Vaccinations in asplenic adults.

PURPOSE: The recommended immunizations for adult asplenic patients are reviewed. SUMMARY: Patients without a spleen are at risk of developing overwhelming postsplenectomy infections due to encapsulated organisms, mainly pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib). Due to the high mortality rates associated with these infections, vaccinations are recommended as a preventive measure. It is challenging to ensure optimal immunizations in these high-risk patients due to the number of recommended vaccines, the availability of multiple formulations, and the inability to administer specific formulations at the same time, as well as differences in subsequent vaccine administration schedules. Pharmacists play a key role in recommending specific vaccines and timing for these patients in order to achieve the most robust immune response. This article reviews the specific recommendations for pneumococcal, meningococcal, Hib, and influenza vaccinations in asplenic patients. CONCLUSION: In order to prevent potentially life-threatening infections, asplenic individuals should be vaccinated against S. pneumoniae, N. meningitidis, Hib, and influenza. The optimal timing of vaccination in relation to splenectomy depends on the nature of the splenectomy.

Administration of Extended Infusion Piperacillin-TazobactamWith the Use of Smart Pump Technology.

BACKGROUND: For beta-lactams, the parameter that best predicts bacterial killing is the length of time the antibiotic concentration exceeds the minimum inhibitory concentration (MIC). Studies have demonstrated improved outcomes with extended infusion (4-hour) piperacillin-tazobactam (P-TZ) compared with traditional immediate infusions. OBJECTIVES: To describe how one institution made the conversion from immediate infusion of P-TZ to a 4-hour extended infusion utilizing an approved automatic therapeutic substitution, staff education, and smart pump technology, and to examine the impact of this conversion on patient length of stay and pharmacy costs. METHODS: With approval from the Pharmacy and Therapeutics (P&T), Antimicrobial Stewardship, and Medical Executive Committees, the decision was made to automatically convert all P-TZ orders to a standardized 4-hour infusion given every 8 to 12 hours depending on renal function. The medical records of all adult patients receiving P-TZ during 12 months pre implementation and 24 months post implementation of a 4-hour extended infusion of P-TZ were retrospectively analyzed for length of stay and mortality. The cost of P-TZ was also assessed during these time periods. RESULTS: With the help of smart pump technology, our institution successfully completed a conversion to 4-hour extended infusion P-TZ. Through this conversion, pharmacy expenditure of P-TZ was reduced by 38%; the total cost savings was $387,980.62 for the 24-month postintervention phase. Extended infusion P-TZ reduced hospital length of stay by 0.6 days (P < .05), resulting in an additional cost savings of $1,689,480 for the 24-month postintervention phase. A conservative estimate of total cost savings to the hospital in the first 24 months, including the reduction in P-TZ expenditures, was $2,077,460.