Clinical Impact of Vancomycin MIC on Outcomes in Patients With Coagulase-negative Staphylococcal Bacteremia.

PURPOSE: Coagulase-negative staphylococci (CoNS) are Gram-positive organisms that are a known component of normal skin flora and the most common cause of nosocomial bacteremia. For CoNS species, the vancomycin MIC breakpoint for susceptibility set by the Clinical and Laboratory Standards Institute is ≤4 µg/mL. There has been published reports of vancomycin heteroresistance in CoNS with vancomycin MICs of 2 to 4 µg/mL. The aim of this retrospective cohort analysis was to assess the clinical impact of vancomycin MICs <2 µg/mL versus ≥2 µg/mL in adult patients with CoNS bloodstream infections. METHODS: Adult patients admitted to University Medical Center New Orleans with a blood culture positive for CoNS were assessed. The primary outcome was difference in 30-day mortality. Secondary outcomes were in-hospital, all-cause mortality; duration of bacteremia; hospital length of stay; and percentage of oxacillin-resistant CoNS. FINDINGS: There was no difference in mortality in the vancomycin MIC <2 µg/mL group versus the vancomycin MIC ≥2 µg/mL group at 30 days (15.4% vs 17.4%; P = 1). In-hospital, all-cause mortality was also not different between groups (11.5% vs 13%; P = 1). Hospital length of stay between groups was 28.2 days versus 21 days (P = 0.692). Median duration of bacteremia was 1 day in both groups (P = 0.975), and median scheduled duration of antibiotic therapy was 14.9 days and 19.5 days (P = 0.385). The source and mode of acquisition of CoNS were similar between groups. Of all CoNS isolates, 58.7% (44 of 75) were oxacillin resistant. Staphylococcus epidermidis was the most common CoNS species at 66.7% (50 of 75). Of all isolates, 30.7% (23 of 75) had a vancomycin MIC ≥2 µg/mL, and 87% (20 of 23) of these were S. epidermidis. There was a higher percentage of S. epidermidis in the vancomycin MIC ≥2 µg/mL group than in the MIC <2 µg/mL group (87% vs 57.7%; P = 0.012). CoNS with a vancomycin MIC ≥2 µg/mL were also more likely to be oxacillin resistant (78.3% vs 50%; P = 0.005). IMPLICATIONS: There was no difference in clinical outcomes in adult patients with a CoNS bloodstream infection with a vancomycin MIC <2 µg/mL versus ≥2 µg/mL. At present, vancomycin remains appropriate empiric therapy for CoNS bloodstream infection. Further research is needed to determine if there is a true clinical impact of a vancomycin MIC ≥2 µg/mL in CoNS infections.

Shared learning experiences: Pilot study of an online exchange project between pharmacy students in South Africa and the United States.

INTRODUCTION: Internationalisation enhances students' understanding of social, cultural, and ethical differences, preparing them to be global-minded, socially accountable healthcare practitioners. Traditionally, internationalisation of education involves international student travel. Online tools provide opportunities for international, peer-driven learning and collaboration without costly travel. This research described the experiences of pharmacy students from South Africa (SA) and the United States (US) that participated in a virtual peer exchange project during the COVID-19 pandemic. METHODS: The virtual peer exchange project allowed students in SA and the US to establish connections within the global pharmacy community and compare healthcare, pharmacy education, and pharmacy practice between the countries. Students engaged in facilitated dialogue through video recordings, video conferencing, and a group discussion board. Student introduction video comments and discussion board posts were thematically analysed. RESULTS: Twenty-one students participated in the pilot project that met some of the intentions and goals of internationalisation via a virtual platform. Two over-arching themes of Practice of Pharmacy and Pharmacy Education emerged from both the introduction video and discussion board comments. Students described lessons learned about similarities and differences in socioeconomic determinants of health as well as structure, functioning, and financing of the different healthcare systems. CONCLUSIONS: This project was a unique way to conduct exchange programmes via a virtual platform, and bypassed challenges of traditional exchange programmes. Through technology, more students in diverse geographic locations can be exposed to various perspectives and healthcare experiences with international students.

Effectiveness of mono antiplatelet therapy vs dual antiplatelet therapy in ischemic stroke or transient ischemic attack-Special subgroup consideration for the African-American Population.

PURPOSE: The purpose of this study is to assess the effectiveness of mono antiplatelet therapy vs dual antiplatelet therapy in reducing recurrent stroke and mortality in patients with ischemic stroke or transient ischemic attack (TIA). A subgroup analysis was conducted to compare outcomes in African-American patients compared with non-African-American patients. METHODS: This is a single-centre, retrospective, chart review, cohort study conducted at the University Medical Center New Orleans (UMCNO), New Orleans, Louisiana. This study includes all patients who are admitted to UMCNO with a diagnosis of ischemic stroke or TIA. The subjects were divided into two groups, patients who received mono antiplatelet therapy and patients who received dual antiplatelet therapy. RESULTS: A total of 762 stroke patients were included in the study. Of these, 499 (65.5%) received mono antiplatelet therapy and 263 (34.5%) patients received dual antiplatelet therapy. There was no statistical significant difference in the incidence of mortality and recurrent stroke in the mono antiplatelet therapy group compared with the dual antiplatelet therapy group. When comparing primary outcomes between African Americans and non-African Americans, there was no statistical significant difference in mortality rate and recurrent stroke rate between the two groups. CONCLUSION: This study found no statistical significant difference in the incidence of recurrent stroke and mortality between mono antiplatelet therapy and dual antiplatelet therapy among patients who had ischemic stroke or TIA; with similar findings in a subgroup analysis comparing outcomes in African-American patients compared with non-African-American patients.

Is Ciprofloxacin in Combination With Beta-lactam Antibiotics a Recipe for Thrombocytosis?: A Case Report of Thrombocytosis in a Patient Receiving Ciprofloxacin and Ceftriaxone.

Thrombocytosis is defined as a platelet count greater than 400,000/mcL. We report the case of a patient who developed thrombocytosis after receiving ciprofloxacin and ceftriaxone therapy. A 73-year-old African-American female presented to the hospital with altered mental status attributed to sepsis and urinary tract infection. Patient was initiated on multiple empiric antibiotic therapy and was subsequently transitioned to ciprofloxacin and ceftriaxone at different times as definitive therapy for treatment of Escherichia coli bacteremia and Escherichia coli urinary tract infection. The patient developed thrombocytosis during and/or proximally to the administration of ciprofloxacin and ceftriaxone. A myeloproliferative source for the thrombocytosis was ruled out by the hematology/oncology team with a negative Janus kinase 2 V617F mutation assay result. In addition, other nondrug reactive sources of thrombocytosis (infection and anemia) were generally ruled out because the thrombocytosis was proximally linked with ciprofloxacin and ceftriaxone administration. The Naranjo Adverse Drug Reaction Probability Scale assigned a score of 5, indicating ciprofloxacin or ceftriaxone independently or in combination as a probable cause of thrombocytosis. This case report suggests that ciprofloxacin in combination with ceftriaxone (a beta-lactam antibiotic) may be a probable cause of thrombocytosis.