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Thamer A Almangour,1 Leen Ghonem,2 Ahmad Aljabri,2 Alya Alruwaili,3 Mohammed Al Musawa,4 Nader Damfu,5 Mesfer S Almalki,6 Majda Alattas,4 Hossam Abed,4 Doaa Naeem,5 Nawaf Almalki,5 Abdullah A Alhifany7 1Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia; 2Clinical Pharmacy Services, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 3Infectious Diseases Services, King Fahad Medical City, Riyadh, Saudi Arabia; 4Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia; 5Pharmaceutical Care Department, King Abdul Aziz Medical City, Jeddah, Saudi Arabia; 6Pharmaceutical Services, Security Forces Hospital, Makkah, Saudi Arabia; 7Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi ArabiaCorrespondence: Thamer A Almangour, Email talmangour@ksu.edu.sa.comBackground: The aim of this study was to compare the safety and effectiveness of ceftazidime-avibactam (CAZ-AVI) to colistin-based regimen in the treatment of infections caused by carbapenem-resistant Enterobacterales (CRE).Methods: This was a retrospective, multicenter, observational cohort study of inpatients who received either CAZ-AVI or intravenous colistin for treatment of infections due to CRE. The study was conducted in 5 tertiary care hospitals in Saudi Arabia. Main study outcomes included in-hospital mortality, clinical cure at end of treatment, and acute kidney injury (AKI). Univariate analysis and multivariate logistic regression model were conducted to assess the independent impact of CAZ-AVI on the clinical outcome.Results: A total of 230 patients were included in this study: 149 patients received CAZ-AVI and 81 patients received colistin-based regimen. Clinical cure (71% vs 52%; P = 0.004; OR, 2.29; 95% CI, 1.31– 4.01) was significantly more common in patients who received CAZ-AVI. After adjusting the difference between the two groups, treatment with CAZ-AVI is independently associated with clinical cure (adjusted OR, 2.75; 95% CI, 1.28– 5.91). In-hospital mortality (35% vs 44%; P = 0.156; OR, 0.67; 95% CI, 0.39– 1.16) was lower in patients who received CAZ-AVI but the difference was not significant. AKI (15% vs 33%; P = 0.002; OR, 0.37; 95% CI, 0.19– 0.69) was significantly less common in patients who received CAZ-AVI.Conclusion: CAZ-AVI is associated with higher rate of clinical cure and lower rate of AKI compared to colistin. Our findings support the preferential use of CAZ-AVI over colistin-based regimen for treating these infections.Keywords: ceftazidime-avibactam, colistin, colistimethate sodium, carbapenem-resistant Enterobacterales

Automated container terminals are more efficient than conventional terminals, as they lead to a remarkable decrease in the operational costs of human and equipment resources. However, since there is a lack in labor interference in the Automated Container Terminals (ACTs) as the equipment is controlled automatically, detailed scheduling and efficient planning of each piece of equipment is crucial to smoothly perform the various operations. Therefore, this paper proposes a Mixed Integer Programing model to consider the integrated schedule of Quay Cranes (QCs), Automated Guided Vehicles (AGVs) and Yard Cranes (YCs) to minimize the total waiting time of QCs and the number of needed AGVs, also the storage locations of import containers are determined.

Background The incidence of Invasive Fungal Diseases (IFDs) has dramatically increased in patients with hematologic malignancies due to prolonged neutropenia. IFDs are associated with significant morbidity and mortality. Due to these risks, international guidelines have recommended antifungal prophylaxis for Acute Myeloid Leukemia (AML) and Myelodysplastic syndromes (MDS) patients. Posaconazole has been recommended as the prophylactic agent of choice. Also, voriconazole has been recommended by guidelines with different levels of recommendations. Data on a direct comparison between Posaconazole delayed-release tablets (DR) and Voriconazole for IFD prophylaxis are lacking. Therefore, we aim to compare the efficacy and safety of the fungal prophylaxis; voriconazole versus posaconazole in AML/MDS patients at Princess Nourah Oncology Center, Jeddah Methods Retrospective chart review study for eligible patients from January 2017 to February 2019 to identify the breakthrough IFD rates and assess the frequency of adverse events within AML/MDS patients at PNOC, Saudi Arabia Results A total of 48 patients (130 chemo cycles) were included in the study: 50 using posaconazole (DR) and 80 using oral voriconazole as antifungal prophylaxis. The incidence rates of IFD in the posaconazole group was 8 % (4/50) of those 2 were probable, and 2 were possible infections while 6.26 % (5/80) of patients in the voriconazole group have developed IFD of them 4 had a possible infection, and one had a probable infection (p=0.7325). A higher percentage of patients in the voriconazole group discontinued prophylaxis due to adverse events (5 patients vs. 2 patients). Use of voriconazole as antifungal prophylaxis for 15 days in 130 cycles in 48 AML/MDS patients would cost 175,500 SR in comparison to the cost of the posaconazole for the same duration of 1,350,130 SR. So, use of voriconazole would save 1.13 million SR and is more cost effective when used as antifungal prophylaxis in AML/MDS patients in comparison to posaconazole although later is category 1 recommended antifungal prophylaxis in international guidelines Conclusion Our study has shown that both posaconazole and voriconazole have comparable efficacy and safety in the prevention of IFD in AML and MDS receiving chemotherapy but voriconazole is more cost effective Disclosures All Authors: No reported disclosures