Background: Community acquired pneumonia (CAP) is one of the leading causes of hospitalization in the United States.[1] In an effort to improve the quality of care for this resource-intensive disease, our institution implemented a clinical decision support (CDS) pathway for CAP comprised of three phases: (1) education on best practices, (2) education and a CDS [...]

Background: Outpatient parenteral antimicrobial therapy (OPAT) is common among patients requiring intravenous antibiotics beyond hospitalization. However, OPAT is associated with catheter-related adverse events (AEs), which occur more frequently than drug-related AEs and may lead to care interruptions or harm. We compared AEs related to the most common venous catheters used for OPAT: midline catheters (midlines) [...]

Background: Inappropriate diagnosis of urinary tract infections (UTI) contributes to antibiotic overuse. We previously validated and refined a patient safety measure that defines inappropriate diagnosis of UTI (i.e., treatment of asymptomatic bacteriuria [ASB]) and was endorsed by the National Quality Forum. Use of this measure as a pay-for-performance metric in the Michigan Hospital Medicine Safety [...]

Background: Patients (pts) with congestive heart failure (CHF) are at an increased risk for community-acquired bacterial pneumonia (CABP) [1]. Moreover, CABP itself and macrolide antibiotics, which current guidelines recommend for CABP treatment [2], are both associated with increased risk of cardiac events, including worsening heart failure [3,4]. Lefamulin (LEF) is a first-in-class systemic pleuromutilin antibiotic [...]

Background: Clostroidiodes difficile (CD) is the most prevalent hospital-acquired infection in the United States, accounting for approximately 224,000 infections with 13,000 deaths and over 1 billion dollars spent in 2017, according to the Centers for Disease Control and Prevention (CDC). Clostroidiodes difficile accounts for 10-20% of diarrhea in the setting of recent antibiotics exposure.In St [...]

Case Presentation: A 54-year old female was hospitalized for 3-week history of abdominal pain, chills, nausea and diarrhea. Her past medical history was significant for multiple self-reported antibiotic allergies, Roux-en-Y gastric bypass complicated by gastrojejunostomy leak, and prior perisplenic abscess requiring percutaneous drainage. On admission, blood pressure was 137/79, heart rate of 80, respirations 20, [...]

Case Presentation: A 73-year-old man with a history of atrial fibrillation on apixaban and panhypopituitarism secondary to resection of a pituitary adenoma in the 1980s presented to our hospital for chest pain. His recent history is notable for recurrent cystitis and Clostridium difficile infections requiring stress-doses of glucocorticoids; his endocrinologist had been attempting to taper [...]

Background: Dichotomous outcomes—such as mortality—rarely capture the range of potential outcomes important to patients and clinicians. To address this limitation, the Desirability of Outcome Ranking (DOOR) score was created to rank potential outcomes from least to most desirable. Currently, there is no standardized method to develop a DOOR score and data are limited on whether [...]

Background: Intravenous vancomycin treatment is often necessary beyond hospitalization. Peripherally inserted central catheters (PICCs) are usually placed for this indication. Whether the less invasive midline catheters (midlines) are safe alternatives for outpatient parenteral antimicrobial therapy (OPAT) with vancomycin is unclear. We compared the safety of midlines and PICCs among patients receiving vancomycin for OPAT. Methods: [...]