Evaluating hop extract concentrations found in commercial beer to inhibit Streptococcus mutans biofilm formation.

AIMS: The purpose of this study was to compare the effect of hop extracts with diverse ß-acid concentrations on Streptococcus mutans biofilm formation. METHODS AND RESULTS: Ten different hop extracts, with α-acid concentrations similar to those found in commercial beer products and ß-acid concentrations ranging from 2.6 to 8.1%, were added to distilled water to make standardized concentrations. S. mutans isolates were treated with hop extract dilutions varying from 1:2 to 1:256. The minimum inhibitory, minimum bactericidal and minimum biofilm inhibitory concentrations were determined and the optical density was evaluated. Live/dead staining confirmed the bactericidal effects. Biofilm formation of several strains of S. mutans was significantly inhibited by hop extract dilutions of 1:2, 1:4, 1:8, 1:16 and 1:32. Strong negative correlations were observed between α- and ß-acid concentrations of the hop extracts and S. mutans total growth and biofilm formation. CONCLUSIONS: The use of hop extracts prepared similarly to commercial beer decreased S. mutans biofilm formation. SIGNIFICANCE AND IMPACT OF THE STUDY: The inclusion of hops in the commercial beer products may provide beneficial health effects. Further studies are warranted to determine an effect in vivo on the development of dental caries.

Implementation of EMR-based standardized antibiotic desensitization protocols and its impact on providers.

Background: As desensitization protocols become more readily available and published, more institutions are implementing them and searching for ways to streamline the process. There have been no published studies to date on the effect that electronic medical record systems (EMR) have on the safety and efficiency of ß-lactam antibiotic desensitization. Objective: The purpose of this study was to evaluate the changes in workflow, efficiency, and medical errors after implementation of ß-lactam antibiotic desensitization. Methods: A collaborative effort between the Allergy/Immunology Division and the Pharmacy Department led to the creation and implementation of antibiotic desensitization order sets. Pre- and postimplementation of ß-lactam antibiotic surveys were sent to pharmacists and allergy/immunology fellows and attendings at a single-center tertiary care center. Results: There were only 26 valid respondents (12.3%) to both the pre- and postimplementation surveys. The percentage of respondents who thought that the time needed to prepare desensitization materials was < 4 hours increased from 23% to 77% (p < 0.001). The percentage of respondents who thought that the time needed to input electronic desensitization orders was < 1 hour increased from 19% to 54% (p = 0.002). The percentage of respondents who identified zero errors increased from 42% to 92% (p = 0.001). The perception of the overall desensitization process efficiency significantly increased (p < 0.001). Conclusion: Creation of standardized electronic ß-lactam antibiotic desensitization order sets significantly decreased the time taken to order and prepare materials and increased overall efficiency.

Modifiable Risk Factors Associated With Disposal of Unused Prescription Drugs by Parents of Adolescents.

The safe disposal of unused medications is one primary prevention strategy to reduce nonmedical prescription drug use among adolescents. We sought to identify modifiable risk factors associated with disposal of unused prescription drugs by parents of adolescents residing in ten south central Kentucky counties with disposal programs. In the fall of 2017, 4148 parents of adolescents participated in an anonymous, paper-based survey. We conducted generalized logit mixed models adjusted for within-school clustering to assess the relationship between disposal behaviors and modifiable risk factors while controlling for respondents' sociodemographic characteristics. The analytic sample consisted of parents in households in which someone had been prescribed an opioid medication within the past 12 months (N = 627). Our findings indicated that almost 42% of parents reported disposing of unused prescription medication within the past 12 months, and the majority disposed of medications at home rather than using a disposal program. Parents who perceived that any, compared to none, of their child's close friends engaged in nonmedical prescription opioid use had higher odds of reporting use of a disposal program. Parents who were aware of disposal programs, compared to those who were not aware, had greater odds of using them, rather than not disposing at all or disposing unused prescription medications at home. Compared to parents who perceived prescription drugs to be hard for adolescents to obtain for nonmedical use, parents who believed that prescription drugs were easily accessible to adolescents for nonmedical use had lower odds of using disposal programs than disposing of medications at home. Collectively, our findings suggest that enhancing awareness of disposal programs, while addressing parents' perceptions of their children's peers' use of nonmedical prescription opioids, should be considered to facilitate the disposal of unused medications and optimize current public health prevention efforts related to adolescent nonmedical use of these drugs.

Power of the Peer and Parent: Gender Differences, Norms, and Nonmedical Prescription Opioid Use Among Adolescents in South Central Kentucky.

This study examined risk factors of nonmedical prescription opioid use (NMPOU) among adolescents and how risk factors differ by gender. In the fall of 2017, adolescents attending 6th through 12th grades across 44 schools in 10 south central Kentucky counties were invited to participate in an anonymous, school-based survey. A total of 11,761 adolescents completed the survey. Logistic regression was conducted to examine the association between NMPOU and constructs of the Theory of Reasoned Action (i.e., attitudes and subjective norms), descriptive norms (i.e., peer use), and parental control of prescription medications in the home. There were 297 (2.7%) adolescents who reported NMPOU in the past 12 months. In the adjusted multivariate logistic regression model, for both males and females, the adolescents who perceived that more of their peers engaged in NMPOU were significantly more likely to endorse NMPOU, whereas male and female adolescents who perceived their peers disapproved of use were significantly less likely to report NMPOU. Parent disapproval was significantly associated with decreased NMPOU for females only. Moderated regression analyses revealed that gender moderated the relationship between parental disapproval and NMPOU. We found that during adolescence, NMPOU is influenced by peer norms for both genders and parental norms for females. These results indicate that prevention efforts should focus on changing adolescents' peer and parental norms related to NMPOU.

Disposal of prescription drugs by parents of middle and high school students.

To determine how parents dispose of unused prescription medications and correlates of disposal, we recruited 3,043 parents of adolescents to complete a survey. Multivariate and multinomial logistic regression was conducted to examine correlates of disposal of prescription medication. Only 17.8% of parents in a household prescribed a controlled medication in the past year disposed of unused medications. Of those, 36.7% used organized disposal (e.g., take-back event or drop box) and 63.3% disposed of medications at home. Organized disposal was associated with awareness of disposal opportunities. Increasing awareness of organized disposal opportunities is a promising mechanism to increase their use by parents.

From dispensed to disposed: evaluating the effectiveness of disposal programs through a comparison with prescription drug monitoring program data.

BACKGROUND: Organized disposal of controlled medications, such as take-back events and permanent drug donation boxes, is a prevention strategy that has been widely used to reduce the availability of controlled medications for diversion or abuse. However, little is known as to whether this strategy actually reduces the overall availability of these medications for the purposes of diversion or abuse. OBJECTIVES: The objective of this study was to compare the number and types of controlled medications that were disposed through organized efforts to the number dispensed in local communities. METHODS: The quantity and type of controlled medication collected from three take-back events and permanent drug donation boxes over 4-week-long periods in five counties in south-central Kentucky was measured and compared to the number of controlled medications dispensed, as reported by Kentucky All Schedule Prescription Electronic Reporting system. RESULTS: In 2013, 21,121,658 controlled medications units were dispensed in the participating counties. Of those, 46.9% were opioid analgesics, 13.1% tranquilizers, and 37.3% "other." During the assessment periods, a total of 21,503 controlled medication units were collected. Of those, 39.9% were opioid analgesics, 2.7% tranquilizers, and 57.4% "other." Annually, controlled medications disposed were estimated to account for 0.3% of those dispensed. CONCLUSION: Controlled medications collected by take-back events and permanent drug donation boxes constituted a miniscule proportion of the numbers dispensed. Our findings suggest that organized drug disposal efforts may have a minimal impact on reducing the availability of unused controlled medications at a community level.

Association of vancomycin-induced acute kidney injury with trough versus AUC monitoring in patients receiving extended durations of therapy.

Objective: Vancomycin therapy is associated with an increased risk of acute kidney injury (AKI). Previous studies suggest that area under the curve (AUC) monitoring reduces the risk of AKI, but literature is lacking to support this in patients receiving longer durations of vancomycin therapy. Design: Retrospective cohort study. Method: Patients ≥18 years old, admitted between August 2015 and July 2017 or October 2017 and September 2019, and received at least 14 days of intravenous (IV) vancomycin therapy were included in the study. Our primary outcome was the incidence of AKI between trough monitoring and AUC monitoring groups using Kidney Disease Improving Global Outcomes criteria. Secondary outcomes included inpatient mortality, median inpatient length of stay, and median intensive care unit length of stay. Results: Overall, 582 patients were included in the study, with 318 patients included in the trough monitoring group and 264 included in the AUC monitoring group. The median duration of vancomycin therapy was 23 days (interquartile range, 16-39). Patients within the trough monitoring group had a higher incidence of AKI compared to the AUC monitoring group (45.6% vs 28.4%, p < 0.001). Furthermore, logistic regression analysis showed that AUC monitoring was associated with a 54% lower incidence of AKI (OR 0.46, 95% CI [0.31-0.69]). All-cause inpatient mortality was numerically higher in the trough monitoring group (12.9% vs 8.3%, p = 0.078). Conclusions: In patients who received at least 14 days of IV vancomycin therapy, AUC monitoring was associated with a lower incidence of AKI.

The Intersection of Antimicrobial Stewardship, the Pharmaceutical Industry, and the Federal Legislature.

To mitigate the dangers of inappropriate antimicrobial use leading to increased multidrug-resistant organisms and mortality, antimicrobial stewardship programs have become a mainstay in many health systems. Unfortunately, some pharmaceutical manufacturers simultaneously have ended antimicrobial research and development efforts altogether due to suboptimal return on investments. An optimal and sustainable antimicrobial armamentarium requires a broad alliance between antimicrobial stewardship programs, the pharmaceutical industry, the legislature, and federal and state agencies. Public-private relationships such as the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) and legislative policies creating push and pull incentives, including the Generating Antibiotic Incentives Now (GAIN), Developing an Innovative Strategy for Antimicrobial-Resistant Microorganisms (DISARM), and Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Acts, are each a step in the right direction, but more work remains. Understanding these legislative actions is imperative for all clinicians, as is teamwork from those involved in the antimicrobial field to develop and maintain the life cycle of each drug that harbors societal value.

Pharmacist and physician insight of vancomycin therapeutic drug-monitoring changes.

The updated vancomycin guideline for treatment of serious methicillin-resistant Staphylococcus aureus infections prompted institutions to convert from trough to area-under-the-curve monitoring. The physician perception of the transition, coupled with that of pharmacists, was measured by pre- and postimplementation surveys. Both groups believed safety would be increased without efficacy changes.

Pharmacologic Management of Mycobacterium chimaera Infections: A Primer for Clinicians.

Mycobacterium chimaera, a member of the Mycobacterium avium complex, can cause infections in individuals after open heart surgery due to contaminated heater-cooler units. The diagnosis can be challenging, as the incubation period can be quite variable, and symptoms are nonspecific. In addition to aggressive surgical management, combination pharmacologic therapy is the cornerstone of therapy, which should consist of a macrolide, a rifamycin, ethambutol, and amikacin. Multiple second-line agents may be utilized in the setting of intolerances or toxicities. In vitro susceptibility of these agents is similar to activity against other species in the Mycobacterium avium complex. Drug-drug interactions are frequently encountered, as many individuals have chronic medical comorbidities and are prescribed medications that interact with the first-line agents used to treat M. chimaera. Recognition of these drug-drug interactions and appropriate management are essential for optimizing treatment outcomes.

Δ(1232) axial charge and form factors from lattice QCD.

We present the first calculation on the Δ axial vector and pseudoscalar form factors using lattice QCD. Two Goldberger-Treiman relations are derived and examined. A combined chiral fit is performed to the nucleon axial charge, N to Δ axial transition coupling constant and Δ axial charge.

Pharmacist Survey: Pharmacist Perception of Vancomycin Area Under the Curve Therapeutic Drug Monitoring.

BACKGROUND: Evidence suggests the standard vancomycin trough goal of 15 to 20 mg/L for serious Staphylococcus aureus infections is associated with acute kidney injury, whereas appropriate monitoring of 24-hour area under the curve (AUC) may decrease nephrotoxicity. As a result, institutions have transitioned to AUC monitoring, the predictive pharmacokinetic/pharmacodynamic parameter of vancomycin to improve safety outcomes. However, this method may require increased pharmacist time and effort. Pharmacist perception of the practice change is largely unknown and warrants investigation. METHODS: An electronic survey was disseminated via e-mail to pharmacists 5 months post-AUC implementation. Items of interest were focused on pharmacist perception, including quantity of patients monitored using AUC, justification of the practice change, differences in efficacy and safety, and changes in monitoring time requirements. RESULTS: The pharmacist survey was distributed to 196 pharmacists and 84 responded (43% response rate). Eighty-one pharmacists had monitored patients using AUC methods. Sixty-nine percent of these respondents perceived the change to result in increased or slightly increased patient safety, 27% described no difference, and 4% stated safety was decreased or slightly decreased. Forty-two percent perceived the transition to result in increased or slightly increased efficacy, while 48% noted no difference and 10% responded that efficacy was decreased or slightly decreased. Pharmacists stated the creation of an institutional calculator decreased the time required to calculate AUC. CONCLUSION: After the change to AUC monitoring, pharmacists perceived improvements in safety outcomes while efficacy was at least similar if not increased.

Vancomycin Area Under the Curve Dosing and Monitoring at an Academic Medical Center: Transition Strategies and Lessons Learned.

Due to the inconsistent correlation of vancomycin trough concentrations with 24-hour area under the curve (AUC) and a desire to reduce rates of vancomycin-associated acute kidney injury, an institutional guideline was implemented by the Antimicrobial Stewardship Team in September 2017 to monitor vancomycin using AUC. Three stages were utilized to organize the process: preparation, implementation, and evaluation. The preparation stage was used to present literature to key stakeholders, and pharmacy meetings focused on the development of a dosing and monitoring guideline. Along with institution-wide education, the implementation stage included information technology development and support. The evaluation stage was comprised of quality improvement and clinical research. Future plans include dissemination of the results and analyses. Numerous lessons were learned due to barriers experienced during the process, but the transition was successful.

COVID-19 and Religious Ethics.

The editors of the JRE solicited short essays on the COVID-19 pandemic from a group of scholars of religious ethics that reflected on how the field might help them make sense of the complex religious, cultural, ethical, and political implications of the pandemic, and on how the pandemic might shape the future of religious ethics.

Trimethoprim/Sulfamethoxazole and Moxifloxacin Therapy for a Pediatric Stenotrophomonas Maltophilia Ventriculoperitoneal Shunt Infection.

Stenotrophomonas maltophilia is an increasingly prevalent cause of nosocomial infections. This report describes a 5-month-old male diagnosed with a S maltophilia ventriculoperitoneal shunt infection after a neurosurgical procedure. Intravenous trimethoprim/sulfamethoxazole and moxifloxacin successfully treated the patient. A literature review revealed a scarcity of similar reports, with none using moxifloxacin as an effective concomitant treatment with trimethoprim-sulfamethoxazole.