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

Background:Methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) testing can rapidly detect MRSA colonization via nasopharyngeal swab. With a high negative predictive value for MRSA pneumonia, this test may help minimize the duration of anti-MRSA therapy and associated adverse drug events. Objective: This study aimed to evaluate the impact of a pharmacist-initiated MRSA nasal PCR protocol on pneumonia therapy. Methods: This retrospective, quasi-experimental study evaluated adult patients with pneumonia before and after the implementation of a pharmacist-initiated MRSA nasal PCR protocol. The primary outcome of this study was to compare duration of anti-MRSA therapy between the Pre-PCR group and PCR group. Secondary comparisons included duration of antipseudomonal therapy, time from intravenous (IV) to oral interchange, and clinical outcomes. Results: In total, 210 patients (Pre-PCR: n = 138, PCR: n = 72) were included. The MRSA nasal PCR result was negative for 63 patients (87.5%), and 56 (88.9%) vancomycin orders were discontinued within 24 hours of the negative result. The mean duration of vancomycin therapy was significantly shorter in the PCR group (2.5 vs 1.4 days, P < .001) as well as duration of IV therapy (5 vs 3.9 days, P = .003). There was no difference between groups in duration of antipseudomonal therapy ( P = .425), acute kidney injury (AKI; P = .332), 30-day readmission ( P = .137), or 30-day mortality ( P = .179). Conclusion and Relevance: A pharmacist-driven MRSA nasal PCR protocol significantly decreased the duration of anti-MRSA therapy and IV antibiotics in patients with pneumonia. These findings add to the relatively small body of literature supporting pharmacist-initiated rapid diagnostic testing and follow-up.

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1994. Impact of Pharmacist-initiated MRSA Nasal PCR Protocol on Pneumonia Therapy in a Community Teaching Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1674 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S669-S669

Author(s):

Selena Pham ◽

Abby Sturm ◽

Lisa Dumkow ◽

Joshua Jacoby ◽

Nnaemeka Egwuatu

Keyword(s):

Median Time ◽

Teaching Hospital ◽

Adverse Drug Events ◽

Kidney Injury ◽

Nasopharyngeal Swab ◽

Protocol Implementation ◽

Before And After ◽

Quasi Experimental ◽

The Impact ◽

Community Teaching

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) nasal PCR testing can rapidly detect MRSA colonization via nasopharyngeal swab. With a high negative predictive value for MRSA pneumonia, this test may help minimize the duration of anti-MRSA therapy and associated adverse drug events. This study aimed to evaluate the impact of a pharmacist-initiated MRSA nasal PCR protocol on pneumonia therapy in a community teaching hospital. Methods This retrospective, quasi-experimental study evaluated adult patients with pneumonia before and after the implementation of a pharmacist-initiated MRSA nasal PCR protocol. The GeneXpert MRSA/SA Nasal Complete Assay was utilized for PCR testing. Prior to protocol implementation the MRSA nasal PCR was not routinely used to assist in pneumonia treatment decisions. Following protocol implementation, pharmacists ordered MRSA PCR testing after an order for anti-MRSA pneumonia therapy; however, prescriber approval was required to discontinue therapy following negative result. The primary outcome of this study was to compare the duration of anti-MRSA therapy between the pre-PCR group (June 1–November 1, 2017) and PCR group (June 1–November 1, 2018). Secondary comparisons included the duration of antipseudomonal therapy, time from IV to PO interchange, adverse events, and clinical outcomes between groups. Results 210 patients were included (pre-PCR n = 138, PCR n = 72). Vancomycin was the anti-MRSA therapy ordered for all patients in both groups. In the PCR group, the median time from vancomycin order to PCR order was 2.8 hours (0–45.6 hours), while median time from PCR order to PCR result was 4.4 hours (0.6–31.5 hours). The PCR result was negative for 63 patients (87.5%) and 56 (88.9%) vancomycin orders were discontinued within 24 hours of the negative result. The mean duration of vancomycin therapy was significantly shorter in the PCR group (2.5 vs. 1.4 days, P < 0.001) as well as duration of IV therapy (5 vs. 3.9 days, P = 0.003). There was no difference between groups in duration of antipseudomonal therapy (P = 0.425), acute kidney injury (P = 0.332), 30-day readmission (P = 0.137), or 30-day mortality (P = 0.179). Conclusion A pharmacist-led MRSA nasal PCR protocol significantly decreased the duration of anti-MRSA therapy and IV antibiotic duration in patients with pneumonia. Disclosures All authors: No reported disclosures.

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The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

The Journal of Applied Laboratory Medicine ◽

10.1373/jalm.2018.026955 ◽

2019 ◽

Vol 3 (4) ◽

pp. 545-552

Author(s):

Nathalia De Oro ◽

Maria E Gauthreaux ◽

Julie Lamoureux ◽

Joseph Scott

Keyword(s):

Lactic Acid ◽

Length Of Stay ◽

Community Hospital ◽

Unit Length ◽

Hospital Setting ◽

Control Group ◽

Before And After ◽

Quasi Experimental ◽

Current Cutoff ◽

The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

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SP10.1.7 The Important Role of In-Situ Simulation in Preparing Surgeons for the COVID-19 Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab361.180 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Pierre Montauban ◽

Charannya Balakumar ◽

Jaideep Rait ◽

Prizzi Zarsadias ◽

Sara Iqbal ◽

...

Keyword(s):

High Risk ◽

In Situ Simulation ◽

Level Of Confidence ◽

Effective Training ◽

Before And After ◽

Quasi Experimental ◽

Surgical Teams ◽

Imminent Threat ◽

The Impact

Abstract Background Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19. Methods This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients. Results 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy. Conclusion In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.

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Efficacy of standard- vs reduced-dose insulin for treatment of hyperkalemia: A quasi-experiment

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab382 ◽

2021 ◽

Author(s):

Sara Catherine Pearson ◽

Kristin O’Connor ◽

Kimberly Keller ◽

T J Hodge ◽

Ross Nesbit

Keyword(s):

Glucose Level ◽

Standard Dose ◽

Additional Treatment ◽

Treatment Pathway ◽

Reduced Dose ◽

Significant Difference ◽

Before And After ◽

Quasi Experimental ◽

Stage Renal Disease ◽

The Impact

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Hyperkalemia more commonly affects patients with a glomerular filtration rate of less than 60 mL/min. Using intravenous (IV) insulin to shift potassium intracellularly may cause hypoglycemia, requiring additional treatment or longer hospitalization. Literature on insulin dosing in this context is limited, with one previous study indicating that 5 units of IV insulin might be as effective and result in less hypoglycemia than the standard dose of 10 units of IV insulin. The hyperkalemia treatment pathway at our institution was revised in May 2018 to include a reduced-dose option (5 units of insulin) for patients with end-stage renal disease. This study aimed to compare the prevalence of hypoglycemia between patients who received standard-dose vs reduced-dose IV insulin. Methods This single-center, retrospective, quasi-experimental study evaluated the impact of revision of the hyperkalemia treatment pathway by assessing rates of hypoglycemia during the 6 months before and after implementation of the revised pathway. The primary endpoint was prevalence of hypoglycemia, defined as a blood glucose level of less than or equal to 70 mg/dL. Results There was no statistically significant difference in the occurrence of hypoglycemia when comparing the pre- and postimplementation groups (36 [17.7%] patients vs 34 [18.7%] patients; P = 0.7924). The postimplementation group had a statistically significant lower reduction in potassium levels after treatment than the preimplementation group (mean [interquartile range], –0.9 [–1.3, –0.5] mEq/L vs –0.6 [–1.2, –0.2] mEq/L; P = 0.0095). Baseline potassium levels were similar between the groups. Conclusion Administration of reduced-dose IV insulin for treatment of hyperkalemia was significantly less effective in lowering serum potassium levels and did not decrease prevalence of hypoglycemia. When accounting for potential confounders, the only variable that was associated with hypoglycemia was pretreatment glucose level.

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2373. Impact of a Change in Testing Strategy for Clostridioides difficile Infection on a Publicly Reported Metric and Treatment Days of Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2051 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S818-S819

Author(s):

Ryan Miller ◽

Jose A Morillas ◽

Joanne Sitaras ◽

Jacob Bako ◽

Elizabeth A Neuner ◽

...

Keyword(s):

Health System ◽

Diagnostic Testing ◽

Cleveland Clinic ◽

Public Reporting ◽

Testing Strategy ◽

Clostridioides Difficile ◽

Days Of Therapy ◽

Before And After ◽

Clostridioides Difficile Infection ◽

The Impact

Abstract Background In an effort to optimize diagnostic testing for Clostridioides difficile infection (CDI) our health system changed from stand-alone PCR testing to a “2-step” approach wherein all positive PCR results reflexed to an EIA. We report the effects of this change on publicly reported CDI metrics and treatment days of therapy (DOT). Methods The setting includes 10 Cleveland Clinic Health System hospitals in northeast Ohio and one in Florida. On June 12, 2018, 9 NE Ohio hospitals changed from PCR alone to PCR followed by EIA. Stand-alone PCR testing remained at one and GDH / EIA / PCR for discordant for another. Testing volumes were obtained from the microbiology laboratory. C. difficile LabID event SIRs were obtained from NHSN. Public reporting interpretative categories were identified based on SIR for second half of 2018. DOT for CDI agents were obtained from an antimicrobial stewardship database. Results Among hospitals that changed strategy the volume of PCR testing and the percent PCR + was similar between time periods. EIA positivity ranged from 23% to 53%. 4/11 hospitals improved their public reporting category: 3/9 that changed testing strategy and 1/2 that did not (Table 1). Two of 3 that changed strategy and improved public reporting also had a decrease in DOT. DOT increased in the 2 hospitals that did not change strategy. Conclusion Six months after adopting a 2-step CDI testing strategy 7 of 9 hospitals had a lower SIR with 3 also demonstrating an improvement in public reporting category favorably impacting reputational and reimbursement risk for our healthcare system. CDI agent DOT was similar before and after the change. The impact of choice of test on publicly reported metrics demonstrates the difficulty of utilizing a proxy for hospital onset CDI, the CDI LabID event, as a measure of quality of care provided. Disclosures All authors: No reported disclosures.

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1039. Forty-eight-hour Antibiotic Time-out: Impact on Antibiotic Duration and Clinical Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.903 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S365-S366

Author(s):

Natasha N Pettit ◽

Palak Bhagat ◽

Cynthia T Nguyen ◽

Victoria J L Konold ◽

Madan Kumar ◽

...

Keyword(s):

Pediatric Patients ◽

Medical Center ◽

Inpatient Setting ◽

Core Element ◽

Time Out ◽

Before And After ◽

Control And Prevention ◽

Quasi Experimental ◽

Tract Infections ◽

The Impact

Abstract Background A core element of the Centers for Disease Control and Prevention Antimicrobial Stewardship standard for the inpatient setting includes a 48-hour antibiotic time-out (ATO) process to reassess antibiotic indication. We implemented an automated alert in the electronic health record (EHR) that identifies patients that have received >=48hours of antibiotic therapy. The alert requires the clinician (physician or pharmacist) to note an indication for continuation or plan for discontinuation. Within the alert, a dashboard was developed to include relevant patient information (e.g., temperature, white blood cell count, microbiology, etc). We sought to evaluate the impact of the ATO alert on the duration of therapy (DOT) of cefepime (CFP), ceftazidime (CTZ) and vancomycin (VAN), for the treatment of pneumonia (PNA) and urinary tract infections (UTI) for adult and pediatric patients. Methods This quasi-experimental, retrospective analysis included adult and pediatric patients that received ≥48 hours of CFP, CTZ, or VAN for UTI or PNA between April 1, 2017 and July 31, 2017 (pre-48H ATO) and October 1, 2018–December 31, 2018 (post-48H ATO). Fields at order-entry to specify an antibiotic indication were not available prior to our EHR interventions. A randomized subset from the Pre-48Hr ATO group was selected for detailed analysis. The primary endpoint was to evaluate the average DOT of CFP/CTZ combined, VAN alone, and the combination of CFP/CTZ/VAN. We also evaluated length of stay (LOS), all-cause inpatient mortality, and 30-day readmissions. Results A total of 157 antibiotic orders (n = 94 patients) were evaluated in the pre-48h ATO group, and 2093 antibiotic orders (n = 521 patients) post-48H ATO group. Pre-48H ATO, 85 patients received CFP/CTZ and 72 VAN. Post-48H ATO, 322 patients received CFP/CTZ and 198 VAN. PNA was the most common indication pre- and post-48H ATO. DOT significantly decreased pre- vs. post-48H ATO (Figure 1). LOS was 2 days shorter (P = 0.01) in the post-48H ATO group, mortality and 30-day readmissions was similar between groups (Table 1). Conclusion Average antibiotic DOT for CFP/CTZ, and VAN significantly decreased following the implementation of the 48H ATO at our medical center. LOS was reduced by 2 days, while mortality and 30-day readmissions were similar before and after. Disclosures All authors: No reported disclosures.

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The impact of a TV report in schizophrenia stigma reduction: A quasi-experimental study

International Journal of Social Psychiatry ◽

10.1177/0020764016688713 ◽

2017 ◽

Vol 63 (3) ◽

pp. 275-277 ◽

Cited By ~ 1

Author(s):

Nathaly de Oliveira Bosoni ◽

Geraldo Busatto Filho ◽

Daniel Martins de Barros

Keyword(s):

Brief Intervention ◽

Social Distance ◽

Mass Communication ◽

Long Term Effects ◽

Stigma Reduction ◽

The Social ◽

Before And After ◽

Quasi Experimental ◽

The Impact

Background: Stigma is a major problem in schizophrenia, and the most effective way to reduce it is to provide information. But literature lacks studies evaluating long-term efficacy of mass communication. Aims: This is a pilot study to assess if a brief intervention (TV report) may have long-term effects. Method: Assessing stigma scores from subjects before and after seeing a vignette. Results: We found that the social distance and restriction to patients not only fell after a brief intervention but also kept lower after 1 and 3 months. Conclusion: We conclude that even brief intervention may create persistent impact in reducing discrimination.

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Transit-oriented economic development: The impact of light rail on new business starts in the Phoenix, AZ Region, USA

Urban Studies ◽

10.1177/0042098017724119 ◽

2017 ◽

Vol 55 (13) ◽

pp. 2838-2862 ◽

Cited By ~ 15

Author(s):

Kevin Credit

Keyword(s):

Service Sector ◽

Interrupted Time Series ◽

Light Rail ◽

Initial Increase ◽

New Business Formation ◽

Before And After ◽

New Business ◽

Quasi Experimental ◽

And Control ◽

The Impact

This article examines the impact of Phoenix’s light rail system, which opened in 2008, on new firm formation in specific industries. Individual business data from 1990–2014 are used in a quasi-experimental adjusted-interrupted time series (AITS) regression to compare the impact of the transit system’s construction on new business starts in ‘treatment’ and ‘control’ areas before and after the opening of the line. Findings show that the transit adjacency is worth an 88% increase in knowledge sector new starts, a 40% increase in service sector new starts and a 28% increase in retail new starts at the time the system opened, when compared with automobile-accessible control areas. However, the light rail also appears to suffer from a ‘novelty factor’– after the initial increase in new establishment activity in adjacent block groups, the effect diminishes at the rate of 8%, 6% and 7% per year, respectively. The results also provide insight into the spatial extent of light rail impacts to new business formation, with areas 1 mile from stations observing 21% fewer retail new business starts and 12% fewer knowledge sector new starts than areas within a quarter of a mile of stations.

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Effect of liver resection-induced increases in hepatic venous pressure gradient on development of postoperative acute kidney injury

BMC Nephrology ◽

10.1186/s12882-021-02658-7 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Christian Reiterer ◽

Alexander Taschner ◽

Florian Luf ◽

Manfred Hecking ◽

Dietmar Tamandl ◽

...

Keyword(s):

Liver Resection ◽

Venous Pressure ◽

Portal Pressure ◽

Kidney Injury ◽

Renin Angiotensin System ◽

Plasma Renin ◽

Secondary Outcome ◽

Before And After ◽

The Impact ◽

Postoperative Aki

Abstract Background The impact of changes in portal pressure before and after liver resection (defined as ΔHVPG) on postoperative kidney function remains unknown. Therefore, we investigated the effect of ΔHVPG on (i) the incidence of postoperative AKI and (ii) the renin-angiotensin system (RAAS) and sympathetic nervous system (SNS) activity. Methods We included 30 patients undergoing partial liver resection. Our primary outcome was postoperative AKI according to KDIGO criteria. For our secondary outcome we assessed the plasma renin, aldosterone, noradrenaline, adrenaline, dopamine and vasopressin concentrations prior and 2 h after induction of anaesthesia, on the first and fifth postoperative day. HVPG was measured prior and immediately after liver resection. Results ΔHVPG could be measured in 21 patients with 12 patients HVPG showing increases in HVPG (∆HVPG≥1 mmHg) while 9 patients remained stable. AKI developed in 7/12 of patients with increasing HVPG, but only in 2/9 of patients with stable ΔHVPG (p = 0.302). Noradrenalin levels were significantly higher in patients with increasing ΔHVPG than in patients with stable ΔHVPG. (p = 0.009). Biomarkers reflecting RAAS and SNS activity remained similar in patients with increasing vs. stable ΔHVPG. Conclusions Patients with increased HVPG had higher postoperative creatinine concentrations, however, the incidence of AKI was similar between patients with increased versus stable HVPG.

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Excess Body Mass—A Factor Leading to the Deterioration of COVID-19 and Its Complications—A Narrative Review

Viruses ◽

10.3390/v13122427 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2427

Author(s):

Weronika Gryczyńska ◽

Nikita Litvinov ◽

Bezawit Bitew ◽

Zuzanna Bartosz ◽

Weronika Kośmider ◽

...

Keyword(s):

Body Mass ◽

Kidney Injury ◽

Nasopharyngeal Swab ◽

Ischemic Complications ◽

Prevalence Of Obesity ◽

Health Quality ◽

Obese Subjects ◽

Acid Test ◽

The Impact

Currently, the world is facing two serious pandemics: obesity and COVID-19. It is well-established that the prevalence of obesity has risen dramatically, causing a deterioration in the health quality of the population and increasing susceptibility for the unfavourable course of acute infections. It has been observed that excess body mass significantly influences the COVID-19 outcome. The aim of this review is to present the latest scientific reports on the impact of excess body mass on the course and complications of COVID-19. The Web of Science, PubMed, and Google Scholar databases were searched. Only studies reporting patients stated to be COVID-19 positive based on the results of a nasopharyngeal swab and the ribonucleic acid test were included. It is shown that thromboembolic and ischemic complications, namely stroke, disseminated intravascular coagulation, severe hyperglycaemia, and leukoencephalopathy are more likely to appear in COVID-19 positive patients with obesity compared to non-obese subjects. COVID-19 complications such as cardiomyopathy, dysrhythmias, endothelial dysfunction, acute kidney injury, dyslipidaemia, lung lesions and acute respiratory distress syndrome have a worse outcome among obese patients.

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