariable Cox regression modeling in predicting AKI was also conducted. Results: A total of 3199 patients met inclusion criteria and were evaluated. The incidence of AKI in VAN+PTZ and VAN+CEF/MER groups were 16.4% and 8.7%, respectively (P < .001). The onset to AKI was 1.8 days earlier with VAN+PTZ compared to VAN+CEF/MER (P < .001). Multivariable prediction model showed concomitant VAN+PTZ was identified as an independent risk factor of developing AKI (HR 2.34, 1.82-3.01, P < .001). The VAN+PTZ group experienced significantly higher rates of severe AKI (stage II or III) compared to the VAN+CEF/MER group (P = .002). No differences in the AKI recovery patterns were found between study groups. Conclusions: Concomitant VAN+PTZ in adult general ward patients was independently associated with an increased risk of AKI overall. More severe AKI was also associated with VAN+PTZ.
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Affiliation(s)
- Ivan A Komerdelj
- Department of Pharmacy, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - Paul A D'Alessio
- Department of Pharmacy, Banner Baywood Medical Center, Mesa, AZ, USA
| | - Delia S Ziadat
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - Emir Kobic
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - Pooja Rangan
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
- Department of Medicine, University of Arizona-College of Medicine Phoenix, Phoenix, AZ, USA
| | - Sumit K Agarwal
- Department of Medicine, University of Arizona-College of Medicine Phoenix, Phoenix, AZ, USA
| | - Nicole C Tinta
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | | | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
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2
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Buckley MS, Kobic E, Yerondopoulos M, Sharif AS, Benanti GE, Meckel J, Puebla Neira D, Boettcher SR, Khan AA, McNierney DA, MacLaren R. Comparison of Methicillin-Resistant Staphylococcus aureus Nasal Screening Predictive Value in the Intensive Care Unit and General Ward. Ann Pharmacother 2023; 57:1036-1043. [PMID: 36575978 DOI: 10.1177/10600280221145152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening appears promising for antimicrobial stewardship programs. However, a paucity of data remains on the diagnostic performance of culture-based MRSA screen in the intensive care unit (ICU) for pneumonia and bacteremia. OBJECTIVE The objective of this study was to compare the predictive value of culture-based MRSA nasal screening for pneumonia and bacteremia in ICU and general ward patients. METHODS This multicenter, retrospective study was conducted over a 23-month period. Adult patients with MRSA nasal screening ≤48 hours of collecting a respiratory and/or blood culture with concurrent initiation of anti-MRSA therapy were included. The primary endpoint was to compare the negative predictive value (NPV) associated with culture-based MRSA nasal screening between ICU and general ward patients with suspected pneumonia. RESULTS A total of 5106 patients representing the ICU (n = 2515) and general ward (n = 2591) were evaluated. The NPV of the MRSA nares for suspected pneumonia was not significantly different between ICU and general ward patient populations (98.3% and 97.6%, respectively; P = 0.41). The MRSA nares screening tool also had a high NPV for suspected bacteremia in ICU (99.8%) and general ward groups (99.7%) (P = 0.56). The overall positive MRSA nares rates in the ICU and general ward patient populations were 9.1% and 8.2%, respectively (P = 0.283). Moreover, MRSA-positive respiratory and blood cultures among ICU patients were 5.8% and 0.8%, respectively. CONCLUSION AND RELEVANCE Our findings support the routine use of MRSA nasal screening using the culture-based method in ICU patients with pneumonia. Further research on the clinical performance for MRSA bacteremia in the ICU is warranted.
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Affiliation(s)
- Mitchell S Buckley
- Department of Pharmacy, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Emir Kobic
- Department of Pharmacy, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | | | - Atefeh S Sharif
- Department of Pharmacy, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Grace E Benanti
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
| | - Jordan Meckel
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
| | - Daniel Puebla Neira
- Department of Pulmonary and Critical Care, The University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | - Abdul A Khan
- Department of Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Dakota A McNierney
- Department of Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Robert MacLaren
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
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Salehpour N, Riley LD, Gonzales MJ, Kobic E, Nix DE. Performance of Bayesian Area Under the Concentration-Time Curve-Based Pharmacokinetic Dosing Based on a One-Compartment Model and Trough-Only Monitoring for Vancomycin. Antimicrob Agents Chemother 2023; 67:e0017223. [PMID: 37133362 PMCID: PMC10269041 DOI: 10.1128/aac.00172-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/11/2023] [Indexed: 05/04/2023] Open
Abstract
A novel Bayesian method was developed to interpret serum vancomycin concentrations (SVCs) following the administration of one or more vancomycin doses with potential varying doses and intervals based on superposition principles. The method was evaluated using retrospective data from 442 subjects from three hospitals. The patients were required to receive vancomycin for more than 3 days, have stable renal function (fluctuation in serum creatinine of ≤0.3 mg/dL), and have at least 2 trough concentrations reported. Pharmacokinetic parameters were predicted using the first SVC, and the fitted parameters were then used to predict subsequent SVCs. Using only covariate-adjusted population prior estimates, the first two SVC prediction errors were 47.3 to 54.7% for the scaled mean absolute error (sMAE) and 62.1 to 67.8% for the scaled root mean squared error (sRMSE). "Scaled" refers to the division of the MAE or RMSE by the mean value. The Bayesian method had minimal errors for the first SVC (by design), and for the second SVC, the sMAE was 8.95%, and the sRMSE was 36.5%. The predictive performance of the Bayesian method did degrade with subsequent SVCs, which we attributed to time-dependent pharmacokinetics. The 24-h area under the concentration-time curve (AUC) was determined from simulated concentrations before and after the first SVC was reported. Prior to the first SVC, 170 (38.4%) patients had a 24-h AUC of <400 mg · h/L, 186 (42.1%) had a 24-h AUC within the target range, and 86 (19.5%) had a 24-h AUC of >600 mg · h/L. After the first SVC was reported, 322 (72.9%) had a 24-h AUC within the target range, 68 (15.4%) had low values, and 52 (11.8%) had high values based on the model simulation. Target attainments were 38% before the first SVC and 73% after the first SVC. The hospitals had no policies or procedures in place for targeting 24-h AUCs, although the trough target was typically 13 to 17 mg/L. Our data provide evidence of time-dependent pharmacokinetics, which will require regular therapeutic drug monitoring regardless of the method used to interpret SVCs.
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Affiliation(s)
- Niloufar Salehpour
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - Lacey D. Riley
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
- Banner University Medical Center—Phoenix, Phoenix, Arizona, USA
| | - Marcos J. Gonzales
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - Emir Kobic
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
- Banner University Medical Center—Phoenix, Phoenix, Arizona, USA
| | - David E. Nix
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
- Banner University Medical Center—Tucson, Tucson, Arizona, USA
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Marcella S, Carr AL, Kobic E, Nguyen S, Zhou A. 667. Real-world Experience of Cefiderocol with Pseudomonas aeruginosa in the PROVE (Retrospective Cefiderocol Chart Review) Study. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Gram-negative (GN) bacterial resistance is an urgent global health problem. Cefiderocol (CFDC) is active against many resistant GN pathogens, including Pseudomonas aeruginosa (PA). PROVE is an ongoing international, retrospective study assessment of CFDC use for Gram-negative infections (GNI).
Methods
Patients were eligible if they received ≥ 72 hours of CFDC. Patient and pathogen characteristics, hospital course, and antibiotic treatment patterns were described. All-cause mortality (ACM) at 14 and 30 days and clinical cure were examined as outcomes, overall, and by key characteristics such as pathogen susceptibility (determined at the local level), patient demographics, infection site, and severity of illness. Serious adverse drug reactions (SADR) were recorded.
Results
To date, 123 patients treated with CFDC at 12 sites were included. Sixty-five patients had PA as a pathogen, either alone (N=45) or in combination with another pathogen (N=20) attributed to starting CFDC. The median age was 54 years; 68% were male. The most prevalent comorbidity was diabetes with end stage organ damage (N=15, 23%). CFDC was given in an ICU setting in 54 (82%) patients. Vasopressors and mechanical ventilation were required in 42% and 62%, respectively. Most (91%) PA were carbapenem resistant. The median time from a positive culture to start of CFDC was 6 days. CFDC monotherapy was used in 75%. The most common GN antibiotic class used concurrently with CFDC was aminoglycosides (N=7). Targeted therapy with CFDC against pathogens of known susceptibility with or without prior GN antibiotics accounted for 80% of use. The remainder was used for salvage (15%) or empirically (2%). Susceptibility testing to CFDC, available for 54 cultures (54 patients), showed 94% (51/54) were susceptible. Post-CFDC initiation 14- and 30-day all-cause mortality (ACM) was 9% (95% CI: 3%-19%) and 23% (95% CI: 14%-35%) respectively. Clinical resolution was achieved in 66% (95% CI: 53% -77%). Thirty-day ACM for susceptible pathogens was 25% (13/51).
Cefiderocol Use Patterns in Pseudomonas aeruginosa
Conclusion
Real-world use of CFDC for PA demonstrated that most patients had multiple comorbidities and were severely ill. These data suggest that CFDC is being used appropriately with little empirical use in patients with few treatment options.
Disclosures
Stephen Marcella, MD, MPH, Shionogi: Shionogi employee|Shionogi, Inc: Employee Amy L. Carr, PharmD, BCIDP, Shionogi: Advisory Board Sean Nguyen, n/a, Shionogi: Employee Anan Zhou, MPH, Shionogi, Inc: contracting work for Shionogi, Inc.
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Affiliation(s)
| | | | - Emir Kobic
- Banner University Medical Center Phoenix , Phoenix, Arizona
| | | | - Anan Zhou
- Genesis Research , Hoboken, New Jersey
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Marcella S, Kobic E, Carr AL, Georgiades B, Margiotta C. 666. Outcomes Using Cefiderocol for the Treatment of Acinetobacter baumannii Infections from the PROVE (Real-World Evidence) Study. Open Forum Infect Dis 2022. [PMCID: PMC9752166 DOI: 10.1093/ofid/ofac492.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background PROVE is an ongoing international, retrospective study assessing cefiderocol (CFDC) for Gram-negative (GN) infections. Carbapenem-resistant Acinetobacter baumannii (CRAB) infections are difficult-to-treat with limited treatment options. CFDC is a novel sidero cephalosporin with activity against CRAB. This analysis describes the outcomes and treatment patterns of CFDC treatment in CRAB infections from this study. Methods Patients were eligible if they received ≥ 72 hours of CFDC. Key patient characteristics, infecting pathogen susceptibility, illness severity, and treatment patterns were assessed. Fourteen and 30-day all-cause mortality (ACM) and clinical cure were examined as outcomes. Susceptibility testing was performed locally. Serious adverse drug reactions (SADR) were recorded. Results To date,123 patients treated with CFDC at 12 sites were included. Forty-one had monomicrobial (n=29) or polymicrobial (n=12) Acinetobacter baumannii (AB) infection. All but one were CRAB. The median age was 53 years; 71% were male. The most prevalent comorbidity was severe burns (N=9, 22%). Sixty-one percent of patients received CFDC in the ICU, 51% required mechanical ventilation, and 34% required vasopressor support. The median time from positive culture to CFDC initiation was 5 days. CFDC monotherapy was used in 61%. Tetracyclines were the most common concurrent GN antibiotics used with CFDC (N = 8, 19.5%). Targeted therapy with or without prior GN antibiotics was used in 76%, salvage in 20%, and empirical in 2%. Susceptibility results were available for 28 AB cultures from 28 patients of which 82% were susceptible to CFDC. Post-CFDC 14- and 30-day ACM was 12% (95% CI: 4%-26%) and 22% (95% CI: 11%-38%), respectively. Clinical resolution was achieved in 59% (95% CI: 42% -74%). Thirty-day ACM varied by susceptibility to CFDC: 26% for susceptible, 40% for resistant. One SADR (interstitial nephritis) was reported. Cefiderocol Use Patterns in Acinetobacter baumannii
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Conclusion Real-world use of CFDC for AB demonstrates that most patients were complex with multiple comorbidities and severe illness prior to treatment. It was used mostly as targeted therapy. CFDC may be a treatment option in these difficult-to-treat infections. Disclosures Stephen Marcella, MD, MPH, Shionogi: Shionogi employee|Shionogi, Inc: Employee Amy L. Carr, PharmD, BCIDP, Shionogi: Advisory Board Benjamin Georgiades, PharmD, Shionogi, Inc: Employee Caroline Margiotta, MA, Shionogi, Inc: contracting work for Shionogi, Inc.
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Affiliation(s)
| | - Emir Kobic
- Banner University Medical Center Phoenix, Phoenix, Arizona
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Buckley MS, Komerdelj IA, D'Alessio PA, Rangan P, Agarwal SK, Tinta NC, Martinez BK, Ziadat DS, Yerondopoulos MJ, Kobic E, Kane-Gill SL. Vancomycin with concomitant piperacillin/tazobactam vs. cefepime or meropenem associated acute kidney injury in the critically ill: A multicenter propensity score-matched study. J Crit Care 2021; 67:134-140. [PMID: 34768175 DOI: 10.1016/j.jcrc.2021.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/09/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The risk of acute kidney injury (AKI) associated with concomitant vancomycin and piperacillin/tazobactam in the intensive care unit (ICU) remains controversial. The aim of this study was to compare the AKI incidence associated with concomitant vancomycin and piperacillin/tazobactam compared to either cefepime or meropenem with vancomycin in the ICU. MATERIALS AND METHODS A multicenter, retrospective, propensity score-matched cohort study was conducted in adult ICU patients administered vancomycin in combination with either piperacillin/tazobactam, cefepime, or meropenem were included. Patients developing AKI ≤48 h following combination therapy initiation were excluded. The primary endpoint was to compare the incidence of AKI associated with concomitant antimicrobial therapy. Multivariable Cox regression modeling in predicting AKI was also conducted. RESULTS A total of 1044 patients were matched. The AKI incidence in vancomycin- piperacillin/tazobactam and vancomycin-cefepime/meropenem groups were 21.9% and 16.8%, respectively (p = 0.068). Multivariable prediction models showed concomitant vancomycin-piperacillin/tazobactam was an independent risk factor of AKI using serum creatinine only (HR 1.52, 1.10-2.10, p = 0.011) and serum creatinine with urine output-based KDIGO criteria (HR 1.77, 1.18-2.67, p = 0.006). No significant differences between groups were observed for AKI recovery patterns or mortality. CONCLUSION Concomitant vancomycin and piperacillin/tazobactam administration in adult ICU patients was independently associated with an increased risk of AKI.
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Affiliation(s)
- Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Ivan A Komerdelj
- Department of Pharmacy, Banner MD Anderson Cancer Center, 2946 E. Banner Gateway Dr, Gilbert, AZ 85234, USA.
| | - Paul A D'Alessio
- Department of Pharmacy, Banner Baywood Medical Center, 6644 E. Baywood Ave., Mesa, AZ 85206, USA.
| | - Pooja Rangan
- Department of Medicine, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Sumit K Agarwal
- Department of Medicine, University of Arizona-College of Medicine Phoenix, 550 E Van Buren Street, Phoenix, AZ 85004, USA.
| | - Nicole C Tinta
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Brandon K Martinez
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Delia S Ziadat
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Melanie J Yerondopoulos
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Emir Kobic
- Department of Pharmacy, Banner University Medical Center Phoenix, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Kobic E, Gill CM, Mochon AB, Nicolasora NP, Nicolau DP. Cefiderocol Pharmacokinetics in a Patient Receiving Continuous Venovenous Hemodiafiltration. Open Forum Infect Dis 2021; 8:ofab252. [PMID: 34250190 PMCID: PMC8266675 DOI: 10.1093/ofid/ofab252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial dosing in patients receiving continuous renal replacement therapy is a continued clinical challenge. We describe a case of a patient receiving cefiderocol 2 g intravenously every 8 hours as a 3-hour infusion for a multidrug-resistant Pseudomonas aeruginosa pneumonia and bacteremia while undergoing continuous venovenous hemodiafiltration. The clinical course and cefiderocol pharmacokinetics are described.
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Affiliation(s)
- Emir Kobic
- Department of Pharmacy, Banner University Medical Center, Phoenix, Arizona, USA
| | - Christian M Gill
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | - A Brian Mochon
- Department of Pathology, University of Arizona College of Medicine, Phoenix, Arizona, USA.,Labratory Sciences Arizona/Sonora Quest Laboratories, Phoenix, Arizona, USA
| | - Nelson P Nicolasora
- Division of Infectious Diseases, Banner University Medical Center, Phoenix, Arizona, USA
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA.,Division of Infectious Diseases, Hartford Hospital, Hartford, Connecticut, USA
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