Ceftolozane-tazobactam and ceftazidime-avibactam showed comparable activity against ESBL and P. aeruginosa, with ceftazidime-avibactam having lower MICs against ESBL isolates and ceftolozane-tazobactam having lower MICs against P. aeruginosa. Ceftazidime-avibactam showed better activity against all CRE isolates except for those carrying the NDM-1 enzyme.

Purpose The implementation of an advanced antimicrobial stewardship program (ASP) at a quaternary care hospital in the United Arab Emirates is described, including a report on the implementation and outcomes of the program. Methods This was a single‐center quasi‐experimental study to assess the impact of the ASP on antimicrobial use measures, ASP interventions performed, and clinical outcomes by comparing the data collected at baseline, from the third quarter (Q3) 1 July 2015 to the fourth quarter (Q4) of 31 December 2017, approximately 2 years following program implementation. Results From 1 July 2015 until 31 December 2017, the program reported a total direct cost savings estimated at $1 339 499, despite a significant increase in patient discharges and total patient‐days. The antimicrobial cost per inpatient‐day decreased by 32% from $47.2 to $32.3. Usage of monitored antimicrobials decreased despite an increase in patient census since hospital opening. Hospital‐onset Clostridioides difficile infection (CDI) rates decreased from 0.46 cases per 1000 patient days in 2015 to 0.12 cases per 1000 patient days in 2017 (P = 0.035, 95% CI 0.08 to 0.91). Hospital‐onset infections due to multidrug‐resistant organisms (MDROs) decreased from 2.39 cases per 1000 patient days in 2015 to 0.38 cases per 1000 patient days in 2017 (P = 0.05, 95% CI 0.09 to 0.28). Overall, the number of ASP interventions amounted to a total of 4123 interventions, with an acceptance rate of 91%. Conclusion The implementation of an advanced ASP at a quaternary care hospital in the United Arab Emirates was associated with a decrease in antimicrobial utilization, antimicrobial expenditure, and a reduction in hospital‐onset CDI and MDRO rates. To our knowledge, this is the first report describing the outcomes of an advanced ASP program at a quaternary care hospital utilizing real‐time surveillance software and CDSS in the Middle East.

This report describes a longitudinal case of immunocompromised patient post kidney transplant who was admitted to our institution repeatedly for treatment of various infections caused by multi-drug resistant Klebsiella pneumoniae. The patient was successfully treated with a combination of ertapenem/meropenem on multiple occasions despite the elevated MICs. Our observations corroborate previous preclinical studies and case reports showing the efficacy of double carbapenem regimens against resistant Enterobacteriaceae.

There are conflicting data regarding the use of hydroxychloroquine (HCQ) in COVID-19 hospitalized patients. The objective of this study was to assess the efficacy of HCQ in increasing SARS-CoV-2 viral clearance. Hospitalized adult patients with confirmed SARS-CoV-2 infection were retrospectively included in the study. The primary outcome was the time from a confirmed positive nasopharyngeal swab to turn negative. A negative nasopharyngeal swab conversion was defined as a confirmed SARS-CoV-2 case followed by 2 negative results using RT-PCR assay with samples obtained 24 hours apart. Multiple linear regression analysis was used to adjust for potential confounders. Thirty-four confirmed COVID-19 patients completed the study. Nineteen (55.9%) patients presented with symptoms, and 14 (41.2%) had pneumonia. Only 21 (61.8%) patients received HCQ. The time to SARS-CoV-2 negativity nasopharyngeal test was significantly longer in patients who received HCQ than those who did not receive HCQ [17 (13–21) vs 10 (4–13) days, P = .023]. HCQ was independently associated with time to negativity test after adjustment for potential confounders (symptoms, comorbidities, antiviral drugs, pneumonia, or oxygen therapy) in multivariable Cox proportional hazards regression analysis (hazard ratio = 0.33, 95% confidence interval: 0.13–0.9, P = .024). On day 14, 47.8% (14/23) patients tested negative in the HCQ group compared with 90.9% (10/11) patients who did not receive HCQ ( P = .016). HCQ was associated with a slower viral clearance in COVID-19 patients with mild to moderate disease. Data from ongoing randomized clinical trials with HCQ should provide a definitive answer regarding the efficacy and safety of this treatment.

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