Presentation Outline ICHP Annual Meeting September 13-15

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Bode L et al. NEJM 2010 Evidence: Surgical Patients Evidence: Surgical Patients Evidence: Inpatient ICU MRSA Colonization - Infection Control Fraser TG et al. Infect Control Hosp Epidemiol 2010. Bode L et al. NEJM 2010 Bode L et al. NEJM 2010 Evidence: Surgical Patients Evidence: Surgical Patients Departments included: internal medicine, cardiothoracic surgery, vascular surgery, orthopedics, gastrointestinal surgery, or general surgery Evidence: Inpatient ICU MRSA Colonization - Infection Control Fraser TG et al. Infect Control Hosp Epidemiol 2010. 8/29/2012 3
Evidence: Inpatient ICU MRSA Colonization - Infection Control • Forty-five US hospital currently participating in a cluster randomized trial • Prevention of MRSA infection in ICUs 1. Positive screening cultures of ICU admission � contact precaution 2. Positive screening cultures of ICU admission � decolonization 3. Universal decolonization of ICU admission without screening Platt R et al. Med Care 2010 Evidence: Recurrent Skin and Soft Tissue Infections – Community-associated MRSA • Recurrent SSTI despite optimizing wound care/hygiene measures • Ongoing transmission among household members or close contacts despite optimizing wound care/hygiene measures • Decolonization strategies should be offered in conjunction with ongoing reinforcement of hygiene measures • Mupirocin twice daily for 5-10 days • Mupirocin twice daily for 5-10 days and topical body decolonization regimens with a skin antiseptic solution (eg, chlorhexidine) for 5–14 days or bleach baths • Evidence: CIII Liu C, et al. CID 2011 Tenover FC. AAC 2012 Mupirocin Resistance in the US Evidence: Recurrent Skin Soft Tissue Infections – Community-associate MRSA Liu C, et al. CID 2011 Mupirocin for Decolonization • Clinical and epidemiological outcomes influencing use – Perioperative eradication of S. aureus colonization – Controlling for HA-MRSA and transmission – Incidence of CA-MRSA • Learning from others – UK – screening includes all hospital admissions – Utilizing much more mupirocin – UK - high-level mupriocin resistance ~ 12% • MICs >/= 512 mg/mL • Independently associated with decolonization failure • Selection of increased drug resistance in S. aureus – Plasmid carrying resistance determinants to other antimicrobial agents, including macrolides, gentamicin, tetracycline, and trimethoprim References 1. Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice L, et al. Bad Bugs, No Drugs: No ESKAPE! An Update from the Infectious Diseases Society of America. Clinical Infectious Diseases 2009;48:1–12. 2. Rybak M, Lomaestro B, Rotschafer JC, Moellering R.,Craig W,Billeter M, et al. Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health-Syst Pharm. 2009; 66:82-98. 3. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children. Clinical Infectious Diseases 2011;1–38. 4. Styers D, Sheehan DJ, Hogan P, Sahm DF. Laboratory-based surveillance of current antimicrobial resistance patterns and trends among Staphylococcus aureus: 2005 status in the United States. Ann Clin Microbiol Antimicrob 2006;5:2. 5. Wyllie DH, Crook D, Peto T. Mortality after Staphylococcus aureus bacteraemia in two hospitals in Oxfordshire, 1997-2003: cohort study. BMJ 2006; BMJ 2006;333:281. 6. Kluytmans JA, Mouton JW, VandenBergh MF, Manders MJ, Maat AP, Wagenvoort JH, et al. Reduction of surgicalsite infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol. 1996 Dec;17(12):780-5. 7. van Rijen M, Bonten M, Wenzel RP, Kluytmans J. Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review. JAC 2008;61:254. 8. Bode LGM, Kluytmans JAJW, Wertheim HFL, Bogaers B, Vandenbroucke-Grauls CM, Roosendaal R, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010; 362: 9–17. 9. Fraser TG, Fatica, C, Scarpelli, M, Arroliga, AC, Guzman J, Shrestha,NK. Decrease in Staphylococcus aureus Colonization and Hospital- Acquired Infection in a Medical Intensive Care Unit after Institution of an Active Surveillance and Decolonization Program Infect Control Hosp Epidemiol 2010; 31(8):779-783. 10. Platt R, Takvorian SU, Septimus E, Hickok J, Moody J, Perlin J, et al. Cluster Randomized Trials in Comparative Effectiveness Research: Randomizing Hospitals to Test Methods for Prevention of Healthcare-Associated. Med Care 2010;48: S52–S57. 11. Tenover FC, Tickler IA, Goering RV, Kreiswirth BN, Mediavilla JR, Persing DH. Characterization of Nasal and Blood Culture Isolates of Methicillin-Resistant Staphylococcus aureus from Patients in United States Hospitals Antimicrob. Agents Chemother. 2012, 56(3):<strong>13</strong>24. 8/29/2012 4
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ACTIVITY DESCRIPTION Target Audienc
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Current Challenges • Expansion of
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Examples of Medication Consideratio
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Etiology (Dana Point, 2008) 1’. P
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PAH Therapy Targets Schulze-Neick I
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Chronic Adjuvant Therapies in PAH D
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Cummulative suurvival Survival in I
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ACCF/AHA Consensus PAH Treatment Al
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Study Name Drug SUPER-1 Oral silden
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IV Epoprostenol in PAH Due to Scler
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70 60 50 40 30 20 10 Inhaled Ilopro
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Conclusions • PAH therapy improve
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ESC/ERS Guidelines Galie N, et al.
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FUTURE DIRECTIONS WHICH MAY IMPACT
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Rationale for “Front-Loaded” Ap
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Addressing gthe Challenges g in PAH
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Considerations • Central vs. peri
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Pulmonary Hypertension • Approxim
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Example Cassette Calculations • V
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Assessment Question 1 Which of the
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Illinois Council of Health‐System
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Patient Activity ‐ 1 Patients in
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Hospitalists National Trends • Ja
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Pharmacy Landscape • PGY‐2: So
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Primary Care Physicians by Field, F
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Health Systems Pharmacy and TATAI
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Readings The 21 Irrefutable Laws of
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What is a “Practice Model”? •
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Completing the Self Assessment •
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Residency trained (B23p) Illinois N
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Solving the PPMI Puzzle ‐ Here Ar
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Overview of Value Based Purchasing
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Implementation of Medication‐ rel
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Question #1 Within which programs a
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Solving the PPMI Puzzle‐ Here are
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Discharge Education/Med Rec • New
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Media‐Worthy Trials? Making Sense
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Prevention of Recurrent VTE • Unp
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VTE recurrence during study period
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Which patient might be a candidate
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Azithromycin and CV Death • Endpo
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Azithromycin and CV Death Azithromy
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Hormonal Contraception and VTE •
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• Age • Calendar year • Educa
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ARR=2.20, 2.28 for stroke, MI when
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Which of the following combinations
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3 Months of Treatment for Latent TB
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3 Months of Treatment for Latent TB
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T/F: Rifapentine in combination wit
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2. Which of the following statement
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Fitting the Counseling Piece into M
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Current Evidence: Implementing Bund
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Teach Back Process • Step 1 Expla
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Questions for Consideration and Dis
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Why do we care about ADE? • Adver
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True or False • Medication errors
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Check Point Which of the following
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Proactive Screening Process Patient
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MTI Pilot at NAH PharmD Students tr
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ASHP PPMI Case Study Adding Value:
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Interdisciplinary Teamwork: How Phy
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Highly Effective Healthcare • Wha
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Inter‐Professional Teams ‐ Chan
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Meeting the PPMI Goals for Technolo
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Drug‐Bug Mismatch Example Con’t
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Drug‐Bug Mismatch Build Rules •
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Patient Scanning Compliance Sample
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Global Immunizations 3 • Jan 2012
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Mobile Devices: Beyond Angry Birds
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Google Play • Google Play - Inter
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Other Useful Productivity Apps •
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Mobile Devices: Beyond Angry Birds
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Net Activations by Industry Source:
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News Readers/Aggregators Features S
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Contact Information • E‐mail: -
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Early‐Onset Sepsis • Sign and s
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• BR is on day 2 of cefotaxime wi
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Immunizations: The Superheroes to P
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Current ACIP Recommendations Influe
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Herpes Zoster Vaccine Recommendatio
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Assessment Questions 1. What are th
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HIV Linkage and Retention in Care T
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DHHS Guidelines, March 2012: When t
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Protease Inhibitors • Require “
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Mean Change (mg/ /dL) STARTMRK: Lip
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RAL Drug Interactions • Does not
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Instructions for Credit In order to
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Staging Stage Criteria (Durie‐Sal
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Salvage Therapy Partial List Regime
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Bortezomib-Thalidomide-Dexamethason
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Case 2 ST is a 76 y/o African Ameri
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Thalidomide and Lenalidomide • Ad
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Page 191 and 192: New Drugs 2012 Anna Nowobilski‐Va
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Page 197 and 198: NEW DRUGS AND BIOLOGICALS 2012 RESO
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Page 201 and 202: Chronic Obstructive Pulmonary Disea
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Page 211 and 212: Unraveling Unraveling The The Puzzl
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Page 237 and 238: Error Potential • Inadvertent IV
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Page 255 and 256: Special thanks to: • Carol Heunis
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Page 269 and 270: Questions? Residency Project Pearls
Page 271 and 272: The Interview: Your Preparation •
Page 273 and 274: PGY1 Residency Options Carol Heunis
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Page 283 and 284: Piecing together the new CHEST guid
Page 285 and 286: Initiating therapy CHEST 2012 2.1.8
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What would you do for JJ? • A. Ho
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Considerations for SB • Bleeding
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Presentation Outline ICHP Annual Meeting September 13-15

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