Innovative approach to preparing radial artery cocktails in response to manufacturer shortages of nitroglycerin and verapamil.

BACKGROUND: Transradial access has gained popularity over transfemoral access for cardiac catheterization, because of the decreased risk of bleeding, time to ambulation, and length of stay leading to improved patient satisfaction. One disadvantage of the radial artery approach is vasospasm, which can be prevented with the administration of verapamil and nitroglycerin in a pre- and postradial cocktail. Unfortunately, there have been manufacturer shortages for both of these medications. METHODS: The utilization of radial artery cocktails and other nitroglycerin compounding practices were evaluated in response to cost containment and waste reduction initiatives and to medication shortages. RESULTS: A modified process for supplying verapamil and nitroglycerin for the transradial approach via separate syringes enabled physicians to have quick access to the medications and to customize the cocktail based on the patient's needs. This process also decreased costs and minimized wastage. The change in practice decreased waste from 44% for preradial cocktail syringes and 66% for postradial cocktail syringes to 8.7%. DISCUSSION: This process for supplying the medications necessary to perform a radial artery catheterization and intracoronary nitroglycerin has allowed for conservation of commercial product supply.

Extended-spectrum beta-lactamase-producing bacterial infections in adult solid organ transplant recipients.

BACKGROUND: Limited research is available evaluating infections due to extended-spectrum ß-lactamase (ESBL)-producing organisms in adult recipients of solid organ transplant (SOT). OBJECTIVE: To evaluate clinical response and rate of recurrence of ESBL-producing organisms in 20 SOT recipients. METHODS: In a retrospective case series, records of adult SOT recipients with an admitting diagnosis of infection and a positive culture for an ESBL-producing organism from January 2003 through August 2006 were reviewed. RESULTS: Twenty patients met inclusion criteria. The median time to infection following transplant was 3.5 years (range 1-23 years). Overall, 85% of the patients received inadequate empiric antibiotic therapy, including ciprofloxacin or piperacillin/tazobactam, to manage their infection. Nineteen patients had clinical resolution; however, 12 patients required at least 1 readmission due to infection recurrence. One patient's death occurred during the study period. The median time to readmission for a recurrence was 41 days (18-455 days). All recurrent infections were caused by the same ESBL-producing pathogen and 10 of 12 (83%) infections occurred at the same site as the initial infection. Among patients with recurrent infections, 75% received inadequate empiric therapy upon readmission. All 12 patients with recurrent infections had successful clinical responses to both initial and recurrent infections. CONCLUSIONS: The provision of inadequate empiric therapy for new and recurrent infections due to ESBL-producing pathogens was common in this study population. SOT recipients with a history of infection due to an ESBL-producing organism presenting with a new infection should receive adequate empiric therapy with a carbapenem agent until a definitive diagnosis can be established.