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Spring Meeting Platform Presentations
Platform Presentation Abstracts

PLATFORM PRESENTATION ABSTRACTS

Platform Presentation – Student Research

Title: Assessment of the Illinois Pharmacist’s Understanding of Palliative Care – Winner Best Platform Presentation

Submitting Author: Blake Cornwell, PharmD Candidate

Authors: Blake Loran Cornwell, PharmD candidate, Southern Illinois University at Edwardsville School of Pharmacy; Katie Ronald, PharmD, BCPS, Professor, Pharmacy Practice, Southern Illinois University at Edwardsville School of Pharmacy.

Organization: Southern Illinois University at Edwardsville School of Pharmacy

Abstract

Purpose: The purpose of this palliative care survey was to assess Illinois pharmacists’ level of involvement and understanding related to palliative care.  

Methods: The 22 question palliative care survey was distributed through Qualtrics after the IRB was approved. Once the survey was finalized an email was sent to the Illinois Pharmacists Association (IPhA) and the Illinois Council of Health-System Pharmacists (ICHP). These organizations then distributed the survey to their respective members. The email gave Illinois pharmacists an idea of what the research would be about and how it could benefit the pharmaceutical profession as a whole. Participants were able to access the survey through an anonymous link within the email. The survey was open to access from October 29, 2018 to November 30, 2018. 

Results:  A total of 152 responses were recorded with 131 of those participants completing the entire survey.  The majority of pharmacists stated that they rarely (26.1%) or never (45.5%) engage in palliative care at their practice site. The majority of survey respondents selected that a goal of palliative care is improving quality of life (51.7%) and/or optimizing symptom management (43.6%) as opposed to halting the progress of life (2.6%) and/or doing whatever is necessary to keep patient alive (2.1%). When asked to rank objectives of palliative care respondents thought providing relief from pain and other distressing symptoms (30.9%) and enhancing patient’s quality of life (32.4%) were the most important palliative care objectives. When asked what challenge would make it the most difficult to educate patients about palliative care the 3 answers that made up the majority of responses were not enough time to discuss palliative care topics (37.3%), patients being unwilling to talk about palliative care topics (23.9%), and pharmacists’ lack of knowledge about palliative care topics (23.1%). Pharmacists were very interested in receiving additional education about pain management based on disease state (60.9%), symptom management based on disease state (53%), and mental health management for patient and family (45.1%). In addition to the topics listed above, most pharmacists were at least very interested or moderately interested in receiving additional education about communication with patient and family, spiritual needs, cultural beliefs re: death and dying, and legal aspects of patient care decisions.  

Conclusions: The Illinois pharmacists who completed this survey displayed an understanding of the goals of palliative care and they believed enhancing quality of life as well as providing symptomatic relief was of the utmost importance for patients receiving palliative care. Despite multiple challenges making it difficult to educate patients about palliative care, pharmacists were willing to receive education about a plethora of palliative care topics to assist them in educating patients in the future. As the pharmacy profession progresses, the hope is that pharmacists will feel more comfortable discussing palliative care topics with patients and implementing palliative care management plans with other healthcare providers.

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 Platform Presentation – Student Research

Title: Exploration of Aztreonam in Combination with Avibactam or Vaborbactam for the Potential Treatment of Levofloxacin and/or Sulfamethoxazole-trimethoprim Resistant Strains of Stenotrophomonas Maltophilia Infections

Submitting Author: Denise Lamm, PharmD Candidate

Authors: Denise Lamm, PharmD Candidate, Graduate Research Assistant, UIC College of Pharmacy; Mark Biagi, PharmD, Infectious Diseases Pharmacotherapy Fellow, UIC College of Pharmacy; Tiffany Wu, PharmD Candidate, Graduate Research Assistant, UIC College of Pharmacy; Kevin Meyer, PharmD Candidate, Graduate Research Assistant, UIC College of Pharmacy; Eric Wenzler, PharmD, Assistant Professor of Pharmacy Practice, UIC College of Pharmacy.

Organization: University of Illinois at Chicago College of Pharmacy

Abstract

Purpose: Given the widespread antibiotic resistance among Stenotrophomonas maltophilia and potential for toxicities and/or drug interactions to currently preferred agents, alternative therapies are needed.  Aztreonam is the only β-lactam capable of avoiding hydrolysis by the L1 metallo-β-lactamase intrinsically expressed by S. maltophilia. Aztreonam remains susceptible to hydrolysis, however, by the L2 serine β-lactamase, thus making it ineffective for treating S. maltophilia. Combining aztreonam with a β-lactamase inhibitor with activity against L2 may restore aztreonam’s activity against S. maltophilia. 

Methods: Thirty-seven S. maltophilia isolates resistant to levofloxacin and/or sulfamethoxazole-trimethoprim underwent MIC testing in triplicate by broth microdilution method according to CLSI guidelines. Modal MICs are reported and susceptibility interpretations were determined based on CLSI breakpoints for both levofloxacin and sulfamethoxazole-trimethoprim against S. maltophilia and Pseudomonas aeruginosa for aztreonam-based regimens. Time kill analyses for five isolates at standard inoculum (106) were performed in triplicate for aztreonam, aztreonam/avibactam, and aztreonam/vaborbactam. Time kills were performed at either fCmax or ¼, ½, 1, 2, and 4x the MIC. A >3 log10 reduction in CFU/mL from the starting inoculum was considered to be bactericidal. Synergy was considered to be ≥2 log10 reduction in CFU/mL compared to the most active agent alone. 

Results: Only one of the 37 isolates (2.7%) was susceptible to aztreonam alone (MIC50/90> 128/>128 mg/L; MIC range 8->128 mg/L).  Combining aztreonam with avibactam restored aztreonam susceptibility in 97.2% (35/36) of aztreonam-resistant isolates (MIC50/90 2/4 mg/L; MIC range 0.5-16 mg/L). Combining aztreonam with vaborbactam restored aztreonam susceptibility in 11.1% (4/36) of aztreonam-resistant isolates (MIC50/90 64/>128 mg/L; MIC range 2->128 mg/L).  In time kill analyses, aztreonam alone failed to demonstrate bactericidal activity against any of the tested isolates at fCmax.  Aztreonam/avibactam showed bactericidal activity at 4x MIC in 3/5 isolates while aztreonam/vaborbactam exhibited bactericidal activity against only 1/5 isolates at fCmax. 

Conclusions: Combining aztreonam with avibactam resulted in restored susceptibilities at a higher rate than combing aztreonam with vaborbactam. This suggests that this combination could be an effective treatment alternative for S. maltophilia  resistant to currently preferred agents. Until the commercial availability of aztreonam-avibactam, aztreonam combined with ceftazidime-avibactam may be an optimal treatment option for S. maltophilia, including isolates resistant to levofloxacin and/or sulfamethoxazole-trimethoprim.  Future studies with this combination against S. maltophilia are warranted.

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