Necrotizing enterocolitis is a life-threatening condition in preterm neonates that is associated with severe morbidity and mortality. Several studies have suggested that probiotics can potentially decrease the risk of developing necrotizing enterocolitis via several proposed mechanisms of action, including increasing diversity of the intestinal flora. However, due to a lack of standardized study designs, including variability in product selection, dose, time of initiation, and duration, as well as a concern for safety in this vulnerable population, the use of probiotics in this population remains controversial. Regulations for testing of products and well-validated dosing regimens are needed before considering routine use of probiotics in these high-risk patients.

OBJECTIVE Pharmacy-driven antibiotic dosing services have been shown to improve clinical outcomes in adult patients. This study evaluated the effect of a pharmacist-driven antimicrobial dosing service on the percentage of therapeutic serum concentrations achieved following initial vancomycin or aminoglycoside dosing regimens. A secondary objective was to determine the effect of the dosing service on nephrotoxicity in pediatric patients. METHODS This single-center, retrospective study used data obtained from an electronic medical record to evaluate the utility of a pharmacist-driven vancomycin or aminoglycoside dosing protocol. Assessments of target, subtherapeutic, and supratherapeutic serum concentrations were evaluated. The occurrence of changes in serum creatinine and presentation of acute kidney injury (AKI) were also determined. RESULTS The incidence (n [%]) of a therapeutic initial serum concentration was not statistically significant between pre-protocol and post-protocol groups (21 [46.7%] vs 22 [48.9%], respectively; p = 0.834). The incidence of initial supratherapeutic concentrations (19 [42.2%] vs 7 [15.6%]; p = 0.005) and the average number of supratherapeutic concentrations per antibiotic course (0.76 vs 0.26; p = 0.01) were higher in the pre-protocol group compared with the post-protocol group. The incidence of AKI was significantly lower in the post-protocol group (2.2% vs 13.3%; p = 0.049). CONCLUSIONS Implementation of a pharmacist-driven dosing service did not affect the likelihood of achieving an initial therapeutic concentration. However, it did reduce the likelihood of both supratherapeutic concentrations and AKI. Additional studies in pediatric patients are needed to affirm the use of pharmacist dosing services.

BackgroundPediatric cardiothoracic (CT) surgery poses significant infectious risks, mitigated by antimicrobial prophylaxis and standardized infection control practices. Little is known about the most appropriate postoperative antimicrobial regimen and duration of therapy. In efforts to decrease exposure to broad-spectrum (BS) antimicrobial prophylaxis while preventing postoperative infection, we implemented a risk-stratified algorithm CT surgery prophylaxis algorithm (Figure 1) at our institution.MethodsThis quasi-experimental study included pediatric CT surgery patients at an urban academic medical center. Algorithm implementation in conjunction with daily prospective audit-with-feedback started simultaneously in September 2017, with retrospective review of pre- and postintervention groups. Data related to length of hospital admission, narrow and BS antimicrobial days and appropriateness, infectious complications, and drug toxicity were collected. The preliminary preintervention arm was compared with the postintervention arm using descriptive statistics via SPSS.ResultsPreliminary data suggest a trend toward decreased BS antimicrobial use in the postintervention group by 27%, with a significant decrease in the rate of inappropriate use during the postintervention period. There were no episodes of drug-related nephrotoxicity. ConclusionContinued review is ongoing; however, risk-based limited-spectrum antimicrobial therapy for pediatric CT surgery patients appears efficacious and safe while limiting antimicrobial exposure. Figure 1: Process map for pediatric cardiothoracic surgery algorithmDisclosures All authors: No reported disclosures.