Edwards, Megan

ABSTRACT Background Valganciclovir is the preferred antiviral agent for cytomegalovirus (CMV) prophylaxis in solid organ transplant (SOT) recipients; however, limited data exist to guide optimal dosing in patients requiring intermittent hemodialysis (iHD). This study evaluated the safety and efficacy of our institution's current dosing strategy of valganciclovir 450 mg three times weekly. Methods In this single‐center, retrospective study, adult liver, heart, lung, and kidney transplant recipients from January 2014 to November 2024 were included. Patients requiring ≥ 3 iHD sessions posttransplant and receiving valganciclovir 450 mg three times weekly were compared with recipients with normal renal function receiving 900 mg once daily. The primary outcomes were the risk of neutropenia, leukopenia, and thrombocytopenia within 3.5 months posttransplant. Results A total of 116 patients were included in the iHD cohort and were matched 1:2 to 232 patients in the normal renal function cohort. Rates of leukopenia and neutropenia were comparable between cohorts. However, thrombocytopenia occurred significantly more frequently in the iHD cohort (45.2% vs. 26.7%; p = 0.002). No significant differences were observed in rates of CMV infection between groups. Conclusion Valganciclovir 450 mg three times weekly appears safe and effective for CMV prophylaxis in SOT recipients requiring iHD, though it may be associated with an increased risk of thrombocytopenia. image

ABSTRACT Inpatient, acute care clinical pharmacists have contributed to many notable improvements in patient outcomes. Several studies have shown a reduction in mortality and other clinical markers when pharmacists are integrated within the care team. Economic analyses of inpatient clinical pharmacy services (CPS) generally demonstrate cost savings related to specific medication classes, prevention of adverse drug events, decreased length of stay, and decreased rehospitalization. Studies also show high satisfaction from other health care professionals, noting improvements in medication‐related patient safety. Finally, studies conducted in tertiary care hospital settings report high levels of patient satisfaction with CPS. As such, the ECHO framework, based on economic, clinical, and humanistic outcomes, is used herein to organize the summary of literature associated with CPS. Given the growing body of evidence, numerous health professional and government organizations recognize the role of pharmacists as an integral part of the inpatient team. Yet implementation of CPS has not been fully realized by hospitals and health systems. This paper briefly describes inpatient CPS, highlights many benefits of and endorsements for clinical pharmacist participation on interdisciplinary teams, and provides high‐level recommendations for health system administrators and the profession of pharmacy to further encourage broader integration of CPS into patient care teams. Effectively positioning inpatient clinical pharmacists as indispensable team members will require intentional work and strategic planning with a focus on high‐impact value, visibility, and leadership.

Abstract Purpose Data regarding the incidence, onset, and management of complex outpatient antimicrobial therapy–induced neutropenia (COIN) are limited, and pharmacist involvement in COIN management has not been reported. This report describes the incidence, onset, and management of COIN at a large academic medical center. Methods This multisite retrospective cohort study examined adult patients undergoing serum laboratory monitoring for antimicrobials over a 4-year period. Patients receiving chemotherapy or immunosuppressants were excluded. Data collected included the antimicrobial regimen, complete blood count, duration of antimicrobial therapy until outcome occurrence, infectious syndrome, type of intervention, outcome, and pharmacist involvement. Logistic regression was used to assess risk factors for COIN incidence. The primary outcome was the incidence of COIN by antimicrobial drug. Results From 4,261 treatment episodes, 161 cases of COIN were identified (3.8% COIN incidence). The most common antimicrobials associated with COIN were intravenous piperacillin/tazobactam, cefepime, and meropenem. The majority of COIN events were attributed to a combination of at least 2 antimicrobials. Piperacillin/tazobactam was significantly associated with higher odds of developing COIN (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.04-3.34; P = 0.038), whereas ertapenem was associated with significantly lower odds of COIN (OR, 0.43; 95% CI, 0.24-0.77; P = 0.005). The median time to neutropenia diagnosis was 22 days (interquartile range, 14-29 days) from the time of inpatient antimicrobial start. Intervention for COIN occurred in 66.5% of cases, with neutrophil count recovering in 96.9% of these patients. Clinical pharmacists initiated 74.8% of interventions. Conclusion COIN can be effectively identified and managed by a multidisciplinary team reviewing routine laboratory monitoring, enabling most patients to safely complete antimicrobial treatment.