Browsing by Author "Kussin, Michelle L."

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    P-1749. Implementation of an Automatic 36-hour Stop Order on Empiric Meropenem Usage
    (Oxford University Press, 2025-01-29) Parker, Connor; Schneider, Jack G.; Boyd, LaKeisha; Kussin, Michelle L.; Graduate Medical Education, School of Medicine
    Background: Implementation of automatic stop orders (ASOs) for empiric antimicrobials have reduced antimicrobial use without negatively impacting patient outcomes. Given a recent increase in empiric meropenem use at our tertiary referral pediatric hospital, a 36-hour meropenem ASO option was implemented in the EMR for patients with sepsis requiring empiric antibiotics active against ESBL-producing organisms. We sought to evaluate the impact this initiative had on meropenem use and safety outcomes. Methods: A 36-hour ASO for meropenem was implemented on October 12th, 2022. We conducted a single-center, retrospective pre/post evaluation of order set implementation of all patients admitted to Riley Hospital for Children and treated with meropenem between 9/01/2019–9/01/2021 (pre-intervention) and 10/13/2022–10/13/2023 (post-intervention). The primary outcome was meropenem utilization, as measured by the number of meropenem days and doses per admission. Secondary outcomes included total hospital and ICU mean length of stay (LOS), mortality within 30 days of meropenem exposure, and 30-day readmission rate. Results: 309 admissions during which meropenem was administered were included. Demographics between pre-ASO (147 patients; n = 193 admissions) and post-ASO (88 patients; n = 116 admissions) groups were similar. There was no difference in the number of meropenem days (pre and post-ASO: median = 4; p = 0.88) or the number of meropenem doses (pre-ASO: 11 vs. post-ASO: 10; p = 0.63). Secondary safety outcomes including death within 30 days of meropenem administration (8.7% vs. 8.7%; p = 0.99), hospital LOS (18 vs 15.5 days; p = 0.42), ICU admission, and 30-day readmission rate were not significantly different. The new ASO was utilized in 23.3% of admissions in the post-implementation period. Conclusion: Use of the new ASO was not widely adopted, making evaluation of impact difficult. No significant difference in meropenem use nor clinical outcomes were identified after implementation, which has informed the next Plan-Do-Study-Act (PDSA) cycle for quality improvement at our center, likely with a focus on EMR modifications and education.
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    A Review of Extended and Continuous Infusion Beta-Lactams in Pediatric Patients
    (Pediatric Pharmacy Association, 2022) Imburgia, Taylor A.; Kussin, Michelle L.; Pediatrics, School of Medicine
    Intravenous beta-lactam antibiotics are the most prescribed antibiotic class in US hospitalized patients of all ages; therefore, optimizing their dosing is crucial. Bactericidal killing is best predicted by the time in which beta-lactam drug concentrations are maintained above the organism's minimum inhibitory concentration (MIC), rather than achievement of a high peak concentration. As such, administration of beta-lactam antibiotics via extended or continuous infusions over a minimum of 3 hours, rather than standard infusions over approximately 30 minutes, has been associated with improved achievement of pharmacodynamic targets and improved clinical outcomes in adult medical literature. This review summarizes the pediatric medical literature. Applicable studies include pharmacodynamic models, case series, retrospective analyses, and prospective studies on the use of extended infusion and continuous infusion penicillins, cephalosporins, carbapenems, and monobactams in neonates, infants, children, and adolescents. Specialized patient populations with unique pharmacokinetics and high-risk infections (neonates, critically ill, febrile neutropenia, cystic fibrosis) are also reviewed. While more studies are needed to confirm prospective clinical outcomes, the current body of evidence suggests extended and continuous infusions of beta-lactam antibiotics are well tolerated in children and improve achievement of pharmacokineticpharmacodynamic targets with similar or superior clinical outcomes, particularly in infections associated with high MICs.