Meropenem-vaborbactam is a new beta-lactam/beta-lactamase inhibitor combination that combines a carbapenem antibiotic with a first-in-class, boronic acid pharmacophore, serine beta-lactamase ...inhibitor which has potent inhibitory activity against class A carbapenemases, especially Klebsiella pneumoniae carbapenemases (KPC), in addition to other class A and class C beta-lactamases. The US Food and Drug Administration has recently approved meropenem-vaborbactam for the treatment of adult patients with complicated urinary tract infections including acute pyelonephritis. Areas covered: A PubMed search was performed to gather the most current and relevant articles regarding meropenem-vaborbactam. In this review the authors discuss the chemistry, mechanism of action, pharmacokinetics, pharmacodynamics, antimicrobial spectrum, and efficacy and safety of meropenem-vaborbactam for the treatment of complicated urinary tract infections including acute pyelonephritis Expert opinion: Although meropenem-vaborbactam is approved for treatment for complicated urinary tract infections including acute pyelonephritis, it is unlikely, at this point, to be utilized widely beyond cases that are caused by KPC-producing Enterobacteriaceae. It may also be a potential treatment option for complicated urinary tract infections caused by KPC-producing Enterobacteriaceae that are resistant to ceftazidime-avibactam. Long-term safety data with this novel beta-lactamase inhibitor is still needed although early data suggests that it will be safe and well tolerated.
Abstract
It is well-appreciated that patients with documented penicillin allergies often receive broader-spectrum antibiotics. This practice has been associated with increased antimicrobial ...resistance and cost. In recent years, considerable efforts have been made to spread awareness on the implications of self-reported penicillin allergies. The use of penicillin skin testing to evaluate for true allergies has been strongly recommended by major organizations for decades. However, testing remains underutilized. Current literature has suggested various models of incorporating penicillin allergy screening and testing by different healthcare practitioners (ie, physicians, allergists, nurses, pharmacists). We suggest broader adoption for the role of pharmacists in the provision of penicillin skin testing. This would help expand the service and maximize the potential benefits of penicillin skin testing.
Although penicillin skin testing to verify true allergies has been recommended for decades, problems with implementation have been encountered. We suggest wider adoption of a model wherein pharmacists play an active role in such testing.
Background: Guidelines from the 2021 American Diabetes Association recommend basal or basal plus correctional insulin dosing for non-critically ill hospitalized patients with poor oral intake or are ...nil per os (NPO). The recommended adjustment is 75-80% of long-acting basal insulin administered perioperatively. The aim of this study was to build on the current data available to determine the optimal management of insulin detemir dosing between medicine and surgery patients who were unable to eat.
Methods: This was a retrospective single-center observational study between January and December 2019 that included patients with type 2 diabetes and confirmed NPO status receiving insulin detemir. To determine best practices of long-acting insulin management, 100%, 80-33%, and 0% insulin detemir dosing in medical and surgical patients were evaluated. The primary endpoint was incidence of hypoglycemia (<70 mg/dL) after insulin dose adjustment. Secondary endpoints were incidence of severe hypoglycemia (<40 mg/dL) and hyperglycemia (>180 mg/dL) after insulin dose adjustment.
Results: Of the 100 adult patients who met the criteria, there were no incidences of hypoglycemia or severe hypoglycemia regardless of insulin detemir dose adjustment in either medical or surgical patients. In the medicine group, hyperglycemia occurred in 23/67 (34.3%), 2/6 (33.3%), 4/12 (33.3%) for 100%, 80-33%, and 0% insulin dose adjustments, respectively. In the surgery group, hyperglycemia occurred in 8/12 (66.7%) in patients receiving 100% insulin detemir dosage with no notable outcomes in the remaining 3 patients.
Conclusions: There was no incidence of hypoglycemia or severe hypoglycemia between medical and surgical patients, regardless of insulin detemir dose adjustment. A numerically higher incidence of hyperglycemia was observed in patients receiving 100% insulin detemir in both medicine and surgery patients. Further education is planned to reduce hyperglycemia.
Disclosure
J. Sacdal: None. H. A. Habib: None. E. Cheon: None. E. Oh: None.
Emergency department (ED) visits and hospitalizations from skin and soft tissue infections (SSTIs) have been on the rise and have led to an increased clinical and economic burden. Owing to their ...single-dose regimen, recently approved lipoglycopeptides such as oritavancin have the potential to shift the management of SSTIs from an inpatient to outpatient setting. Limited data exist regarding the use of these drugs in the ED setting.
The purpose of this study was to describe the impact that clinical decision support (CDS) incorporation into the computerized physician order entry (CPOE) system had on oritavancin use and to assess compliance with appropriate use guidelines in the ED.
This was a retrospective cohort study evaluating patients who received oritavancin from September 2016 to May 2018. The patients were assigned to the pre-CDS-implementation group if oritavancin was used between September 13, 2016, and June 28, 2017 and to the post-CDS-implementation group if oritavancin was used between August 28, 2017, and May 25, 2018. There was a 2-month transition period between the 2 study time periods. Patients were excluded if the administration occurred outside of the ED or during the transition period. The primary endpoints were oritavancin use and compliance with the appropriate use guidelines after the implementation.
There were 169 oritavancin orders in total, of which 119 met the inclusion criteria. There was a marked decrease in use post-CDS implementation (9.2 orders/mo vs. 3 orders/mo). Among those who were prescribed oritavancin, compliance with the appropriate use guidelines increased; however, this did not reach statistical significance.
The implementation of the appropriate use guidelines with CDS integration into the CPOE system decreased overall oritavancin use but did not have an impact on compliance with the appropriate use guidelines.
Overall, the small sample is a major limitation due to oritavancin formulary availability and AMA event documentation (became a discrete EMR field in 2014) preventing OAB group expansion. ...lack of ...standardized scoring tools to objectively categorize SSTI severity prevents consistent assessment and makes comparisons with oritavancin and standard therapy difficult. Additional studies in high-acuity settings with larger sample sizes are needed to identify the optimal population for oritavancin.Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Credit authorship contribution statement John Paul A. Sacdal: Writing – review & editing, Writing – original draft, Investigation, Formal analysis, Data curation.
Biocompatible, biodegradable polyionic micelles were used as a building component for layer-by-layer (LbL) assembly that can produce drug-loaded nanolayers. To prepare the polycationic micelles, ...poly(lactic-co-glycolic acid)-b-poly(l-lysine) PLGA-b-P(Lys) copolymers were synthesized. In an aqueous phase, PLGA-b-P(Lys) copolymers were self-assembled to form spherical micelles with the inner core of poly(lactic-co-glycolic acid) (PLGA) and the cationic outer shell of P(Lys). The micelles were characterized by zeta potential, dynamic light scattering, and nuclear magnetic resonance. PLGA-b-P(Lys) micelles showed the positive zeta potential values in a broad range of pH (3-11), indicating the high stability of the polyionic micelles with the outer shell of positive charges. Cationic polymeric micelles were coated on the surface via electrostatic interactions with the oppositely charged polyelectrolyte, poly(sodium 4-styrenesulfonate). Formation of multiple micelle layers was monitored using quartz crystal microbalance in situ, and the surface topology of the layers was characterized by atomic force microscopy ex situ, as the number of micelle layer was increased. The multiple micelle layers were stable, and the thickness of micelle layer grew as the number of LbL coating increased. The approach described in this work can be used for the development of the biocompatible, biodegradable, drug-loaded bioactive nanocoatings.PUBLICATION ABSTRACT
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