Impact of Extended- Versus Intermittent-Infusion Cefepime on Clinical Outcomes in Hospitalized Patients.

Background: Pharmacodynamic models support potential improved antimicrobial pharmacokinetic and pharmacodynamic goal attainment in patients treated with extended-infusion (EI) versus intermittent-infusion (II) cefepime. Small clinical studies demonstrate inconsistent findings in patient outcomes, necessitating a deeper review of this administration method. Methods: This was a retrospective cohort study comparing patients receiving EI versus II cefepime between September 1, 2017, and March 31, 2018. The primary outcome was in-hospital all-cause mortality. Secondary objectives included length of hospital and ICU stay, time to defervescence, duration of therapy, duration of mechanical ventilation, and readmission rate. Subgroup analyses for the primary objective were conducted based on comorbid burden and isolate susceptibilities. Results: No statistically significant differences were noted in the 645 included patients for the primary outcome between the EI and II groups (7.8% vs 10.4%, P = .32). Median length of stay was 9 days (IQR 12) versus 11 days (IQR 14) (P = .30), respectively. In addition, statistical significance was not seen in any of the subgroups for the primary outcome including patients with APACHE II score ≥ 20 (17.4% vs 30.6%, P = .26) and for infections caused by Pseudomonas aeruginosa (5.9% vs 20.0%, P = .23) or Enterobacteriaceae (11.1% vs 20.0%, P = .13) with minimum inhibitory concentration (MIC) ≥ 4. Conclusion: No statistically significant differences were noted between EI and II groups, although benefits in specific subpopulations may exist when these results are correlated with findings from studies examining alternative antipseudomonal beta lactams.

Impact of COVID-19 pandemic on training of pharmacy residents and fellows: Results from a national survey of postgraduate pharmacy trainees.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has impacted the activities of healthcare workers, including postgraduate pharmacy trainees. Quality training experiences must be maintained to produce competent pharmacy practitioners and maintain program standards. METHODS: A cross-sectional survey of postgraduate pharmacy trainees in the United States was conducted to evaluate training experience changes and assess perceived impacts on residents and fellows following the COVID-19 pandemic's onset. RESULTS: From June 4 through June 22, 2020, 511 pharmacy trainees in 46 states completed the survey. Participants' median age was 26 (interquartile range [IQR], 25-28) years, with included responses from postgraduate year 1 residents (54% of sample), postgraduate year 2 residents (40%), and postgraduate fellows (6%). Compared to experiences prior to the onset of the COVID-19 pandemic, fewer trainees conducted direct patient care (38.5% vs 91.4%, P < 0.001), more worked from home (31.7% vs 1.6%, P < 0.001), and less time was spent with preceptors per day (2 [IQR, 2-6] hours vs 4 [IQR, 1-4] hours, P < 0.001). Sixty-five percent of respondents reported experiencing changes in their training program, 39% reported being asked to work in areas outside of their routine training experience, and 89% stated their training shifted to focus on COVID-19 to some degree. Most respondents perceived either major (9.6%) or minor (52.0%) worsening in quality of experience, with major and minor improvement in quality of experience reported by 5.5% and 8.4% of respondents, respectively. CONCLUSION: Pharmacy resident/fellow experiences were perceived to have been extensively impacted by the COVID-19 pandemic in varying ways. Our findings describe shifts in postgraduate training and may aid in the development of best practices for optimizing trainee experiences in future crises.

Bleeding rates of Veterans taking apixaban or rivaroxaban for atrial fibrillation or venous thromboembolism.

This study examined potential differences in bleeding between apixaban and rivaroxaban, the most commonly utilized direct oral anticoagulants at the Richard L. Roudebush VA Medical Center. Additionally, the analysis included a comparison between observed and literature-reported bleeding rates. This retrospective chart review examined 452 (39%) Veterans receiving rivaroxaban and 716 (61%) Veterans receiving apixaban. Bleeding rates were expressed per 100 patient-years and the overall rates were analyzed as the primary analysis. Secondary objectives included comparisons based on indication and severity, as well as comparisons to literature-reported bleed rates, time to bleeding event, and location of the bleed. The analysis did not detect any statistically significant differences between apixaban and rivaroxaban in terms of overall, (ARR 0.90% per 100 patient-years, 95% CI - 0.58 to 2.38%, p > 0.05) major, (ARR 0.22% per 100 patient-years, 95% CI - 0.74 to 1.17%, p > 0.05) or non-major clinically relevant (ARR 0.35% per 100 patient-years, 95% CI - 0.57 to 1.27%, p > 0.05) bleeding. Observed bleeding for both rivaroxaban and apixaban in the Veteran population exceeded the rates reported by the literature when used for atrial fibrillation (1.96% vs. 0.15%, p < 0.05; 1.08% vs. 0.16%, p < 0.05) but the opposite was seen for long term venous thromboembolism (VTE) treatment (3.97% vs. 8.03%, p < 0.0001; 0.14% vs. 15.51%, p < 0.0001) or extended VTE prophylaxis (0.07% vs 5.98%, p < 0.0001; 0.07% vs 1.88%, p < 0.01). Results from this study suggest these agents impart similar levels of risk, but variations in bleeding risk between the Veteran population and the patients in the original clinical trials may exist.