Background: Acute chest syndrome (ACS) is an acute complication of sickle cell disease (SCD). Historically, the most common pathogens were Chlamydophila pneumoniae, Mycoplasma pneumoniae, and respiratory syncytial virus. Pediatric patients receiving guideline-adherent therapy experienced fewer ACS-related and all-cause 30-day readmissions compared with those receiving nonadherent therapy. This has not been evaluated in adults. Objectives: The primary objectives were to characterize antibiotic use and pathogens. The secondary objective was to assess the occurrence of readmissions associated with guideline-adherent and clinically appropriate treatment compared with regimens that did not meet those criteria. Methods: A retrospective cohort analysis was conducted for adults with SCD hospitalized between August 1, 2014, and July 31, 2017, with pneumonia (PNA) or ACS. The study was approved by the institutional review board. Results: A total of 139 patients with 255 hospitalizations were reviewed. Among 41 respiratory cultures, 3 organisms were isolated: Cryptococcus neoformans, Pseudomonas aeruginosa, and budding yeast. Respiratory panels were collected on 121 admissions, with 17 positive for 1 virus; all were negative for Chlamydophila pneumoniae and M pneumoniae. There were significantly more ACS-/PNA-related 7-day readmissions from patients on guideline-adherent regimens compared with nonadherent regimens (3.7% vs 0%; P = 0.04). Conclusion and Relevance: These findings challenge existing knowledge regarding the most common pathogens in adults with SCD with ACS or PNA. Routine inclusion of a macrolide may not be necessary. Future studies focused on pathogen characterization with standardized assessment are necessary to determine appropriate empirical therapy in this population.

Background: Previous studies have demonstrated the benefit of clinical pharmacist intervention in the care of patients with human immunodeficiency virus (HIV) in an ambulatory care setting. Patients who receive interprofessional care that includes a clinical pharmacist are more likely to see clinical benefit including improved adherence and reduced HIV viral load. With recent improvements in virologic testing and HIV medications, it is useful to identify which types of pharmacist interventions are significantly improving clinical outcomes in the most difficult-to-treat patients. Aims: Determine the impact of clinical pharmacy interventions and specialty pharmacy involvement in an uncontrolled HIV population. Methods: HIV patients with a detectable HIV viral load (>20 copies/mL) were retrospectively included in the study if they had at least one visit with a clinical pharmacist and at least one follow-up HIV viral load documented after the visit between January 1, 2017 and March 1, 2019. Patient charts were reviewed to obtain information regarding HIV history, relevant interventions made by the clinical pharmacist, and adherence rates. The primary outcome was the proportion of patients who achieved an undetectable viral load (<20 copies/mL) after seeing a pharmacist in clinic. Secondary outcomes included types of pharmacist interventions, and specialty pharmacy capture rate. Results: Fifty-one patients were included in the primary analysis. The median baseline viral load was 22,900 copies/mL and 68.6% of patients were able to achieve an undetectable HIV viral load after meeting with a pharmacist. The most common pharmacist intervention was compliance counseling, followed by medication change and medication initiation. In this cohort where 30% of patients were uninsured and unable to fill medications at the associated specialty pharmacy, the specialty pharmacy capture rate was 39%. Conclusions: The clinical pharmacists within the Regional Center for Infectious Disease care for a large proportion of the clinic’s difficult-to-treat HIV patients with uncontrolled viral loads. Within this population, patients whose care included clinical pharmacist interventions were able to achieve an undetectable viral load more than two-thirds of the time. Clinical pharmacists are also uniquely positioned to encourage utilization of specialty pharmacies to improve delivery and adherence. Utilization of skilled pharmacists will be vitally important in achieving new viral suppression rate targets, particularly within difficult-to-treat patient populations.

The Global Initiative for Asthma (GINA) guidelines acknowledge that beta-blockers can cause bronchospasm, however specific recommendations regarding patients with asthma in addition to a chronic condition warranting beta blocker therapy are absent beyond closely monitoring patients. A network meta-analysis was conducted to elucidate the risk of experiencing an asthma attack precipitated by beta blocker therapy. The primary outcome was the incidence of an asthma attack in patients with or without a past medical history of asthma and either receiving a beta blocker or placebo. A total of 24 articles comprising 1301 adult patients were included in the analysis. Patients had an average age of 54.5 (range 22.0-77.3) years and 22.6% of patients were female. Investigated beta blockers included oral propranolol, oral pindolol, oral atenolol, oral acebutolol, oral sotalol, oral metoprolol, oral practolol, oral oxprenolol, oral timolol, oral nadolol, infusion of sotalol, oral labetalol, oral bisoprolol, oral carvedilol, oral celiprolol, infusion of esmolol, infusion of propranolol, infusion of tolamolol, oral carteolol, infusion of propranolol and labetalol, infusion of practolol, oral celiprolol and propranolol, and oral bevantolol. The authors determined that oral timolol (RR ¼ 3.35, 95% CI 1.04-10.85) and infused propranolol (RR ¼ 10.19, 95% CI 1.29-80.41) were associated with a higher risk 219