Ceftazidime-avibactam and ceftolozane-tazobactam are currently FDA-approved and available for use, while cefiderocol and imipenem-cilastatin/relebactam are in development. Current evidence suggests ceftazidime-avibactam and ceftolozane-tazobactam both may have a role in treatment of MDR P. aeruginosa infections. Ceftolozane-tazobactam appears to be modestly more potent against P. aeruginosa, but emergence of resistance has been noted in various reported cases. Trials are ongoing for cefiderocol and imipenem-cilastatin/relebactam and early results appear promising. The aforementioned agents fill important gaps in the antibiotic armamentarium, particularly for patients with MDR P. aeruginosa infections who otherwise have extremely limited and often toxic antibiotic options. However, resistance to all of these agents will likely emerge, and additional antibiotic development is warranted to provide sufficient options to successfully manage MDR P. aeruginosa infections.

Objective. To characterize Grit-S scores in pharmacy students, determine whether Grit-S scores change within individual pharmacy students and cohorts over time, and investigate the relationship between Grit-S scores, academic outcomes, and professional outcomes. Methods. A survey was conducted in fall 2016 and again in fall 2017 to determine Grit-S scores in first-through fourth-year pharmacy students. Participant demographic variables, grade point average (GPA), advanced pharmacy practice experience (APPE) ratings, and residency match results were collected.Results. Over the study period, 852 survey responses were completed by 85% of students surveyed. The mean Grit-S scores of each cohort ranged from 3.5 to 3.7 (on a 5-point scale with 5 representing the highest level of grit). Underrepresented minorities had slightly higher Grit-S scores and first-generation college students had slightly lower Grit-S scores. Two hundred eighty-seven students responded to both the 2016 and 2017 surveys. Among these paired responses, small but significant changes in individual Grit-S scores over time that varied in direction and magnitude by school year were noted. Higher Grit-S scores were not associated with higher GPA or superior APPE performance, nor were they predictive of a student matching to a postgraduate pharmacy residency. Conclusion. Significant associations between grit and measures of academic or professional achievement were not detected in this pharmacy student cohort. The presence of small but significant changes in Grit-S scores over time, in the absence of any intervention, has implications that further research should be conducted in this area.

B alamuthia mandrillaris is an ameba that can cause skin lesions, endophthalmitis, or granulomatous amebic encephalitis (GAE) in previously healthy patients. Routes of infection include possible soil exposure (1) and transplanted organs from infected donors (2,3). The mortality rate is high. During 1974-2016, of 109 Balamuthia GAE cases in the United States, 10 patients survived; mortality rate was >90% (4).The recommended medication regimen for Balamuthia GAE includes pentamidine, sulfadiazine, azithromycin/clarithromycin, fluconazole, flucytosine, and miltefosine (5). This regimen is based on survivor case series, and results have been inconsistent. Of those medications, only miltefosine, pentamidine, and azithromycin exhibit in vitro evidence of amebicidal or amebistatic activity (6,7). Furthermore, in vitro activity requires high concentrations of drug that are implausible in vivo (50% inhibitory concentration for azithromycin 244 μM and miltefosine 62 μM) (6). We report a patient with B. mandrillaris granulomatous amebic encephalitis who survived after receiving treatment with nitroxoline, a drug typically used to treat urinary tract infections, which was identified in a screen for drugs with amebicidal activity against Balamuthia. The CaseThe patient was a man in his 50s, with no remarkable medical history, who received care at a hospital in northern California, USA, after experiencing a generalized seizure. Magnetic resonance imaging (MRI) demonstrated a solitary left temporal lobe T2 hyperintensity with gadolinium rim enhancement and surrounding edema. After receiving treatment with dexamethasone and levetiracetam, he was transferred to the University of California San Francisco Medical Center (UCSF) (Figure 1).Examination by neurology consultants indicated disorientation, inattention, moderate aphasia, and mild right hemiparesis. The aphasia and hemiparesis improved during hospitalization, suggesting that those signs were postictal. Cerebrospinal fluid (CSF) testing revealed increased nucleated cells up to 80/ UL (60% lymphocytes, 17% neutrophils, 23% monocytes), protein concentration 38 mg/dL, and glucose concentration 100 mg/dL. A biopsy sample from the left temporal lobe lesion was preliminarily reported as well-formed granulomata with acute inflammation (Figure 2, panel A).Cultures from the brain biopsy sample did not grow bacteria, fungi, or mycobacteria. We performed metagenomic next-generation sequencing (mNGS) on a CSF sample (8,9) and sent brain biopsy samples for universal broad-range PCR amplicon sequencing (uPCR) for bacteria, fungi, Mycobacterium tuberculosis,

Methods. We conducted a descriptive qualitative study of APPE readiness using workplace learning as a guiding conceptual framework. We collected data between March and September 2019 through semi-structured focus groups and interviews with students (5 groups), preceptors (4 groups), and faculty site directors (1 group, 2 individual interviews). We analyzed these data using directed content analysis. Results. Participants described APPE readiness as a multifaceted construct comprised of four themes: learner characteristics, participation in workplace activities, relationship-building, and workplace practices to orient and support students. While all participant groups collectively addressed each category, faculty site directors and preceptors tended to focus on learner characteristics, whereas students placed emphasis on their participation in the workplace and relationship-building. Conclusion. Knowledge is widely recognized as a requirement for APPE readiness. Our study identified learner characteristics, workplace participation, and relational skills as additional requirements. Some of these components are challenging to assess prior to APPEs, which makes orienting both prior to and at the start of APPEs particularly important to support readiness. Thus, a comprehensive view of APPE readiness might also include assessing the readiness of workplaces, administrators, and preceptors for APPE students.

IntroductionThe University of California, San Francisco (UCSF) School of Pharmacy employs Objective Structured Clinical Examinations (OSCEs) to assess students' skills. The Coronavirus disease 2019 (COVID‐19) pandemic made in‐person OSCEs infeasible. This article describes the implementation and evaluation of a two‐station virtual OSCE (vOSCE) for first‐year pharmacy students.MethodsA summative vOSCE was conducted in June 2020 using Zoom and ExamSoft. Faculty and residents served as standardized patients (SPs) and evaluated student performance. Students and SPs were surveyed on their perceptions post‐vOSCE. A mixed methods analysis was conducted, incorporating thematic analysis of survey responses and quantitative analyses of student performance on the virtual vs in‐person OSCE.ResultsNinety‐six (75%) students and 17 SPs (94.4%) completed the survey. Students and SPs (69% vs 88%, P = .10) felt that vOSCEs were acceptable alternatives for demonstrating knowledge, communication, and telehealth skills. SPs felt that in‐person OSCEs were more effective to assess communication skills and ability to conduct in‐person encounters (P < .05). Qualitative comments from students and SPs corroborated these differences, emphasizing limitations of vOSCEs for demonstrating nonverbal skills, and additional considerations regarding exam administration and assessment. Students who failed an OSCE generally had lower median communication scores (P < .01). Technological difficulties, before OSCE performance, and before telehealth experience were not associated with passing the vOSCE (P > 0.05).DiscussionThe virtual environment did not seem to negatively impact student performance. However, students and SPs felt vOSCEs may be less effective to demonstrate and assess nonverbal communication. To address these limitations, future implementation of vOSCEs may include providing students with instruction on nonverbal telehealth skills and SP training on virtual assessment of nonverbal communication skills.