Background: Antistaphylococcal penicillins have historically been regarded as the drugs of choice for methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSI). However, recent outcomes data compared to cefazolin treatment are conflicting. Objective: This study compared treatment failure and adverse effects associated with nafcillin and cefazolin for MSSA BSI. Methods: Adult inpatients with MSSA BSI between January 1, 2009 and August 31, 2015 were included in this retrospective cohort study if they received ≥72 h of nafcillin or cefazolin as directed therapy after no more than 72 h of any empiric therapy. The primary composite endpoint was treatment failure defined by clinician documentation, 30-day recurrence of infection, all-cause 30-day in-hospital mortality, or loss to follow-up. Secondary outcomes included antibiotic-related acute kidney injury (AKI), acute interstitial nephritis (AIN), hepatotoxicity, and rash. Results: Among 157 patients, 116 (73.9%) received nafcillin and 41 (26.1%) received cefazolin. The baseline characteristics were similar except cefazolin-treated patients had higher APACHE II scores and more frequent renal dysfunction. No difference in the composite treatment failure outcome (28.4 vs. 31.7%; p = 0.69) was detected between the nafcillin and cefazolin groups, respectively. In a sensitivity analysis excluding patients without known follow-up, there was no significant difference of treatment failure. AKI, AIN, hepatotoxicity, and rash were all numerically more frequent among nafcillin-treated patients. Conclusions: Among nafcillin- or cefazolin-treated patients with MSSA BSI, there was no significant difference in treatment failure. Observing more frequent presumptive adverse effects associated with nafcillin receipt, future prospective studies evaluating cefazolin appear warranted.

Purpose The results of a study to determine the difference in HIV management with clinical pharmacist input in an adult psychiatric hospitalized patient population are reported. Methods Single-center, retrospective study of patients admitted to a psychiatric hospital on antiretroviral (ARV) medication(s) from October 2016 to March 2017 (phase I: no pharmacist involvement), October 2017 to March 2018 (phase II: partial pharmacist involvement), and November 2018 to January 2019 (phase III: consistent pharmacist involvement). Patients were excluded if less than 18 years of age, pregnant, incarcerated, or taking ARV medication(s) for non-HIV indications. The primary outcome was difference in appropriateness of ARV therapy prior to and during pharmacist involvement. Secondary outcomes were appropriateness of opportunistic infection (OI) prophylaxis, laboratory testing, and comprehensive HIV management. Results Thirty-seven patients were included per phase. An increased number of appropriate ARV regimens were initiated in phase II compared to phase I (62% vs 32%; P = 0.01) and in phase III compared to phase II (84% vs 62%; P = 0.036). Increased laboratory monitoring was seen with partial and consistent pharmacist involvement. Among the patients requiring OI prophylaxis, appropriate prophylaxis was initiated in more patients in phase III (57%) than in phase II (50%) or phase I (11%). More patients had comprehensive HIV management in phase II compared to phase I (38% vs 5%; P < 0.001) and in phase III compared to phase II (46% vs 38%; P = 0.48). Conclusion Pharmacist involvement in HIV management in a psychiatric patient population increased appropriateness of ARV therapy, laboratory testing, and OI prophylaxis.

BackgroundPatients with mental illnesses are more than four times more likely to have human immunodeficiency virus (HIV) compared with the general population. HIV management can be especially challenging in these patients due to potential substance abuse, drug interactions, and nonadherence. The purpose of this study was to determine the impact of pharmacist management of antiretroviral (ARV) therapy in a psychiatric patient population.MethodsThis is an institutional review board-approved, single-center, retrospective study of patients admitted to a psychiatric hospital with an order for one or more ARV medication(s) between October 2016 and March 2017 (no pharmacist involvement), October 2017 and March 2018 (partial pharmacist involvement), and November 2018 and January 2019 (consistent pharmacist involvement). Patients were excluded if less than 18 years of age, pregnant, incarcerated, or taking ARV medication(s) for a non-HIV indication. The primary outcome was difference in appropriateness of ARV therapy prior to and during pharmacist involvement. Secondary outcomes were appropriateness of opportunistic infection (OI) prophylaxis and laboratory testing.ResultsA total of 37 patients were included per group. A greater number of appropriate ARV regimens were initiated with partial pharmacist involvement compared with no pharmacist involvement (62% vs. 32%, P = 0.0096), as well as with consistent pharmacist involvement compared with partial pharmacist involvement (84% vs. 62%, P = 0.0327). There was a trend toward increased HIV viral load draws with partial vs. no pharmacist involvement (54% vs. 43%, P = 0.24) and additionally with consistent vs. partial pharmacist involvement (62% vs. 54%, P = 0.32). With consistent pharmacist involvement, more patients had a resulted CD4 cell count (65%) than with both partial and no pharmacist involvement (57%). Of the patients requiring OI prophylaxis, appropriate prophylaxis was initiated in more patients with consistent pharmacist involvement (57%) than with partial pharmacist involvement (50%) or no pharmacist involvement (11%).ConclusionPharmacist involvement in HIV management in a psychiatric patient population increased appropriateness of ARV therapy, laboratory testing, and OI prophylaxis.Disclosures All authors: No reported disclosures.