Use of lipoglycopeptides for moderate to severe ABSSSI in the emergency department.

The burden of acute bacterial skin and skin structure infections (ABSSSI) continue to plague the healthcare system. One approach to managing moderate-to-severe ABSSSI in low-risk patients involves use of a single dose lipoglycopeptide (LGP), dalbavancin or oritavancin, in the emergency department (ED) and discharge to home with follow-up care. Limited ED studies indicate decreased hospital stays, ED revisits, readmissions, and healthcare costs, as well as improved patient satisfaction with use of these antibiotics. However, existing literature has limitations and gaps, such as insufficient quantifiable data on patient selection criteria, outcome predictors, and risk factors leading to treatment failure. Moreover, there is lack of research on the impact of LGPs on organizational productivity, patient quality of life, and utility in indications beyond ABSSSI. This review focuses on the role of long-acting LGPs in the ED setting for select patients presenting with ABSSSI, aiming to avoid hospitalizations, expedite patient discharge, and prevent readmissions while acknowledging potential limitations of therapy. Additionally, it provides insights into strategies and considerations specifically relevant to implementing this therapeutic approach in the ED.

Impact of clinical decision support on oritavancin prescribing in the emergency department.

BACKGROUND: Emergency department (ED) visits and hospitalizations from skin and soft tissue infections (SSTIs) have been on the rise and have led to an increased clinical and economic burden. Owing to their single-dose regimen, recently approved lipoglycopeptides such as oritavancin have the potential to shift the management of SSTIs from an inpatient to outpatient setting. Limited data exist regarding the use of these drugs in the ED setting. OBJECTIVES: The purpose of this study was to describe the impact that clinical decision support (CDS) incorporation into the computerized physician order entry (CPOE) system had on oritavancin use and to assess compliance with appropriate use guidelines in the ED. METHODS: This was a retrospective cohort study evaluating patients who received oritavancin from September 2016 to May 2018. The patients were assigned to the pre-CDS-implementation group if oritavancin was used between September 13, 2016, and June 28, 2017 and to the post-CDS-implementation group if oritavancin was used between August 28, 2017, and May 25, 2018. There was a 2-month transition period between the 2 study time periods. Patients were excluded if the administration occurred outside of the ED or during the transition period. The primary endpoints were oritavancin use and compliance with the appropriate use guidelines after the implementation. RESULTS: There were 169 oritavancin orders in total, of which 119 met the inclusion criteria. There was a marked decrease in use post-CDS implementation (9.2 orders/mo vs. 3 orders/mo). Among those who were prescribed oritavancin, compliance with the appropriate use guidelines increased; however, this did not reach statistical significance. CONCLUSION: The implementation of the appropriate use guidelines with CDS integration into the CPOE system decreased overall oritavancin use but did not have an impact on compliance with the appropriate use guidelines.

New Avenues for Antimicrobial Stewardship: The Case for Penicillin Skin Testing by Pharmacists.

It is well-appreciated that patients with documented penicillin allergies often receive broader-spectrum antibiotics. This practice has been associated with increased antimicrobial resistance and cost. In recent years, considerable efforts have been made to spread awareness on the implications of self-reported penicillin allergies. The use of penicillin skin testing to evaluate for true allergies has been strongly recommended by major organizations for decades. However, testing remains underutilized. Current literature has suggested various models of incorporating penicillin allergy screening and testing by different healthcare practitioners (ie, physicians, allergists, nurses, pharmacists). We suggest broader adoption for the role of pharmacists in the provision of penicillin skin testing. This would help expand the service and maximize the potential benefits of penicillin skin testing.

Meropenem-vaborbactam for the treatment of complicated urinary tract infections including acute pyelonephritis.

INTRODUCTION: Meropenem-vaborbactam is a new beta-lactam/beta-lactamase inhibitor combination that combines a carbapenem antibiotic with a first-in-class, boronic acid pharmacophore, serine beta-lactamase inhibitor which has potent inhibitory activity against class A carbapenemases, especially Klebsiella pneumoniae carbapenemases (KPC), in addition to other class A and class C beta-lactamases. The US Food and Drug Administration has recently approved meropenem-vaborbactam for the treatment of adult patients with complicated urinary tract infections including acute pyelonephritis. Areas covered: A PubMed search was performed to gather the most current and relevant articles regarding meropenem-vaborbactam. In this review the authors discuss the chemistry, mechanism of action, pharmacokinetics, pharmacodynamics, antimicrobial spectrum, and efficacy and safety of meropenem-vaborbactam for the treatment of complicated urinary tract infections including acute pyelonephritis Expert opinion: Although meropenem-vaborbactam is approved for treatment for complicated urinary tract infections including acute pyelonephritis, it is unlikely, at this point, to be utilized widely beyond cases that are caused by KPC-producing Enterobacteriaceae. It may also be a potential treatment option for complicated urinary tract infections caused by KPC-producing Enterobacteriaceae that are resistant to ceftazidime-avibactam. Long-term safety data with this novel beta-lactamase inhibitor is still needed although early data suggests that it will be safe and well tolerated.