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Rate and Incidence of Adverse Reactions Associated With Ceftaroline Exposure: Importance of Cutaneous Manifestations
No full textBackground: Ceftaroline is a broad-spectrum, methicillin-resistant Staphylococcus aureus (MRSA)-active β-lactam approved for acute bacterial skin and skin structure infections (ABSSSIs) and community-acquired pneumonia. Because of its favorable spectrum and pharmacokinetics, ceftaroline is frequently utilized for infections such as osteomyelitis and endocarditis. Ceftaroline has been associated with neutropenia, but evaluation of other adverse events remains limited. Objective: To describe the rates and types of ceftaroline-associated adverse events and determine if patients’ baseline allergies affect the rates of an adverse event. Methods: A single-center, retrospective, observational analysis was conducted of all patients who received ceftaroline between November 4, 2011, and March 28, 2017, at the VA Saint Louis Health Care System. The Naranjo algorithm was utilized as a standardized method to evaluate likelihood that the adverse events were caused by ceftaroline therapy. Ceftaroline dose, duration, indication, and baseline allergy information were collected for all patients. Results: There were 75 patients who received 78 courses of ceftaroline identified for inclusion. The most common indications were osteomyelitis (51.3%) and ABSSSI (16.7%). Overall, 13/75 (17.3%) patients developed an adverse event, and 10/75 (13.3%) required discontinuation of ceftaroline. Rash was the most common adverse reaction and occurred in 7/75 (9.3%) patients, followed by neutropenia in 3/75 (4.0%) patients. There were no differences in baseline allergy characteristics between patients who experienced an adverse reaction to ceftaroline and those who did not. Conclusions: When compared with clinical trials, ceftaroline use appears to be associated with an increased rate of overall adverse events, which is driven by cutaneous reactions
Preceptor Perceptions of Team Quality Improvement Projects Conducted With the Educating Pharmacists in Quality Program
No full textOutcomes and Predictors of Early Infection after Heart Transplantation
No full textBackground: Limited data exist on the incidence and outcome of early infection after orthotopic heart transplantation (OHT). The purpose of this study was to describe characteristics and outcomes of OHT recipients with an early infection and to identify predictors of such infections. Methods: This retrospective, single-center study included patients greater than 18 years of age who underwent OHT from February 2009 to May 2014 and had an infection within 30 days of transplantation. Patient demographics, clinical variables, and outcomes were collected. Multivariable logistic regression was performed to identify independent predictors of infection. Results: Of the 172 eligible OHT recipients, 51 (29.7%) had an early infection. The median time to diagnosis was five days, with gram-negative organisms being slightly more common (58.2%). No differences in mortality rate, rejection, or re-admission were found between the groups. Longer durations of mechanical ventilation and lengths of stay were found in the infection group (p \u3c 0.001). Patients with an early infection also had a higher incidence of mechanical circulatory support, history of drive-line infection, longer duration of mechanical ventilation, continuous renal replacement therapy (CRRT), and delayed chest closure (p \u3c 0.05 for all). Pre-OHT left-ventricular assist device (adjusted odds ratio [AOR] 2.53; 95% confidence interval [CI] 1.015-6.286; p \u3c 0.046), pre-OHT extracorporeal membrane oxygenation (AOR 14.10; 95% CI 1.38-150.5; p = 0.026) and post-OHT CRRT (AOR 3.98; 95% CI 1.67-9.52; p = 0.002) were found to be independent risk factors for an early infection. A total of 90% of the available susceptibility panels for the gram-negative isolates (26/29) were resistant to the standard peri-operative cephalosporin given. Conclusions: Prior mechanical circulatory support and the acute need for CRRT may predispose OHT patients to an infection early in the post-operative period. Evaluation of peri-operative antimicrobial prophylaxis, based on an individual center\u27s resistance panels, may be warranted
Severely prolonged vancomycin half-life in a patient with normal serum creatinine and creatinine clearance
No full textVancomycin remains the antibiotic of choice to treat resistant Gram-positive infections and is dosed utilizing weight-based protocols or pharmacokinetic calculations. Pharmacokinetic calculations are a more proactive approach to vancomycin dosing but are occasionally limited as certain patient-specific variables such as volume of distribution, renal function, and severity of illness do not allow all patients to follow population estimates. In these situations, if the above-mentioned variables are adjusted for an individual patient rather than the population estimates, the kinetic models reflect accurate vancomycin dosing. We present a patient with apparently normal renal function (Cockcroft-Gault) following a significant renal injury who had sustained supratherapeutic vancomycin serum concentrations and a calculated peak elimination half-life of 346 h. Importantly, this patient had adequate clearance of other highly renally eliminated medications (digoxin and meropenem), which suggests limited long-term deficit due to the previous sustained renal injury. In this patient case, vancomycin\u27s chemical properties and pharmacokinetics are explored to best explain the patient\u27s highly unusual response. In addition, an analysis of vancomycin\u27s less well-described pharmacokinetics such as active secretion, tubular reabsorption, and nonrenal elimination pathways is explored. Ultimately, this patient represents a perplexing case which highlights the continued need for therapeutic drug monitoring with vancomycin
Data Protection Standards - Conditions of Use and Computing Ethics
No full textThe Conditions of Use and Computing Ethics applies to all active members of the University community, including faculty, students, staff, and affiliates, and to authorized visitors, guests, and others for whom University technology resources and network access are made available by the University. This policy also applies to campus visitors who avail themselves of the University’s temporary visitor wireless network access, and to those who register their computers and other devices through Conference and Event Services programs or through other offices, for use of the campus network
Safe Handling of Cryogenic Materials Guidelines
No full textApplies to University of Health Sciences and Pharmacy in St. Louis students, faculty, and staff working with cryogenic materials
Uniform Policy
No full textThe Office of Facilities needs its employees to be identifiable and visible to the campus community. To help make the employees identifiable and visible, standard dress is required. This policy provides clear guidelines so that employees of the department present a professional image as they represent the Office of Facilities and the University to our students, faculty, staff and community partners at all times.
This policy applies to all University of Health Sciences and Pharmacy in St. Louis Office of Facilities employees in the maintenance and housekeeping departments
Facility and Administrative Cost Distribution Policy
No full textIt is the policy of the University of Health Sciences & Pharmacy in St. Louis (UHSP) to support the sponsored research activities of its faculty and staff as a way to contribute to the pursuit of knowledge, the enhancement of student learning, and the promotion of the common good. The purpose of this policy is to set expectations for reimbursement of Facilities and Administration (F&A) costs for externally sponsored projects, and to establish guidelines for the distribution of recovered F&A costs among appropriate campus units at UHSP.
The policy described herein addresses several issues. The goals of the policy are to: Streamline the process for requesting F&A reimbursement in grants and contracts. Ensure that campus units that provide the services and products that define indirect costs are adequately reimbursed for these costs. Establish a distribution mechanism that recognizes PIs and their corresponding colleges to reinvest in the research enterprise. Optimize the use of recovered F&A dollars to develop campus infrastructure supporting high quality and nationally competitive research and creative activities
Recent Advances in the Medicinal Chemistry of Liver X Receptors
No full textNuclear hormone receptors represent a large family of ligand-activated transcription factors that include steroid receptors, thyroid/retinoid receptors, and orphan receptors. Among nuclear hormone receptors, the liver X receptors have emerged as very important drug targets. These receptors regulate some of the most important metabolic functions, and they were also identified as anti-inflammatory transcription factors and regulators of the immune system. The development of drugs targeting liver X receptors continues to be a challenge, but advances in our knowledge of receptor structure and function move us forward, toward achieving this goal. This review highlights the latest advances in the development of synthetic LXR modulators in the primary literature from 2013 to 2017. In this review, we place great emphasis on the structure and function of LXRs because of their essential role in the drug design process. The structure-activity relationships of the most active and promising synthetic modulators are discussed
Assessment of Apixaban Prescribing Patterns for Nonvalvular Atrial Fibrillation in Hospitalized Patients
No full textBackground: Apixaban is a direct oral anticoagulant (DOAC) for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). Other DOACs require renal dose adjustments based solely on creatinine clearance. Apixaban differs in that its dose adjustments are more complex, potentially leading to prescribing errors. Objective: To determine if adherence to Food and Drug Administration (FDA)-approved dosing for apixaban is maintained in hospitalized patients with NVAF. Methods: Patients ≥18 years old with NVAF who received apixaban during admission to 1 of 3 hospitals were evaluated. The primary outcome was to determine if providers order apixaban in accordance with FDA-approved dosages. Secondary outcomes included determining if pharmacist review increased the number of orders in accordance with FDA-approved dosing, which of the 3 criteria (age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL) were met in patients receiving off-label dosing, and the rationale for off-label prescribing. Results: A total of 556 patients met inclusion criteria. Apixaban was dosed according to FDA labeling by providers in 83.4% (n = 464) of orders. After pharmacist review, 87.0% (n = 484) of orders were at the approved dose, 12.2% (n = 68) were underdosed, and 0.7% (n = 4) were overdosed. Most patients who were underdosed met only 1 dose reduction criterion—most commonly age ≥80 years (56.0%). Reasons for off-label dosing included home dose continuation (39.0%), history of or perceived bleeding risk (30.5%), or unspecified/other (30.5%). Conclusions: The majority of apixaban orders for NVAF were based on FDA-approved dosages after provider entry and pharmacist review