Oritavancin is a lipoglycopeptide antibiotic indicated for the treatment of acute bacterial skin and soft tissue infections. The prolonged half-life of this agent allows for a course of therapy to be completed with a single dose. Oritavancin was added to our formulary as an option for treatment of acute bacterial skin and soft tissue infection to reduce admission and length of stay. The purpose of this study was to determine whether oritavancin is used appropriately at our hospital and to evaluate the impact to the institution. A retrospective and concurrent chart review was performed on all patients who had received oritavancin within our health system between June 2015 and December 2016. The primary endpoint was to determine the appropriateness of oritavancin use. Secondary endpoints include documenting readmission rates for patients prescribed oritavancin and assessing potential financial benefits to the institution. In the 67 patients identified, 51 (76%) patients received oritavancin for an appropriate indication. Orders from infectious disease physicians constituted 81% of inappropriate cases of oritavancin use. No patients who received oritavancin required readmission within 14 days of therapy. The estimated potential financial benefit to our institution when using oritavancin to prevent hospital admissions was $653,451. The majority of oritavancin use at our institution is appropriate according to indication. Oritavancin offers an outpatient option for the treatment of acute bacterial skin and soft tissue infections with the potential to decrease hospital cost by reducing admissions and length of stay.

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Background: The utilization of long-term oral anticoagulation is steadily expanding due to the growing number of patients diagnosed with thromboembolic diseases, such as atrial fibrillation or venous thromboembolism. Anticoagulation use can exacerbate hematoma expansion and increase intracerebral hemorrhage (ICH) volume resulting in high mortality and severe morbidity. However, unlike the treatment of ischemic stroke, the optimal time to reversal for hemorrhagic stroke is not clearly defined in the guidelines. Observational studies have evaluated the effect of time to reversal administration and have shown improvement on inpatient mortality and hematoma enlargement. The objective of this study was to evaluate the change in functional outcomes for intracerebral hemorrhage patients who received anticoagulant reversal within 90 minutes of presentation. Methods: This retrospective, observational cohort study included anticoagulated adult patients diagnosed with an intracerebral hemorrhage on a computerized tomography scan who received anticoagulant reversal at Northeast Georgia Medical Center between January 1, 2018 – September 30, 2022. Patients were excluded if diagnosed with an aneurysm, another bleed, or administered desmopressin. The primary outcome was to evaluate the change in functional outcomes for ICH patients who received anticoagulant reversal within 90 minutes of presentation. Secondary outcomes included the change in functional outcomes for ICH patients who received anticoagulation reversal within 30 or 60 minutes of presentation, time to international normalized ratio (INR) normalization if on warfarin, and to assess the incidence of thrombotic and rebleed events after reversal. Results: Sixty-one patients met inclusion criteria with thirty-six patients receiving reversal within 90 minutes and twenty-five receiving reversal after 90 minutes of arrival. Baseline characteristics were similar between groups. Overall, there was no change in functional outcomes for patients who received anticoagulation reversal within 90 minutes (75% vs. 52%, p=0.07); 60 minutes (71% vs. 63%, p=0.49) or 30 minutes of arrival (100% vs. 64%, p=0.3) compared to after these time points. There was a similar incidence of rebleed (3% vs. 4%) and thrombotic events (6% vs. 0%) between groups. Conclusion: Functional outcomes were similar for intracerebral hemorrhage patients who received anticoagulation reversal within 90 minutes compared to those who received it after 90 minutes of Emergency Department arrival.

BACKGROUND: Dexmedetomidine is an α-2 receptor agonist commonly used as a continuous infusion for sedation and analgesia; however, dose-dependent hypotension may limit its utility. Despite its widespread use, there is no consensus on appropriate dosing and titration. OBJECTIVE: The objective of this study was to determine whether a dexmedetomidine dosing and titration protocol is associated with decreased rates of hypotension in trauma patients. METHODS: This pre-post intervention study took place at a Level II trauma center in the Southeastern United States from August 2021 to March 2022 and included patients admitted by the trauma service to either the surgical trauma intensive care unit or intermediate care unit and received dexmedetomidine for greater than or equal to 6 hours. Patients were excluded if they were hypotensive or on vasopressors at baseline. The primary outcome was incidence of hypotension. Secondary outcomes included dosing and titration practices, initiation of a vasopressor, incidence of bradycardia, and time to goal Richmond Agitation Sedation Scale (RASS) score. RESULTS: Fifty-nine patients met inclusion criteria: 30 in the pre-intervention group and 29 in the post-intervention group. Protocol adherence in the post group was 34% with a median of one violation per patient. Rates of hypotension were similar between the groups (60% vs. 45%, p = .243) but significantly lower in the post group patients with zero protocol violations (60% vs. 20%, p = .029). The post group also had a significantly lower maximal dose (1.1 vs. 0.7 μg/kg/hr, p < .001). There were no significant differences in the initiation of a vasopressor, incidence of bradycardia, or time to goal RASS. CONCLUSION: Adherence to a dexmedetomidine dosing and titration protocol significantly decreased incidence of hypotension and maximal dexmedetomidine dose without increasing time to goal RASS score in critically ill trauma patients.