PSHP 2026 Residency Conference

This study assessed whether low-dose versus high-dose intravenous (IV) methylprednisolone may affect clinical response in emergency department (ED) patients presenting with an acute asthma or COPD exacerbation and a high eosinophil count.  


This single-center, retrospective cohort study included adult patients who presented to the ED with an acute asthma or COPD exacerbation and received IV methylprednisolone with a baseline eosinophil count greater than or equal to 3% or 300 cells/mcL. Patients were stratified into two groups, low-dose versus high-dose (< 40 mg or >40 mg of IV methylprednisolone), based on the initial dose of steroid that was administered in the ED. The primary endpoint was to compare Intensive Care Unit (ICU)-free days within a 28-day period. Key secondary endpoints measured include baseline eosinophil count, supplemental oxygen, hospital length of stay, and patient disposition. Cumulative correctional insulin use within 72 hours of initial methylprednisolone administration was evaluated as a surrogate for dose-dependent steroid-related adverse effects.  


Among 50 patients, 25 received low-dose and 25 received high-dose corticosteroids in the ED. Mean ICU-free days at 28 days were similar between groups (27.9 ± 0.34 vs 27.5 ± 1.22; p =0.577). The high-dose group had a higher baseline eosinophil count (median 6.1% [500 cells/mcL] vs 4.3% [400 cells/mcL]) and more patients on supplemental oxygen at baseline (6 vs 3). Hospital length of stay was longer in the high-dose group (4.15 vs 3.57 days; p=0.638), and more patients required ICU admission (5 vs 1 patient; p=0.172). Additionally, cumulative correctional insulin use within 72 hours was higher in the high-dose group (median 22 [IQR 2.5-50]) vs 10 [IQR 1.5-61.5]). 


Low-dose IV methylprednisolone demonstrated similar outcomes to high-dose therapy. Patients receiving higher doses appeared more clinically complex at baseline, with higher eosinophil counts and greater oxygen requirements. No significant differences in patient outcomes were observed. This study may support lower corticosteroid dosing in eosinophilic exacerbations to reduce potential steroid-related harm while maintaining clinical effectiveness. 

Purpose: Tenecteplase (TNK) is guideline-recommended for acute ischemic stroke (AIS) but carries a risk of symptomatic intracranial hemorrhage (sICH). The purpose of this study is to analyze risk factors for sICH after TNK administration in AIS. 
Methods: This is a retrospective, IRB approved, observational analysis of hospitalized adults who received intravenous TNK for AIS. Key exclusion criteria include lack of repeat imaging, known factor deficiency, or clotting disorder. The primary objective is the incidence of sICH after TNK administration. Secondary objectives encompass: identifying factors associated with hemorrhagic conversion (time from last known normal to TNK administration, time from stroke activation to TNK administration, age > 80 years, NIHSS > 25 or <5, large vessel occlusion, underwent mechanical thrombectomy, smoker, atrial fibrillation, diabetes antiplatelet use and anticoagulant use within past 7 days) and incidence of completing CTH 24 hours after IV thrombolytic was given per protocol. 
Results: In the 153 patients included, 11 (7.2%) patients developed a sICH after receiving TNK. Age greater than 80 years (p=0.003), antiplatelet use (p=0.019), and NIHSS > 25 (p=0.042) were considered to be potential contributing factors recognized as an increased risk after receiving TNK. Interestingly, patients who received an anticoagulant within the 7 days preceding TNK therapy were associated with a lower risk of developing a sICH, although it was not statistically significant (p=1.000). Thirty patients (19.6%) did not receive a repeat CTH 24-hours after receiving TNK, which is required per hospital protocol for thrombolytic use in

Evaluate if time to first non-benzodiazepine antiseizure medication (ASM) correlates with the rate of intensive care unit (ICU) admissions in patients presenting with status epilepticus (SE) at Thomas Jefferson University Hospital (TJUH). 


This single-center, retrospective chart review included adult patients presenting with SE to the emergency department (ED) at TJUH between April 2022 and April 2024. Records from the electronic health record were reviewed for eligibility. The primary objective was ICU admission rates in patients receiving a non-benzodiazepine ASM <30 vs ≥30 minutes. Secondary outcomes included ED length of stay (LOS), ICU LOS, hospital LOS, progression to refractory SE, cases of intubation, guideline-directed ASM loading dose administered, administration as intravenous (IV) push vs IV piggyback, medication procurement source, and ED pharmacist presence. Categorical variables were analyzed using chi-square or Fisher’s exact tests, and continuous variables using the Mann-Whitney U test. Multiple logistic regression controlling for Acute Physiology and Chronic Health Evaluation II (APACHE II) score and time to ASM administration was conducted. 


A total of 202 patient encounters were reviewed, of which 110 met inclusion criteria. Majority of patients were African American males. Among these, 22 encounters received ASM within <30 minutes, with a median APACHE II score of 22.5 and GCS of 4, while 88 encounters received ASM ≥30 minutes, with a median APACHE II of 8.5 and GCS of 9. ICU admission occurred in 86.4% of the <30-minute group and 45.5% of the ≥30-minute group (OR 7.6, 95% CI: 2.1–27, p<0.001). Median time to ASM was 19.5 vs 102 minutes. Median ED LOS was 2.71 vs 4.49 hours, ICU LOS 3.97 vs 0 days, and hospital LOS 7.39 vs 3.73 days, respectively. Higher rates of intubation, full loading doses, and drug procurement via automated dispensing systems were seen in the <30-minute group. Logistic regression showed time to non-benzodiazepine ASM was not associated with ICU admission, but higher APACHE II scores were independently associated (OR 1.272, 95% CI: 1.179–1.398). 


Early non-benzodiazepine ASM use was linked to higher ICU admissions, but there was no association after controlling for disease severity. Disease severity, demonstrated by higher APACHE II scores, were independently associated with increased ICU admission rates, particularly in patients receiving ASM <30 minutes. Further studies are needed to clarify the relationship between ASM timing and ICU admissions.

Purpose: The purpose of this study was to compare outcomes in obese patients with aerobic gram-negative rod (GNR) bacteremia treated with either high- or low-bioavailability antibiotics for oral stepdown therapy.
Methods: This retrospective single‑center cohort study compared clinical outcomes in adult patients with a body mass index ≥ 30 kg/m2 who received oral stepdown with either a high‑bioavailability (sulfamethoxazole-trimethoprim, fluoroquinolones) or low‑bioavailability (beta-lactams) agent for uncomplicated GNR bacteremia. All patient and clinical data were obtained from the electronic health record by automated reports and manual review, then compiled in Excel. Patients were identified from Lehigh Valley Health Network Cedar Crest, Muhlenberg, Hecktown Oaks, Hazleton, Schuylkill, Pocono, and Carbon campuses. The primary outcome was 30-day bacteremia recurrence, which was analyzed descriptively due to limited events. Secondary outcomes were 90-day bacteremia recurrence, 30- and 90-day all-cause mortality, length of stay, and 30- and 90-day all-cause readmission, which were analyzed using both descriptive and inferential statistics.
Results: A total of 203 individuals were included, with 127 in the high‑bioavailability group and 76 in the low‑bioavailability group. Urinary sources accounted for 75% of infections, E. coli for 66% of pathogens, and most patients received 3 days of IV therapy followed by 7 days of oral step‑down, typically with a fluoroquinolone (55%). No bacteremia recurrences occurred at 30 days, and only one recurrence was observed in the low‑bioavailability group at 90 days. All secondary outcomes were similar between groups, apart from all‑cause 30‑day readmission, which was higher in the high‑bioavailability step‑down group.
Conclusion: One 90‑day bacteremia recurrence occurred in a patient receiving oral cefpodoxime 100 mg twice daily, a notably low dose. The findings of this study suggest that oral stepdown for uncomplicated GNR bacteremia in obesity may be more nuanced than distinguishing between the bioavailability of agents. Clinical factors and real‑world dosing practices may influence outcomes, extending beyond what oral bioavailability alone can predict.

Identify whether oral third generation cephalosporins are as effective as standard of care, ceftriaxone or vancomycin, for the treatment of penicillin-non-susceptible, ceftriaxone-susceptible alpha-hemolytic Streptococcal infections. This retrospective chart review evaluated patients > 18 years old admitted to St. Luke’s University Health Network for treatment of penicillin-non-susceptible, ceftriaxone-susceptible alpha-hemolytic Streptococcal infections from January 2017 to December 2025.  Patients were included if they received parenteral-only therapy with ceftriaxone/vancomycin or oral transition therapy with cefpodoxime/cefdinir. Sterile cultures obtained from blood, fluid, and tissue were assessed. Patients were excluded if they had deep-seated and/or polymicrobial infections or were transitioned to comfort/hospice prior to treatment completion. The primary outcome was 90-day all-cause mortality. Secondary outcomes included recurrence of infection, hospital length of stay, and treatment-related adverse events. For analysis of continuous variables, the Student’s T-test or Mann-Whitney U Test were utilized and the Chi-square or Fisher’s exact test were conducted for categorical data. A total of 409 patients were screened. Of those, 43 were included in the IV group and 9 were included in the oral transition group. The gastrointestinal tract was the most common source of infection among both groups (42.3%) and most patients had secondary bacteremia (94.2%). No significant difference in all-cause mortality at 90-days was observed between the IV-only and oral transition therapy groups (9.3% vs. 11.1%; p = 1.00). In patients that received oral-transition therapy, the total duration of definitive therapy was significantly shorter (10 vs. 15 days; p < 0.01). The median hospital length of stay was significantly shorter in the oral-transition group (5 vs. 8 days, p < 0.05). No significant difference in adverse effects was observed between the groups. It remains unclear if there is a difference in all-cause mortality or recurrence of Streptococcal infections at 90 days between the IV-only and oral transition groups.  However, results suggest oral transition therapy with cefpodoxime and cefdinir may significantly reduce median hospital length of stay and total duration of definitive therapy.

Purpose: To compare the impact of polymerase chain reaction (PCR)-based and culture-based methicillin-resistant Staphylococcus aureus (MRSA) nasal swab testing on time to vancomycin de-escalation, test turnaround time, and cost-effectiveness.  
Methods: A multi-center, retrospective, observational pre-/post-implementation cohort study was conducted within two community hospitals in a large academic health system. The study evaluated hospitalized adults receiving empiric intravenous vancomycin for suspected pneumonia during March 1st to August 1st, 2024 (culture-based MRSA screening) and March 1st to August 1st, 2025 (MRSA nasal PCR screening). The primary outcome was time from MRSA screening test collection to vancomycin discontinuation. Secondary outcomes included test turnaround time, total vancomycin days of therapy, proportion of patients de-escalated within 36 hours, and rate of reinitiation of MRSA therapy during the admission. A cost analysis was also conducted.  
Results: Implementation of MRSA PCR testing significantly reduced the time from screening collection to vancomycin discontinuation. Median time decreased from 34.9 hours (IQR 25.8–51.0) pre-implementation to 18.8 hours (IQR 9.7–36.2) post-implementation (p < 0.001). Turnaround time was also significantly shorter with PCR (4.9 vs 28.3 hours, p < 0.001). While median total vancomycin days of therapy remained 2.0 days in both groups, the difference was still statistically significant (p = 0.004). De-escalation within 36 hours was numerically higher post-implementation (68% vs 51%, p = 0.132). 
Conclusions: Implementation of MRSA nasal PCR screening was associated with significantly faster test turnaround time and earlier discontinuation of vancomycin compared with culture-based screening. These findings support the use of rapid molecular diagnostics as a valuable tool in antimicrobial stewardship in the aim of timely de-escalation of empiric anti-MRSA therapy in patients with suspected or confirmed pneumonia.

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Purpose: The incidence of delayed infusion reactions from PV is unknown. The label recommends post-infusion monitoring for delayed infusion reactions. This study investigates the incidence and characterization of delayed infusion reactions with PV. 


Methods: This is an IRB approved, single-institution, retrospective, cohort study utilizing electronic health record data within the Penn Medicine health system. All adult patients who received a dose of PV between June 10th, 2019, and August 31st, 2025 were included for analysis. Data collected included patient and disease demographics, infusion administrations, and infusion reaction event documentation. The primary endpoint was the incidence of delayed infusion reactions occurring within 72 hours after infusion completion. Secondary endpoints include symptom characterization of delayed infusion reactions, time of onset of delayed infusion reactions, incidence and symptom characterization of all infusion reactions, and ambulatory infusion chair time. Analyses of primary and secondary endpoints were conducted using descriptive statistics. 


Results: Overall, 352 patients with lymphoma were included, and a total of 1310 infusions of PV were administered. The frequency of delayed infusion reactions was 0.5% (6/1310) of total infusions occurring in 1.4% (5/352) of total patients. Of these reactions, 33% (2/6) and 66.7% (4/6) were CTCAE grade 1 and 2, respectively. Median time to delayed reaction onset was 30 minutes (IQR 25-63). Frequency of delayed infusion reactions occurring on first infusion was 50% (3/6) and one reaction occurred each with 2nd, 3rd, and 4th doses. Median chair time for regimens consisting of first and subsequent PV administrations was 6 (IQR 4–8) and 5 (IQR 4– 6) hours respectively. 


Conclusion: To our knowledge, this is the first characterization of delayed infusion reactions to PV. We determined the incidence of delayed infusion reactions to be 0.5% out of 1310 infusions. Of those who experienced delayed reactions, all were grade 2 or lower requiring minimal intervention, and no resulting hospitalizations were reported secondary to events. Our results suggest that observation post-PV infusions may be potentially mitigated or omitted. 


Authors: Michael P. Roney, PharmD; Oxana Megherea, PharmD, BCOP; Niti Patel, PharmD, BCOP; Mitchell E. Hughes, PharmD, BCOP

Purpose
The care of oncology patients is complex, requiring multidisciplinary support. Due to the complex nature of these patients, a pilot project was implemented to assess the value of a clinic based pharmacist to support solid tumor patients.  


Methods
For a three-week period, a PGY-2 hematology/oncology pharmacy resident was embedded into the medical oncology clinic space. During this time the resident provided patient education, worked with the oncology providers, and developed quality improvement projects. Patient education was provided to all solid tumor patients prior to the start of their first cycle and follow up calls were made about 1 week after chemotherapy. All interventions were tracked within the patient chart, and categorized as patient education, drug information, medication error, toxicity management, medication reconciliation, or chemotherapy adjustment. Interventions were then examined and based on previously published data, cost value associations were assigned to each to determine a return on investment. In addition, the resident met with physicians to discuss quality improvement projects that a pharmacist could assist with or champion.
 
Results
During the pilot period 160 pharmacist interventions were made. Of these 160 interventions, 39 separate patient educations were completed, 34 chemotherapy regimens were adjusted, 17 chemotherapy toxicities were managed, 29 medication reconciliations were completed, and 35 drug information questions were answered, 13 of which were related to antimicrobial stewardship. For the 160 interventions made over the course of the 3 weeks, cost savings were estimated to be $76,976. This results in an estimated annualized cost savins of $1,334,651. Two quality improvement projects were identified, one focused on developing a standardized pathway for prescribing bone modifying agents and a second focused on patient education.  


Conclusion 
The addition of a clinical pharmacist in solid tumor clinics offers both cost savings and improved quality of care. These savings can offset the added FTE while providing enhanced clinical support to providers, improving patient satisfaction, and driving ongoing advancements in patient care. 

Purpose 
The purpose of this retrospective review is to compare hematologic and iron-related responses between traditional 1000 mg iron courses, and high dose courses. The goal is to inform optimal dosing strategies and maximize clinical outcomes.
Methods 
This single center, retrospective study evaluated patients who received IV iron between January 1st 2024 and December 31st 2024 at Thomas Jefferson University. Patients were divided into two arms based on total IV iron dose: 1000 mg or 1500 mg. Exclusion criteria was applied removing comorbidities and incomplete records, with final patients case-control matched on: ferritin, baseline hemoglobin (hgb), age, and gender. The primary outcome was mean change in hgb from baseline to between 4-52 weeks post infusion. Secondary outcomes included changes in relevant iron labs (ferritin, transferrin saturation (TSAT), total iron binding capacity (TIBC), iron, and hematocrit (Hct)) and regression analysis of variable associated with change in hgb greater than the 25th percentile (>P25).  


Results 
From 3,508 patients, 591 met eligibility after exclusions. A random sample of 300 patients (150 per arm) were chart reviewed, with exclusions for missing data yielding 213. After matching 166 patients, 83 in each arm, were used for analysis.  IV iron formulation was the significant demographic, with 76 vs 0 receiving ferric carboxymaltose in 1500 mg vs 1000 mg arms respectively. Mean Hgb increased by 3.4 vs 2.7 g/dL (p=0.002) in the 1500 mg vs 1000 mg arms respectively. Greater improvements in Hct, iron, TSAT, TIBC, and ferritin (p<0.01), were

Purpose: Bromocriptine is hypothesized to have an antipyretic effect in patients with neurogenic fever, however the evidence is limited to small retrospective studies. This study aimed to evaluate the impact of bromocriptine on neurogenic fever.


Methods: This retrospective chart review included adult patients admitted to the neurological intensive care unit (ICU) who received at least one dose of bromocriptine for suspected neurogenic fever between 6/1/2020 and 6/1/2025. The primary outcome was the change in maximum body temperature (Tmax) from the 24-hour period prior to bromocriptine administration (day 0) to the 48-to-72-hour period after initial administration (day 3). Secondary outcomes included change in Tmax from day 0 compared to 0 to 24 hours after administration (day 1) and 24 to 48 hours after administration (day 2), duration of fever, ICU length of stay (LOS), hospital LOS, and mortality during and 30 days after bromocriptine administration. Outcomes were analyzed by Mann-Whitney U test.


Results: A total of 75 patients were included in the analysis with a median age of 53 years. Administration of bromocriptine resulted in a significant decrease in temperature on day 3 (38.8 ºC vs 38.2 ºC, p < 0.001). The median dose of bromocriptine administered was 15mg on day 1, 30mg on day 2, and 40mg on day 3. Patients with a traumatic injury (n=22) had a greater reduction in fever compared to those with a non-traumatic injury at 72 hours (-0.8 ºC vs -0.5 ºC, p=0.002). The median duration of fever was 2 days. Hypotension occurred in 27 patients after administration, and 20 patients experienced nausea.


Conclusion: In patients with suspected neurogenic fever, bromocriptine may be an option for temperature reduction when added to other antipyretics. Patients with traumatic injury demonstrated a greater reduction in fever, suggesting greater efficacy in this population. Further investigation into dosing strategies is needed


IRB Approval: This study went through IRB approval and received exempt status.

Purpose: The purpose of this research project is to determine lorazepam-equivalent usage with a gabapentin taper compared to no gabapentin taper in the inpatient management of alcohol withdrawal syndrome. 


Methods: This was a retrospective chart review that was approved by the Jefferson Health Institutional Review Board and conducted from January 1, 2024 to December 31, 2024. Patients were identified by initiation on the alcohol withdrawal scale (AWS) protocol. The study was divided into 2 groups: gabapentin and benzodiazepine or benzodiazepine-only. The primary endpoint was lorazepam-equivalent usage with a gabapentin taper compared to no gabapentin taper. Secondary outcomes included time from admission to AWS protocol initiation, time from AWS protocol initiation to gabapentin start, time to resolution of AWS symptoms, and length of stay in days from admission to discharge. A subgroup analysis of the primary endpoint was conducted among patients who received the appropriate gabapentin taper according to the AWS protocol.  


Results: A total of 400 patients were screened for study inclusion, 70 patients met criteria for evaluation, and 35 patients were included in each group. The median lorazepam-equivalent usage (mg) during the withdrawal period was statistically significantly higher in the gabapentin and benzodiazepine group than in the benzodiazepine-only group (20 vs 3.10; p = 0.020). Among the 23 patients who received the appropriate gabapentin taper, the median lorazepam-equivalent usage (mg) was statistically significantly higher in the gabapentin and benzodiazepine group than in the benzodiazepine-only group (18 vs 3.10; p = 0.032). None of the secondary endpoints in the primary or subgroup analyses were statistically significant. 


Conclusion: Benzodiazepine utilization in the management of alcohol withdrawal syndrome was not reduced by the addition of a gabapentin taper. Further research is needed to fully evaluate the benzodiazepine-sparing potential of gabapentin and to develop a standardized regimen for alcohol withdrawal management.

Evaluate the safety and efficacy of fixed dose versus titratable vasopressin infusions in critically ill patients with septic shock by comparing rebound hypotension when stopping fixed dose vs. weaning titratable vasopressin infusions. 


This retrospective cohort study reviewed patients in a medical/surgical ICU at a community hospital from October 1, 2023 to October 1, 2024 and January 1, 2025 to January 1, 2026. Adults with septic shock who received vasopressin and norepinephrine were included. Exclusion criteria included use of other catecholamines at wean, vasopressor withdrawal due to death or comfort care, mechanical circulatory support, or non-adherence to vasopressin orders. The primary endpoint was rebound hypotension defined as MAP ≤ 60 mmHg with an intervention to improve blood pressure within six hours of vasopressin discontinuation or dose reduction. Secondary endpoints included MAP changes after vasopressin discontinuation, vasopressor duration, time to vasopressor wean, time on mechanical ventilation, and ICU length of stay. Exploratory endpoints compared rebound hypotension when vasopressin or norepinephrine was discontinued first. 


A total of 78 patients were included in the analysis, with 43 in the fixed‑dose (FD) group and 35 in the titratable (TD) group. The primary outcome was met by 20 (47%) patients in the FD group and 23 (61%) patients in the TD group. There was no significant difference in rebound hypotension between groups (OR, 0.82; 95% CI, 0.45–2.01; p = 0.666). When comparing FD vs. TD vasopressin, there was no difference in rebound hypotension based on the order of vasopressor discontinuation, whether vasopressin (p = 0.524) or norepinephrine (p = 0.747) was stopped first. Patients in the TD group demonstrated significantly shorter time to vasopressor wean (p ≤ 0.001), duration of mechanical ventilation (p = 0.010), and ICU length of stay (p = 0.006). 


Overall, there was no difference in the incidence of rebound hypotension in patients who underwent abrupt discontinuation of vasopressin and those who were down-titrated off the infusion. The order of vasopressor discontinuation did not affect the likelihood of rebound hypotension. These findings suggest that titratable vasopressin strategies may support more efficient critical care management with similar hemodynamic outcomes in septic shock. 

0.25 contact hour continuing education

0.25 contact hour continuing education

0.25 contact hour continuing education

Purpose:
To evaluate early transition (at day 3 or less) compared to late transition (after day 3) of intravenous (IV) to oral (PO) antibiotics on clinical outcomes. 


Methods:
This study utilized retrospective chart review of patients treated for CAP within Lankenau Medical Center (LMC). Adult patients were included if they met CAP criteria published in the IDSA guidelines and received at least 3 days of antibiotic therapy. Patients were excluded if they did not meet criteria for transition to oral therapy in IDSA CAP guidelines, transferred from another inpatient facility, had concomitant infection treatment, or admitted to an intensive care unit on the day of antibiotic initiation. The primary outcome compared 30-day readmission rates between patients transitioned to PO before and after day 3 of antibiotics. Key secondary outcomes were compared between these groups and included 90-day all-cause mortality, hospital length of stay, total antibiotic days of treatment, and Clostridium difficile infection at day 90. 


Results:
676 patients were screened for meeting criteria, of which 50 met inclusion criteria. Six of these patients met early transition criterion, with 44 qualifying for late transition. Baseline characteristics across the two treatment groups were similar in Charlston Comorbidity Index and Pneumonia Severity Index scores. Thirty-day readmission occurred in 8 (18.2%) of the late transition group, with no readmissions in the early transition group. One patient within the late transition group did have mortality at 90 days, while no patients within the early transition group met this criterion. Both treatment groups had a median length of hospital stay of 5 days. 


Conclusion:
For patients meeting IDSA criteria, early transition to oral antibiotics in CAP patients was associated with decreased 30-day readmission rates as compared to late PO transition.

Purpose: Ideal timing of preoperative antibiotic administration in relation to incision time remains unclear. This study aims to evaluate optimal timing of preoperative antibiotic administration to mitigate the risk of surgical site infection (SSI).


Methods: This study was a retrospective, case-control trial evaluating 993 adult patients admitted to St. Luke’s University Health Network for a surgical procedure between January 2022 and December 2024. Patients were included at a 1:4 case-to-control, with cases defined as patients who developed a SSI, and controls defined as patients without subsequent SSI. Patients were excluded if they did not receive preoperative antibiotics, received preoperative antibiotics > 120 minutes prior to incision, underwent more than one procedure during index hospitalization, or had a preexisting infection at time and anatomical site of index procedure. The primary outcome was SSI rate by preoperative antibiotic administration time. Secondary outcomes included admission for SSI, hospital length of stay, readmission for SSI, and mortality at 30 and 90 days post-operation. SSIs were categorized based on National Healthcare Safety Network (NHSN) definitions.


Results: Cefazolin was the most frequent preoperative antibiotic administered (863 of 993 cases). Preoperative administration time was evaluated at 15-minute intervals, with time 0 being start of procedure. The SSI rate when cefazolin was administered before or at 45 minutes prior to procedure was significantly lower than the SSI rate when cefazolin was administered beyond 45 minutes (18.5% vs 44.4%, P = 0.005). The majority of patients presenting with a SSI were admitted for inpatient management (67.6%). In the subgroup analysis, cefazolin was associated with a significantly lower rate of SSIs compared to clindamycin (P = 0.013).


Conclusion: Cefazolin should be administered within 45 minutes of procedure initiation to best mitigate the risk of SSIs. Cefazolin was associated with a lower rate of SSIs compared to clindamycin, supporting its use as the preoperative antibiotic of choice.


IRB approval: yes 

Purpose:
This study evaluates the impact of reduced-dose amikacin liposome inhalation suspension (ALIS) on treatment outcomes in patients with pulmonary nontuberculous mycobacteria (NTM) infections who may experience treatment intolerance. 


Methods:
This was a retrospective, descriptive study. Eligible patients started ALIS therapy from September 1, 2018-June 30, 2024, and filled ALIS through the health system specialty pharmacy. Patients must have completed at least 6 months of ALIS therapy by June 30, 2025. Data was sourced through the pharmacy software system, and data collection was conducted through chart review. Patient adherence was quantified by a percentage of days covered (PDC), calculated based on refill history. The primary outcome was prevalence of negative cultures with various dosing strategies. Secondary outcomes included the incidence of culture reconversion up to one year after the first negative culture conversion or at the end of the study period, new culture resistance, number of patients with reduced ALIS dosing strategies, reasons for ALIS dose adjustments, and total duration of ALIS treatment.  Descriptive statistics were used to report outcomes. 


Results:
30 patients were included in this study and 17 (56%) were considered adherent to daily dosing based on a PDC of >80%. Overall, 24 (80%) patients achieved culture conversion, with 12 of 17 patients in the >80% PDC group and 12 of 13 in the <80% PDC group. Median time to culture conversion was 178.5 (117-216.5) days. Median time to culture conversion in the >80% PDC group was 201 (105-247.25) days vs.146 (122.5-210.75) days in the <80% PDC group. There were 12 (20%) patients with culture reconversion, with 6 of 17 patients in the >80% PDC group and 6 of 13 in the <80% PDC group. One patient (3.3%) developed new resistance to amikacin. There were several reasons for dose adjustment, with the most frequent reason being adverse effects. 


Conclusion:
Dose adjustments of ALIS did not appear to influence the rate of culture conversion in this study. There was a limited impact on resistance or duration of ALIS treatment. This suggests dose adjustment strategies may be an option for patients with adverse effects; however, further research is needed.

Purpose: Given the opportunity to optimize micafungin therapy in obese patients, our institution established a new protocol that recommends high doses for patients > 125 kg. We aimed to evaluate the outcomes associated with this new protocol.
 
Methods: This is a retrospective cohort study of patients at Thomas Jefferson University Hospital Inc locations from December 2024 to March 2026. Patients were included if they were 18 years or older, had documented invasive candidiasis, and received micafungin for 3 or more days. Patients were excluded if they had a concomitant infection within 7 days, were given empiric combination antifungal therapy, or had Candida species isolated from the genitourinary tract. Outcomes will be compared between patients weighing ≤ 125kg, patients weighing > 125kg on standard dose micafungin, and patients weighing > 125kg on high dose micafungin. The primary outcome is a composite of all–cause 90-day mortality, microbiologic and clinical cure, and incidence of recurrent infections within 30 days. The secondary outcomes are 30-day infection related readmission, duration of micafungin treatment, hospital and ICU length of stay and duration of candidemia.
 
Results: A total of 318 positive Candida cultures were identified and of those, 271 patients were removed to meet the exclusion criteria. Therefore, the study cohort included a total of 42 patients with 40 patients in the ≤ 125kg group, 1 patient in the > 125kg with standard micafungin dose group, and 1 patient in the > 125kg with high micafungin dose group. No difference was seen with the primary composite outcome between the cohorts (p=0.448). Due to low enrollment, exploratory analysis was performed utilizing binomial linear regression. When including mg/kg dosing as a continuous variable and analyzed it with other impactful and confounding variables, we did not find that it added significantly to the model. 
 
Conclusion: Our results from a very limited data set suggest that increased micafungin dosing in obese patients was not associated with improved clinical outcomes for invasive candidiasis. Exploratory analysis did not suggest that higher micafungin dosing (measured in mg/kg) provided additional benefit. Our institution will continue to collect data, in hopes of generating a greater sample size. Larger studies are required to confirm these results. 

Abstract Title: Evaluation of Guideline-Recommended Weight-Based Initial Vancomycin Dosing in Septic Patients and the Effects on Therapeutic Level Achievement and Clinical Outcomes
Purpose: This study was designed to evaluate guideline-recommended weight-based initial vancomycin dosing of 25 mg/kg in septic patients and the effects on therapeutic level achievement and clinical outcomes.  
Methods: Institutional Review Board approval was obtained for this retrospective observational chart review. Patients were identified based on the order set utilized by providers for vancomycin loading dose. The order set used prior to September 2023 allowed providers to order a maximum loading dose of 1,500 mg, while the new sepsis order set guides providers to order 25 mg/kg loading doses with a maximum dose of 3,000 mg. Data was collected from March 1^st 2023, through March 31^st, 2025. The primary outcome is to determine if sufficient loading doses of vancomycin in septic patients result in faster achievement of therapeutic levels. Secondary outcomes include the rate of patients who experienced nephrotoxicity, time to administration of loading doses, length of stay, 30-day mortality, critical care admission, and the rate of MRSA bacteremia. Data analysis was completed with descriptive statistics, Wilcoxon Sum Rank test and Chi-squared test. 
Results: Initial vancomycin doses of 25 mg/kg, based on total body weight, in septic patients results in faster therapeutic achievement (p-value 0.000004) and lower rates of acute kidney injuries (p-value 0.005). The time from order to administration of initial vancomycin doses in the post-implementation group was about 25 minutes faster than the pre-implementation group and was almost one day shorter for the average length of stay compared to the pre-implementation group. In the pre-implementation group, the average loading dose was 15.5 (SD of 3.1) and the average AUC was 365.3 mg/h/L (SD of 122.6). In the post-implementation group, the average loading dose was 20.1 (SD of 4.4) and the average AUC was 419.9 (SD of 95.2).
Conclusion: Increased initial vancomycin doses resulted in faster therapeutic achievement and lower rates of acute kidney injury. There were no statistically significant differences between 30-day mortality, admission to critical care unit, MRSA bacteremia, time from order to administration and length of stay. Results support updating non-sepsis vancomycin order sets to increase the initial dose, as well as promoting batching larger vancomycin doses. 
Authorship: Paige de Fremery, PharmD; Miranda Cason, PharmD, BCPS; Troy Albrecht, PharmD, BCPS, BCIDP

Purpose:  
The purpose of this study is to evaluate the impact of prophylactic anti-Xa monitoring on rates of venous thromboembolism (VTE) events and bleeding in trauma patients at a level one trauma center.  
 
 
Methods:  
This retrospective cohort study includes patients admitted to the trauma surgery service from January 2019 – July 2025 treated with enoxaparin for VTE prophylaxis. Exclusion criteria includes patients who spent 48 hours or more at a referring facility before transfer or an anti-Xa level collected before 3.5 hours of after 6.5 hours from last enoxaparin dose. Patients were identified via an Enterprise Information Management report, data was extracted from the electronic health record using REDCap, and statistical analysis was completed using Microsoft Excel. The primary outcome is rate of thromboembolic events, and secondary outcomes include rates of bleeding, units of red blood cells transfused, ICU and hospital length of stay (LOS). Categorical data is compared using a chi-squared test, and continuous data is reported using descriptive statistics. The study is IRB exempt by the institutional review board at the study site.  
 
Results:  
A total of 196 patients are included in the study; 91 received anti-Xa monitoring and 105 patients did not. No statistically significant differences in rates of VTE events were observed between patients who received anti-Xa monitoring compared with those who did not (9.9% vs 7.6%, p-value 0.573). Rates of bleeding were higher in the anti-Xa monitoring group (44.0% vs 26.7%, p-value 0.01). Patients who received anti-Xa monitoring were more likely to have missed doses of enoxaparin (56.0% vs 41.0% p-value 0.03) and had a longer median ICU LOS (13.6 days vs 6.3 days). In patients receiving anti-Xa monitoring, 48/91 (52.7%) patients had an initial anti-Xa within the goal range, and only 3/91 (2.2%) had an anti-Xa above the goal range.  
 
 
 
Conclusion: 
Anti-Xa monitoring did not result in a difference in VTE events and was associated with higher bleeding rates. However, the anti-xa monitoring group had more missed doses of enoxaparin and longer ICU length of stay, which are risk factors for VTE events. This suggests that patients who received anti-xa monitoring likely had a greater severity of illness, leading to higher rates or bleeding, despite not having supratherapeutic anti-xa levels.  

PURPOSE: This study evaluates the incidence of bradycardia following dexmedetomidine initiation in critically ill patients and identifies clinical predictors and dosing patterns to inform monitoring and optimize sedation practices.
METHODS: This retrospective chart review included critically ill adult patients who received a dexmedetomidine infusion for greater than 2 hours admitted to a non-cardiac intensive care unit (ICU) from November 1st, 2024 to November 1st, 2025. The primary outcome was the incidence of bradycardia defined as less than 60 beats per minute (bpm) following dexmedetomidine initiation. Secondary outcomes included incidence of severe bradycardia (less than 40 bpm or requiring clinical action), incidence of hypotension, time to first bradycardic event, dose and duration of infusion, liver function on ICU admission, body mass index (BMI) at time of infusion initiation, and concomitant use of vasoactive or rate-controlling medications. Descriptive statistics were used to summarize primary and secondary outcomes, and a binary logistic regression was performed as an exploratory analysis to identify predictors of bradycardia.
RESULTS: Seventy patients were included, with bradycardia occurring in 25 patients (35.7%). Severe bradycardia occurred in 2 patients (2.9%). Median time to first bradycardic event was 6.33 hours [2.93, 10.45]. Median infusion duration was 28.1 hours [14.6, 72], and mean infusion rate was 0.99 ± 0.48 mcg/kg/hr. Hypotension occurred in 41 patients (58.6%), and vasopressor therapy was continued or initiated in a subset of patients during infusion. In a binary logistic regression, higher heart rate on hospital admission was associated with increased odds of bradycardia [p=0.013, (OR 1.046, 95% CI 1.010-1.084)], while higher heart rate at dexmedetomidine initiation was associated with decreased odds of bradycardia [p=0.004 (OR 0.936, 95% CI 0.896-0.979)].
CONCLUSION: Bradycardia occurred in over one-third of critically ill patients receiving dexmedetomidine. Baseline heart rate predicted bradycardia risk, with effects varying based on when it was measured, as higher heart rate on hospital admission increased risk while higher heart rate at dexmedetomidine initiation was associated with lower risk. These findings highlight the need for patient-specific assessment and close monitoring during therapy.
IRB Approval: iRISID-2026-0188

0.25 contact hour continuing education

0.25 contact hour continuing education

0.25 contact hour continuing education