1219. Unfavorable Clinical Outcomes with Polymyxins Compared to Ceftolozane/Tazobactam for the Treatment of Carbapenem-Resistant Pseudomonas aeruginosa

Background Patients with carbapenem-resistant Pseudomonas aeruginosa (CRPA) have high in-hospital mortality rates. It is unknown if patients with CRPA treated with ceftolozane/tazobactam (C/T) have improved clinical outcomes compared to those treated with polymyxins. Methods The CDC-funded, Georgia Emerging Infections Program performed active population- and laboratory-based surveillance for CRPA isolated from sterile sites, urine, lower respiratory tract and wounds in metropolitan Atlanta, GA from 8/1/2016–7/31/2018. We reviewed charts of adults without cystic fibrosis who were hospitalized within 1 week of CRPA culture. Using a desirability of outcome ranking (DOOR) analysis which incorporates both benefits and risks into a single outcome, we estimated the probability that a patient treated first with C/T would have a more desirable clinical outcome at 30-days than a patient treated with polymyxins (polymyxin B or colistin). We adjusted for confounding using inverse probability of treatment weighting (IPTW) based on culture source and need for dialysis at baseline. A partial credit analysis allowed for variable weighting of DOOR ranks and calculation of differences in mean partial credit scores. Results Among 710 cases from 18 different hospitals, we identified 73 patients treated for CRPA infections with polymyxins (n=31) or C/T (n=42). Most patients were male (64%) and Black (80%), and those receiving polymyxins were more likely to have required dialysis at baseline (35% vs. 14%, p=0.03) (Table 1). At 30 days after culture, 34 (47%) were alive with no adverse events, 21 (29%) were alive with ≥ 1 adverse event, and 18 (25%) had died. Patients first treated with C/T had a lower 30-day mortality rate than those treated with polymyxins (14% vs 39%, p=0.03). Additionally, those receiving C/T had better overall clinical outcomes, with an adjusted DOOR probability of having an improved outcome of 67% (95% CI 53%–80%) compared to those receiving polymyxins (Figure 1). Partial credit analyses indicated consistent results across different patient values of survival with adverse events (Figure 2). Figure 1: Inverse probability of treatment weighting-adjusted desirability of outcome ranking (DOOR) distributions by treatment group, accounting for adverse events and survival status that occurred up to 30 days after CRPA culture. 1. Percentages are adjusted using inverse probability of treatment weighting, controlling for culture source and need for dialysis at baseline 2. Adverse events measured included: acute kidney injury, discharge to higher acuity location than previous residence, or being hospitalized 30 days after culture Figure 2: Inverse probability of treatment weighting-adjusted partial credit analysis. This displays the difference (ceftolozane/tazobactam minus polymyxin) in mean partial credit scores (black line) and associated 95% confidence bands (gray lines) as a function of the partial credit score assigned to an individual having at least one adverse event (range 0 – 100%). A score of 100% is assigned to patients alive with no adverse events and a score of 0% is assigned to patients who die. A difference in mean partial credit scores of approximately zero suggests there was no difference observed between treatment groups. Conclusion These findings support the recent Infectious Diseases Society of America guidance favoring C/T over polymyxins for treatment of CRPA infections. Disclosures David van Duin, MD, PhD, Entasis (Advisor or Review Panel member)genentech (Advisor or Review Panel member)Karius (Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Pfizer (Consultant, Advisor or Review Panel member)Qpex (Advisor or Review Panel member)Shionogi (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member)Utility (Advisor or Review Panel member) Scott R. Evans, PhD, Abbvie (Consultant)Advantagene (Consultant)Alexion (Consultant)Amgen (Consultant)AstraZeneca (Consultant)Atricure (Consultant)Breast International Group (Consultant)Cardinal Health (Consultant)Clover (Consultant)FHI Clinical (Consultant)Genentech (Consultant)Gilead (Consultant)Horizon (Consultant)International Drug Development Institute (Consultant)Lung Biotech (Consultant)Microbiotix (Consultant)Neovasc (Consultant)Nobel Pharma (Consultant)Novartis (Consultant)Nuvelution (Consultant)Pfizer (Consultant)Rakuten (Consultant)Roche (Consultant)Roivant (Consultant)SAB Biopharm (Consultant)Shire (Consultant)Stryker (Consultant)SVB Leerink (Consultant)Takeda (Consultant)Teva (Consultant)Tracon (Consultant)Vir (Consultant)

SISTEM PENENTUAN PEMBERIAN PINJAMAN DANA PADA KOPERASI SIMPAN PINJAM MENGGUNAKAN METODE SIMPLE ADDITIVE WEIGHTING

In providing loans, cooperatives have stages that must be passed before credit is decided to be disbursed. The aim is to facilitate cooperatives in assessing the feasibility of a credit application. The loan eligibility assessment is carried out with many assessment criteria including employment, income, capital/shares, number of dependents, and house status. Analysis of loan eligibility requires the accuracy of a credit analyst in analyzing credit applicants submitted by members. If the credit analysis is not precise, then the provision of credit funds can be difficult and even make a loss. So to determine whether a loan application can be accepted or not, of course, cooperative management has many multi-criteria considerations. In this study, an analysis was carried out using the Simple Additive Weighting method to facilitate the process of making feasibility decisions and eliminating lending to prospective debtors. The results of the study show that the results of the calculation of the determination of lending funds to members of savings and loan cooperatives using the simple additive weighting method can show alternatives that are eligible to receive loans with a preference value >= 60% and also alternatives that are not eligible to receive loans, namely with a preference value of <= 60%.

ANALISIS PEMBERIAN KREDIT PADA PT.BANK PERKREDITAN RAKYAT SAMUDERA PAINAN

The purpose of this study was to determine the implementation of credit at PT. Bank Perkreditan Rakyat Samudera Painan. The research method used is a qualitative data analysis method. The result described how credit distribution, credit growth, and credit collectibillity. The result of this study found that the granting of credit at PT. Bank Perkreditan Rakyat Samudera Painan has several stages namely, credit application stage, credit analysis stage, credit decision stage, credit contract stage and credit disbursement stage.

PELAKSANAAN KREDIT PADA PT. BPR LENGAYANG

The purpose of this study was to determine the implementation of lending at PT.BPR Lengayang. To analyze the research data, the author uses qualitative data analysis methods as a research method that describes descriptively the implementation of lending at PT. BPR Lengayang. Credit is the capacity to make a purchase or carry out a loan with the promise of payment to be made or deferred within an agreed period of time. In the implementation of lending to PT. BPR Lengayang has several stages, namely the credit application stage, credit analysis, credit approval stage, signing credit / agreement, disbursement stage, customer business supervision, credit repayment

Pelaksanaan Pemberian Kredit Pada Bank Nagari Sumatera Barat

The purpose of this study was to find out how the implementation of giving credit to the Bank Nagari west Sumatra. In analyzing the data, qualitative data analysis was used as a research methods that explained descriptively. The results of the study conclude that in the implementation of lending must go through several prosedures that must be met by customers, namely: credit application, credit analysis, credit approval, credit contract and credit search. arter the signing of the contract, the customer must carry out all agreement, which are binding and cannot be contested

Aktivitas Pemberian Kredit Usaha Pada PT. Bank Perkreditan Rakyat (BPR) Batang Tarusan

The purpose of this study was to determine how credit management at PT. Bank Perkreditan Rakyat Batang Tarusan in the 2015-2019 period. The research method used is a qualitative method. The results of the discussion of the Activities of Business Loans at PT. Bank Perkreditan Rakyat Batang Tarusan in accordance with established procedures, starting from credit applications, credit application analysis, credit application surveys, credit analysis, loan cammites (decision makers), credit contracts, credit disbursement and credit supervision

Aktivitas Pemberian Kredit Pada Bank Nagari Cabang Painan

The purpose of this study was to find out how to provide credit at Bank Nagari Cabang Painan. The research method of data collection uses two methods, namely library research and field research. The results of this study are the implementation of lending at Bank Nagari Cabang Painan in accordance with established procedures, starting from credit applications, credit analysis, recommendations, credit decisions, signing credit contracts, credit realization and credit supervision. The development of credit at the Bank Nagari Cabang Painan has increased every year this is due to the excellent financial performance of the Bank Nagari Cabang Painan.

Factors and Benefits that Affect Lender's Interest in Giving Loans in Peer to Peer (P2P) Lending Platform

Financial technology (fintech) is a combination of the financial industry and technology. One of the uses of fintech is the Peer to Peer (P2P) lending platform, which is a funding channel. This platform is an investment alternative that can increase borrowers' and investors' prosperity. However, P2P also has a high risk that must be considered. Lenders or investors must conduct a loan application feasibility study before giving a loan. The research examined the impact of Character, Capital, Capacity, Collateral (4C) and the benefits that lenders received, as well as the benefits of fintech on lenders' interest in placing their funds on the P2P lending platform. Data were obtained from questionnaires distributed to P2P lending users. The sampling technique was purposive sampling. The total number of respondents who returned the questionnaire was 70 respondents. However, only 53 data could be used in the research. Then, the data were analyzed using Moderated Regression Analysis (MRA). The results show that the 4C factors do not significantly affect the lenders' interest in giving loans. Meanwhile, the benefits and fintech have a significant direct impact. Fintech cannot act as a moderator variable in this model. P2P companies must provide complete information and credit analysis regarding borrowers' conditions to reduce lenders' potential risk.