Hospital Pharmacy - November 2017 - 694
694
Hospital Pharmacy 52(10)
Table 4. In Vitro Antimicrobial Susceptibility of Bloodstream Isolates by Site of Acquisition.
Antimicrobial agent/combination
Community-acquired
(n = 161)
Health care-
associated (n = 159)
Hospital-acquired
(n = 70)
63 (39)
112/160 (70)
128/160 (80)
151 (94)
156 (97)
157/159 (99)
157 (98)
161 (100)
134 (83)
147/158 (93)
126/160 (79)
157 (98)
158 (98)
159 (99)
159/160 (99)
47 (30)
99/158 (63)
112 (70)
139 (87)
152 (96)
151/157 (96)
149 (94)
158 (99)
123/158 (78)
148/158 (94)
119/159 (75)
155/159 (97)
152 (96)
155/158 (98)
152/158 (96)
17 (24)
46 (66)
47 (67)
58/69 (84)
66 (96)
65/69 (94)
64 (91)
68 (97)
60/68 (88)
63/69 (91)
53 (76)
67/69 (97)
66/69 (96)
67 (96)
66/69 (96)
Ampicillin
Ampicillin-sulbactam
Cefazolin
Ceftriaxone
Cefepime
Piperacillin-tazobactam
Ertapenem
Meropenem
Ciprofloxacin
Gentamicin
Trimethoprim-sulfamethoxazole
Cefepime + gentamicin
Cefepime + ciprofloxacin
Piperacillin-tazobactam + gentamicin
Piperacillin-tazobactam +
ciprofloxacin
Meropenem + gentamicin
Meropenem + ciprofloxacin
161 (100)
161 (100)
159 (100)
158 (99)
69 (99)
69/69 (100)
Note. Data show number of susceptible isolates (%) or number of susceptible/number of tested isolates (%), if not all isolates were tested.
Table 5. In Vitro Antimicrobial Susceptibility of Bloodstream Isolates by Site of Acquisition and Acute Severity of Illness.
Health care-associated or
hospital-acquired
Community-acquired
Antibiotic
Pitt score <4
(n = 128)
Pitt score ≥4
(n = 33)
Pitt score <4
(n = 152)
Pitt score ≥4
(n = 77)
Ceftriaxone
Cefepime
Piperacillin-tazobactam
Gentamicin
121 (95)
123 (96)
124/126 (98)
115/126 (91)
30 (91)
33 (100)
33 (100)
32 (97)
NA
144 (95)
143/151 (95)
142/151 (94)
NA
74 (96)
73/75 (97)
69/76 (91)
Note. Data show number of susceptible isolates (%) or number of susceptible/number of tested isolates (%), if not all isolates were tested. NA = not
appropriate.
Next, patients were stratified based on site of acquisition
(community-acquired vs health care-associated/hospitalacquired) and acute severity of illness using the Pitt bacteremia score (Table 5). Utilizing stratified bloodstream
antibiogram, ceftriaxone was selected for communityacquired BSI in noncritically ill patients based on narrower
spectrum of activity compared with the remaining nonrestricted agents. Cefepime and piperacillin-tazobactam were
the only nonrestricted agents that met predefined criteria in
critically ill patients with health care-associated/hospitalacquired BSI. The two antipseudomonal beta-lactams were
selected over gentamicin in the remaining categories based
on preferable side effects profile. An algorithm was developed to guide empirical antimicrobial therapy in patients
with Gram-negative BSI while awaiting final blood culture
results (Figure 1).
In the current cohort, 92% of patients received adequate
empirical antimicrobial therapy for Gram-negative BSI and
82% received at least one antipseudomonal agent empirically. Implementation of proposed guidelines is projected to
increase adequacy of empirical antimicrobial therapy to over
95% and reduce utilization of empirical antipseudomonal
agents to 67% (262/390) of patients.
Discussion
Improvement in quality of care and reduction in antimicrobial resistance rates are 2 major principles of antimicrobial
stewardship.15 Institutional guidelines for management of
hospitalized patients with serious infections are essential
tools to improve quality of care by optimization of empirical
antimicrobial therapy. In addition, if these guidelines advocate for reduction in utilization of broad-spectrum antimicrobial regimens, then implementation may contribute to
reduction in antimicrobial resistance rates as well.8 This
article outlines suggested methodology for development of
Table of Contents for the Digital Edition of Hospital Pharmacy - November 2017
AKD—The Time Between AKI and CKD: What Is the Role of the Pharmacist?
Letter to the Editor
Antithrombotic Therapy Post Endovascular Stenting for Superior Vena Cava Syndrome
Pharmaceutical Pipeline Update
Janus Kinase Inhibitors for the Treatment of Rheumatoid Arthritis
Formulary Drug Reviews
Etelcalcetide
Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis With Insulin, Heparin, and Gemfibrozil: A Case Series
Evaluation of Antimicrobial Stewardship–Related Alerts Using a Clinical Decision Support System
Compatibility, Stability, and Efficacy of Vancomycin Combined With Gentamicin or Ethanol in Sodium Citrate as a Catheter Lock Solution
Development of Institutional Guidelines for Management of Gram-Negative Bloodstream Infections: Incorporating Local Evidence
Underutilization of Aldosterone Antagonists in Heart Failure
Stability of Procainamide Injection in Clear Glass Vials and Polyvinyl Chloride Bags
Development of a Local Health-System Pharmacy Resident Society
Challenges and Solutions to New Manager Onboarding
Hospital Pharmacy - November 2017 - 649
Hospital Pharmacy - November 2017 - 650
Hospital Pharmacy - November 2017 - 651
Hospital Pharmacy - November 2017 - 652
Hospital Pharmacy - November 2017 - 653
Hospital Pharmacy - November 2017 - 654
Hospital Pharmacy - November 2017 - 655
Hospital Pharmacy - November 2017 - 656
Hospital Pharmacy - November 2017 - 657
Hospital Pharmacy - November 2017 - 658
Hospital Pharmacy - November 2017 - 659
Hospital Pharmacy - November 2017 - 660
Hospital Pharmacy - November 2017 - AKD—The Time Between AKI and CKD: What Is the Role of the Pharmacist?
Hospital Pharmacy - November 2017 - 662
Hospital Pharmacy - November 2017 - Letter to the Editor
Hospital Pharmacy - November 2017 - Pharmaceutical Pipeline Update
Hospital Pharmacy - November 2017 - Janus Kinase Inhibitors for the Treatment of Rheumatoid Arthritis
Hospital Pharmacy - November 2017 - Formulary Drug Reviews
Hospital Pharmacy - November 2017 - Etelcalcetide
Hospital Pharmacy - November 2017 - 668
Hospital Pharmacy - November 2017 - 669
Hospital Pharmacy - November 2017 - 670
Hospital Pharmacy - November 2017 - 671
Hospital Pharmacy - November 2017 - 672
Hospital Pharmacy - November 2017 - Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis With Insulin, Heparin, and Gemfibrozil: A Case Series
Hospital Pharmacy - November 2017 - 674
Hospital Pharmacy - November 2017 - 675
Hospital Pharmacy - November 2017 - 676
Hospital Pharmacy - November 2017 - Evaluation of Antimicrobial Stewardship–Related Alerts Using a Clinical Decision Support System
Hospital Pharmacy - November 2017 - 678
Hospital Pharmacy - November 2017 - 679
Hospital Pharmacy - November 2017 - 680
Hospital Pharmacy - November 2017 - 681
Hospital Pharmacy - November 2017 - 682
Hospital Pharmacy - November 2017 - Compatibility, Stability, and Efficacy of Vancomycin Combined With Gentamicin or Ethanol in Sodium Citrate as a Catheter Lock Solution
Hospital Pharmacy - November 2017 - 684
Hospital Pharmacy - November 2017 - 685
Hospital Pharmacy - November 2017 - 686
Hospital Pharmacy - November 2017 - 687
Hospital Pharmacy - November 2017 - 688
Hospital Pharmacy - November 2017 - Development of Institutional Guidelines for Management of Gram-Negative Bloodstream Infections: Incorporating Local Evidence
Hospital Pharmacy - November 2017 - 690
Hospital Pharmacy - November 2017 - 691
Hospital Pharmacy - November 2017 - 692
Hospital Pharmacy - November 2017 - 693
Hospital Pharmacy - November 2017 - 694
Hospital Pharmacy - November 2017 - 695
Hospital Pharmacy - November 2017 - Underutilization of Aldosterone Antagonists in Heart Failure
Hospital Pharmacy - November 2017 - 697
Hospital Pharmacy - November 2017 - 698
Hospital Pharmacy - November 2017 - 699
Hospital Pharmacy - November 2017 - 700
Hospital Pharmacy - November 2017 - 701
Hospital Pharmacy - November 2017 - Stability of Procainamide Injection in Clear Glass Vials and Polyvinyl Chloride Bags
Hospital Pharmacy - November 2017 - 703
Hospital Pharmacy - November 2017 - 704
Hospital Pharmacy - November 2017 - 705
Hospital Pharmacy - November 2017 - 706
Hospital Pharmacy - November 2017 - Development of a Local Health-System Pharmacy Resident Society
Hospital Pharmacy - November 2017 - 708
Hospital Pharmacy - November 2017 - 709
Hospital Pharmacy - November 2017 - Challenges and Solutions to New Manager Onboarding
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Hospital Pharmacy - November 2017 - 712
Hospital Pharmacy - November 2017 - 713
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