Considerations for implementation of vancomycin Bayesian software monitoring in a level IV NICU population within a multisite health system.

PURPOSE: The updated 2020 vancomycin therapeutic drug monitoring guideline advocates for area under the curve (AUC)-based monitoring in neonates, preferably with Bayesian estimation. This article describes the selection, planning, and implementation of vancomycin model-informed precision dosing (MIPD) software with Bayesian estimation in the neonatal intensive care unit (NICU) within an academic health system. SUMMARY: The selection, planning, and implementation of vancomycin MIPD software was completed in approximately 6 months throughout a health system with multiple NICU sites. The chosen software captures data on medications in additional to vancomycin, provides analytics support, includes specialty populations (eg, neonates), and offers the ability to integrate MIPD into the electronic health record. Pediatric pharmacy representatives served on a system-wide project team with key responsibilities including development of educational materials, drafting changes to policies and procedures, and assistance with department-wide software training. Additionally, pediatric and neonatal pharmacist super users trained other pediatric pharmacists on software functionality, were available the week of go-live for in-person support, and contributed to the identification of pediatric and NICU-specific nuances related to software implementation. Neonatal-specific considerations when implementing MIPD software include: the selection of appropriate pharmacokinetic model(s), continued evaluation of such model(s), selection of appropriate model(s) in infants as they age, input of significant covariates, determination of the site-specific serum creatinine assay, decision of the number of vancomycin serum concentrations obtained, discernment of patients excluded from AUC monitoring, and the utilization of actual versus dosing weight. CONCLUSION: This article serves to share our experience with selecting, planning, and implementing Bayesian software for vancomycin AUC monitoring in a neonatal population. Other health systems and children's hospitals can utilize our experience to evaluate a variety of MIPD software and consider neonatal nuances prior to implementation.

Fidaxomicin Use in the Pediatric Population with Clostridioides difficile.

Clostridioides difficile infection (CDI) remains a devastating infection both in hospital settings and in the community. While a number of antibiotics have anti-C. difficile activity, fidaxomicin is unique as a minimally absorbed antibiotic with narrow spectrum of activity. These features make it an appealing option for pediatric CDI to balance safety and efficacy. The purpose of this structured review was to outline the clinical evidence for safety and efficacy of fidaxomicin for pediatric CDI. A structured literature search was performed to identify relevant clinical data. Fidaxomicin is similarly effective to oral vancomycin with a lower rate of recurrent CDI. There were no serious safety signals reported with fidaxomicin. In conclusion, fidaxomicin is a safe and effective treatment option for pediatric CDI.

Early clinical trial data and real-world assessment of COVID-19 vaccines: Insights from the Society of Infectious Diseases Pharmacists.

As of August 2021, there were three COVID-19 vaccines available in the United States for the prevention of coronavirus 2019 (COVID-19). The purpose of this narrative review is to examine the early experience from the Emergency Use Authorization (EUA) of BNT162b2 (Pfizer, Inc./BioNTech), mRNA-1273 (Moderna, Inc.), and Ad26.COV2.S (Johnson and Johnson/Janssen Global Services, LLC) through July 2021. The EUA data from the clinical trials have largely been corroborated by real-world effectiveness investigations post-authorization. These studies indicate that immunity is obtained within 2 weeks post-vaccination and may endure for 6 months. The immunity conferred by the vaccines may also be effective against SARS-CoV-2 variants of concern. Additionally, populations not included in the emergency use authorization studies may also benefit from vaccination. This look back at the initial clinical experience can be used by the global community to inform and develop COVID-19 vaccine programs.

Validation of a Community-Acquired Pneumonia Score To Improve Empiric Antibiotic Selection at an Academic Medical Center.

The 2019 American Thoracic Society and the Infectious Diseases Society of America community-acquired pneumonia (CAP) guidelines recommend that drug-resistant pathogens (DRP) be empirically covered if locally validated risk factors are present. This retrospective case-control validation study evaluated the performance of the drug resistance in pneumonia (DRIP) clinical prediction score. Two hundred seventeen adult patients with ICD-10 (https://www.who.int/classifications/classification-of-diseases) pneumonia diagnosis, positive confirmed microbiologic data, and clinical signs and symptoms were included. A DRIP score of ≥4 was used to assess model performance. Logistic regression was used to select for significant predictors and create a modified DRIP score, which was evaluated to define clinical application. The DRIP score predicted pneumonia due to a DRP with a sensitivity of 67% and specificity of 73%. The area under the receiver operating characteristic (AUROC) curve was 0.76 (95% confidence interval [CI], 0.69 to 0.82). From regression analysis, prior infection with a DRP and antibiotics in the last 60 days, yielding scores of 2 points and 1 point, respectively, remained local risk factors in predicting drug-resistant pneumonia. Sensitivity (47%) and specificity (94%) were maximized at a threshold of ≥2 in the modified DRIP model. Therefore, prior infection with a DRP remained the only clinically relevant predictor for drug-resistant pneumonia. The original DRIP score demonstrated a decreased performance in our patient population and behaved similarly to other clinical prediction models. Empiric CAP therapy without anti-methicillin-resistant Staphylococcus aureus and antipseudomonal coverage should be considered for noncritically ill patients without a drug resistant pathogen infection in the past year. Our data support the necessity of local validation to authenticate clinical risk predictors for drug-resistant pneumonia.

A Case of Ignatzschineria indica Bacteremia following Maggot Colonization.

Ignatzschineria indica is a Gram-negative bacterium that is commonly associated with the larvae of flesh flies. I. indica is difficult to isolate in routine laboratory procedures but has been associated with neglected wounds infested with maggots, fever, elevated white blood count and C-reactive protein, and polymicrobial culture results. Other specific hematological/immunological changes are not known. We present a case of I. indica bacteremia and polymicrobial osteomyelitis resulting from infected decubitus ulcers. The patient improved after treatment with cefepime followed by levofloxacin.