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Research has been conducted on adherence to antiretroviral therapy. Results demonstrate that adherene measurement is important in the assessment of the patients who fail to respond to antiretroviral therapy.

Background: Pneumococcal immunization rates in adults at high‐risk for pneumococcal disease fall below the Healthy People 2020 goal of 60%. Implementation of recommendations from the Advisory Committee on Immunization Practices (ACIP) provides an opportunity to improve patient care. We assessed whether pneumococcal immunization protocols (PIPs) exist for high‐risk adults across diverse clinical settings, determined protocol concordance with the 2012 ACIP recommendations, and identified tactics to improve ACIP recommendation implementation. Methods: We conducted a multicenter, cross‐sectional survey of members of the American College of Clinical Pharmacy Practice‐Based Research Network, with practice responsibilities for high‐risk adult populations, from September 2014 to May 2015. Pediatric and travel vaccine practices were excluded. Objective survey measures evaluated the PIPs in three areas: (a) development, (b) maintenance, and (c) education. Subjective measures evaluated barriers to ACIP recommendation implementation. Results: A total of 94 surveys representing 56 inpatient and 38 outpatient sites across 29 states were completed. Twenty‐five of the 45 inpatient PIPs (56%) were concordant with ACIP recommendations. Regular assessment for updates to and a formalized educational and accountability process was in place for 49 (91%) and 46 (85%) of the 54 inpatient PIPs evaluable in these categories, respectfully. Half of the outpatient sites did not have a standardized, written PIP in place. Of the 17 evaluable outpatient PIPs, 9 (53%) were concordant with ACIP recommendations. The most common perceived barriers to ACIP recommended immunization in adults were a lack of knowledge regarding national recommendations, a lack of accountability for recommendation implementation, and outdated PIPs. Conclusion: Our study demonstrated that only 36% (34 out of 94) of the clinical sites had adopted the ACIP recommendations. While roughly half of the sites had PIPs in place, education of and accountability for immunizers was lacking, particularly in the outpatient setting. A system that enhances PIP prioritization, education, and accountability would likely address the gaps in adult pneumococcal immunization for high‐risk adults. [ABSTRACT FROM AUTHOR]

It has been found that the management of a resident infected with methicillin-resistant Staphylococcus aureus (MRSA) is much more expensive for a long-term care facility (LTCF) than that of a methicillin-sensitive Staphylococcus aureus patient. A retrospective cohort study was carried out in a 375-bed LTCF that offers two levels of care.

Background: The primary objective of this study is to assess whether baseline renal function impacts treatment outcomes of linezolid and vancomycin (with a dose-optimized regimen) for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.Methods: We conducted a retrospective cohort analysis of data generated from a prospective, randomized, controlled clinical trial (NCT 00084266). The analysis included 405 patients with culture-proven MRSA pneumonia. Baseline renal function was stratified based on creatinine clearance. Clinical and microbiological success rates and presence of nephrotoxicity were assessed at the end of treatment (EOT) and end of study (EOS). Multivariate logistic regression analyses of baseline patient characteristics, including treatment, were performed to identify independent predictors of efficacy. Vancomycin concentrations were analyzed using a nonlinear mixed-effects modeling approach. The relationships between vancomycin exposures, pharmacokinetic-pharmacodynamic index (trough concentration, area under the curve over a 24-h interval [AUC0-24], and AUC0-24/MIC) and efficacy/nephrotoxicity were assessed in MRSA pneumonia patients using univariate logistic regression or Cox proportional hazards regression analysis approach.Results: After controlling for use of vasoactive agents, choice of antibiotic therapy and bacteremia, baseline renal function was not correlated with clinical and microbiological successes in MRSA pneumonia at either end of treatment or at end of study for both treatment groups. No positive association was identified between vancomycin exposures and efficacy in these patients. Higher vancomycin exposures were correlated with an increased risk of nephrotoxicity (e.g., hazards ratio [95% confidence interval] for a 5 μg/ml increase in trough concentration: 1.42 [1.10, 1.82]).Conclusions: In non-dialysis patients, baseline renal function did not impact the differences in efficacy or nephrotoxicity with treatment of linezolid versus vancomycin in MRSA pneumonia. [ABSTRACT FROM AUTHOR]

Inadequate empirical antibiotic therapy for serious Pseudomonas aeruginosa infections has been linked to increased mortality. We performed a retrospective cohort study of consecutive patients with ventilator-associated pneumonia, bacteraemia or other sterile-site infections caused by P. aeruginosa occurring during Intensive Care Unit admissions. One hundred and fifty-eight episodes of serious infection with P. aeruginosa occurred in 140 patients. Empirical antibiotic therapy was microbiologically adequate in 67% of episodes of infection. Patients with P. aeruginosa isolates resistant to piperacillin/tazobactam or cefepime were more likely to have received these antibiotics in the month prior to the P. aeruginosa infection or to have had a Gram-negative bacillus resistant to these antibiotics isolated in the month prior to the P. aeruginosa infection. From these data, we have developed simple algorithms for empirical antibiotic choice in seriously ill patients with suspected P. aeruginosa infections based on prior antibiotic exposure and prior isolation of antibiotic-resistant organisms. Application of these algorithms would have improved the adequacy of empirical antibiotic therapy from 67% to 80-84%. Routine empirical addition of amikacin to the beta-lactam would have increased the adequacy of the antibiotics to 96%. We conclude that knowledge of the prior receipt of beta-lactam antibiotics with activity against P. aeruginosa and the isolation of Gram-negative bacilli resistant to such antibiotics in the recent past can readily increase the adequacy of empirical antibiotic therapy for suspected P. aeruginosa infections.