Twelve patients were treated with Omadacycline(OMC) as part of a multi-drug regimen for Mycobacterium abscessus. The majority of infections were of pulmonary origin(7/12;58.3%). The median(IQR) duration of OMC was 6.2(5.0-9.5) months. Clinical success occurred in 9/12(75.0%) of patients. Three patients experienced a possible adverse effect while on therapy.

Objective: To review the use of antibiotic stewardship interventions in the adult oncology and hematopoietic cell transplantation (HCT) populations. Data Sources: A literature search of PubMed was performed from inception to October 31, 2019. The general search terms used were oncology, cancer, hematologic malignancy, antimicrobial stewardship, antibiotic stewardship, febrile neutropenia, neutropenic fever, de-escalation, discontinuation, prophylaxis, practice guidelines, clinical pathway, rapid diagnostics, Filmarray, Verigene, MALDI-TOF, antibiotic allergy, and antimicrobial resistance. Study Selection and Data Extraction: Relevant English-language studies describing interventions supported by the Infectious Diseases Society of America guidelines on “Implementing an Antibiotic Stewardship Program” were included. Data Synthesis: Antibiotic stewardship publications in the oncology population have increased in recent years. Studies have described the impact of stewardship interventions, including preauthorization, prospective audit and feedback, implementation of clinical pathways, de-escalation of empirical antibiotics for febrile neutropenia (FN) prior to neutrophil recovery, allergy assessments, and use of rapid diagnostic testing. Many of these interventions have been shown to decrease antibiotic use without increased negative consequences, such as affecting length of stay or mortality. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence for implementing antibiotic stewardship interventions, particularly de-escalation of antibiotics for FN and implementation of clinical pathways for FN and sepsis, in oncology patients and HCT recipients. Summary tables highlight studies and specific research needs for clinicians. Conclusions: Immunocompromised populations, including oncology patients, have often been excluded from stewardship studies. Antibiotic stewardship is effective in reducing antibiotic consumption and improving outcomes in this patient population, although more quality data are needed.

Background: In 2017, Mbeya Zonal Referral Hospital (MZRH) and the University of South Carolina (UofSC) agreed to collaboratively strengthen antimicrobial prescribing in the southern highlands of Tanzania and train a new generation of clinicians in responsible antimicrobial use. Methods: Key stakeholders and participants were identified and the Mbeya Antimicrobial Stewardship Team (MAST) was created. The team identified assets brought by the collaborators, and four investigations of baseline needs were developed. These investigations included (a) a baseline clinician survey regarding antimicrobial resistance and stewardship, (b) a serial chart review of inpatient antimicrobial prescribing practices, (c) an investigation of antimicrobial resistance rates using existing isolates at the MZRH laboratory, and (d) a survey of antimicrobial availability at community pharmacies in the city. Results: 91% of physicians believe antimicrobial resistance is problem in Tanzania, although only 29% of physicians were familiar with the term “antimicrobial stewardship”. Escherichia coli isolates had resistance rates of over 60% to the commonly used agents ciprofloxacin, trimethoprim-sulfamethoxazole, and ceftriaxone. Thirteen out of 14 community pharmacies offered over-the-counter antibiotics for upper respiratory symptoms. Conclusions: International antimicrobial stewardship collaborations can successfully identify opportunities and needs. Evaluating the team’s efforts to improve patient outcomes will be essential.

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Rhabdomyolysis is a clinical syndrome associated with electrolyte abnormalities and myoglobinuria. Signs and symptoms of rhabdomyolysis include elevated creatinine phosphokinase (CPK) and aspartate transaminase (AST), muscle pain, urine discoloration, fatigue, nausea, vomiting and fever. 1 If untreated, rhabdomyolysis can lead to renal failure and death. 2 Rhabdomyolysis can occur as a result of traumatic injury or chemical causes. 1-3 Prior case reports describing fluoroquinolone-induced rhabdomyolysis occurred within the first week of fluoroquinolone initiation. 4-10 Most of these involved the co-administration of simvastatin and either ciprofloxacin or levofloxacin. 4,5,7-10 We report a rare case of delayed-onset acute rhabdomyolysis that coincided with initiation of levofloxacin in a patient on long-term atorvastatin. A literature search of articles published in English through August 2018 was conducted using PubMed to identify other publications on fluoroquinolone-induced rhabdomyolysis with and without concomitant statin therapy. The following search terms were used alone and in combination: rhabdomyolysis, fluoroquinolone, statin, levofloxacin, atorvastatin. Citations of included articles were also reviewed to identify additional publications. | C A S E DE SCRIP TI ONA 65-year-old white male presented to an outside hospital with complaints of right knee pain, swelling, subjective fevers, chills, and inability to bear weight in the setting of prior right total knee arthroplasty. He was started on vancomycin and aztreonam for empiric treatment of a right knee prosthetic joint infection and was subsequently transferred to our facility for surgical intervention. The