Efficacy of Eravacycline Versus Best Previously Available Therapy for Adults With Pneumonia Due to Difficult-to-Treat Resistant (DTR) Acinetobacter baumannii

BACKGROUND

Multidrug-resistant Acinetobacter baumannii remains challenging to treat. Although eravacycline has in vitro activity against this pathogen, there are no studies evaluating outcomes.

OBJECTIVE

To assess the efficacy of eravacycline compared with best previously available therapy in adults with difficult-to-treat resistant (DTR) A. baumannii pneumonia.

METHODS

This was a retrospective study of adults hospitalized for pneumonia with DTR A. baumannii. Patients receiving eravacycline were compared with those receiving best previously available therapy. The primary outcome was 30-day in-hospital mortality. Secondary outcomes included clinical cure at Day 14, hospital and intensive care unit (ICU) length of stay, microbiologic cure, and readmission within 90 days with a positive A. baumannii respiratory culture.

RESULTS

Ninety-three patients were included, with 27 receiving eravacycline. Eravacycline was associated with higher 30-day mortality (33% vs 15%; P = 0.048), lower microbiologic cure (17% vs 59%; P = 0.004), and longer durations of mechanical ventilation (10.5 vs 6.5 days; P = 0.016). At baseline, eravacycline patients had more A. baumannii bacteremia and coinfection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Among bacteremic patients, all 4 receiving eravacycline died by Day 30 and both patients receiving best previously available therapy survived. Upon exclusion of patients with bacteremia and SARS-CoV-2, there were no differences between the groups across any outcomes.

CONCLUSIONS

Eravacycline-based combination therapy had similar outcomes to best previously available combination therapy for adults with DTR A. baumannii pneumonia. However, eravacycline should be used with caution in the setting of bacteremia as outcomes were poor in this population.

Ten Tips for Pharmacy Faculty Members for Successfully Navigating Promotion and Tenure

This paper presents 10 key tips or recommendations for successful navigation of the promotion and tenure process. The 10 key tips are: know institutional expectations, develop an action plan at least two to three years in advance; identify your balance of teaching, scholarship, service; synergize activities and develop a niche; prioritize time to activities of high-impact to promotion and tenure; track achievements in the format expected for promotion and tenure application; seek out faculty guidance on promotion and tenure; meet with mentor(s) regularly to review progress; have a well-written personal statement; and have your final dossier reviewed by colleagues. Faculty members are more likely to be successful through timely and appropriate planning, balancing and synergizing activities, tracking activities and achievements, developing a well-written personal statement, and requesting help from experienced colleagues.

The Current Landscape of College-Sponsored Postgraduate Teaching and Learning Curriculum Programs

Objective. To describe the landscape of teaching and learning curriculum (TLC) programs sponsored by US schools and colleges of pharmacy and evaluate their adoption of best practice recommendations. Methods. A 28-item electronic survey instrument was developed based on best practice recommendations published by the American Association of Colleges of Pharmacy (AACP), American Society of Health-System Pharmacists (ASHP), and American College of Clinical Pharmacy (ACCP) for the conduct of TLC programs. The survey instrument was electronically distributed to 137 accredited colleges and schools of pharmacy in the United States. Results. Eighty-eight institutions responded, resulting in a response rate of 64%. Sixty-one TLC programs were included in the final analysis. Seventy-five percent of TLC programs reported using best practice recommendations; however, 10% of respondents indicated they were not aware of the published recommendations. Inconsistencies among programs were noted in required teaching experiences, participant evaluation, and ongoing programmatic assessment. Conclusion. Most institutions offering TLC programs are aware of published best practice guidelines and have adopted a majority of the published best practices. However, considerable variability exists across the country. Development of a formal external validation process for TLC programs is necessary to ensure consistent quality.

Qualitative Analysis of the Impact of Changes to the Student Evaluation of Teaching Process

Objective. To determine how changes to the student evaluation of teaching (SET) survey instrument and process at a college of pharmacy contributed to improved student response rates and to understand how the process could be further refined. Methods. Pharmacy students from the class of 2018 who had participated in both the old and new SET process were recruited to participate in one of four focus group interviews. An inductive approach was used for data collection and analysis. A focus group guide was created based on two major domains: comparing changes between the old and new SET process and survey form, and determining how the new SET process could be further refined. Results. In South Jordan, UT, six students participated in one of the focus groups and seven students participated in the other focus group. In Henderson, NV, seven students participated in each of the two focus groups. Twenty-seven total students participated in the four focus groups across two campuses. Students stated that reducing the number of questions on each SET survey instrument and using a 5-point rather than a 10-point Likert scale were positive changes. The changes also motivated them to complete the surveys, which improved overall response rates. Although students reported that the monetary incentive (contributions toward the cost of the class banquet) that had been added to the new SET process was a strong motivator, the incentive itself would have likely been insufficient without the other changes. Several participants stated that receiving feedback from faculty members on changes made to teaching materials based upon previous student evaluations was also an important motivator for students to continue completing the surveys. Conclusion. Students identified several motivators for SET participation. Improving the process for survey completion is essential to improve response rates to more accurately represent the feedback of the entire student body. Additionally, the evaluation process must ensure that the data gathered are robust, accurate, and insightful, to be of good use of student and faculty time.

Development of a bedside scoring system for predicting a first recurrence of Clostridium difficile-associated diarrhea

PURPOSE

A scoring system for identifying patients at high or low risk for recurrent Clostridium difficile-associated diarrhea (CDAD) is described.

METHODS

A retrospective cohort study was performed using data on adults with CDAD admitted to a 3-hospital system from 2009 to 2014. The primary endpoint was the rate of recurrent CDAD within 60 days of clinical cure of CDAD. Risk factors for CDAD recurrence were identified, and a risk prediction tool was developed using multivariate logistic regression.

RESULTS

The CDAD cure rate in the study cohort (n = 340) was 92.3%; the 60-day recurrence rate was 16.9%. Five factors were significantly associated with high recurrence risk: presence of CDAD at admission, body temperature of >37.8 °C at admission, leukocytosis, nosocomial CDAD, and abdominal distention on CDAD presentation. From that information a risk prediction tool, the CDAD "recurrence score," was developed (1 point is assigned for each factor present, for a maximum score of 5). Validation testing of the recurrence score indicated an area under the receiver operating characteristic curve of 0.72 (95% confidence interval, 0.65-0.80). A score of ≥2 had a negative predictive value of 91%, while a score of ≥4 had a positive predictive value of 70%.

CONCLUSION

If externally validated in future studies, a tool for predicting the risk of recurrent CDAD using data readily available at the time of presentation could allow clinicians to identify patients at high risk for recurrence, address modifiable risk factors, and select tailored treatments to improve patient outcomes.

Motivators, barriers, and strategies to improve response rate to student evaluation of teaching

INTRODUCTION

Student evaluation of teaching (SET) is a tool that most pharmacy schools use to evaluate faculty. After multiple years of low response rates to SET, Roseman University began a process to identify motivators, barriers, and strategies to improve SET response rates. Multiple strategies were implemented and response rate was analyzed to determine if the changes were effective.

METHODS

A modified Delphi process was used to identify motivators, barriers, and strategies to improve SET response rates. Faculty, students, and administration engaged in a year-long process involving four distinct phases to build consensus regarding SET implementation and processes. The process was implemented and then response rates were evaluated the following academic year.

RESULTS

Barriers included frequency of surveys, length of surveys, length of rating scale, ambiguity of questions, misunderstanding on importance of SET, and lack of perceived benefit for completion of SET. For each pharmacy class, response rates increased two to three times baseline (p < 0.05). For all classes combined, response rates significantly increased from 24% to 66%.

CONCLUSIONS

The modified Delphi process successfully identified barriers, motivators, and strategies for improving SET. Additionally, the process built consensus that led to successful implementation of the new SET with significantly improved response rates.

Evaluation of a Modified Debate Exercise Adapted to the Pedagogy of Team-Based Learning

Objective. To assess the impact of a debate exercise on self-reported evidence of student learning in literature evaluation, evidence-based decision making, and oral presentation. Methods. Third-year pharmacy students in a required infectious disease therapeutics course participated in a modified debate exercise that included a reading assignment and readiness assessment tests consistent with team-based learning (TBL) pedagogy. Peer and faculty assessment of student learning was accomplished with a standardized rubric. A pre- and post-debate survey was used to assess self-reported perceptions of abilities to perform skills outlined by the learning objectives. Results. The average individual readiness assessment score was 93.5% and all teams scored 100% on their team readiness assessments. Overall student performance on the debates was also high with an average score of 88.2% prior to extra credit points. Of the 95 students, 88 completed both pre- and post-surveys (93% participation rate). All learning objectives were associated with a statistically significant difference between pre- and post-debate surveys with the majority of students reporting an improvement in self-perceived abilities. Approximately two-thirds of students enjoyed the debates exercise and believed it improved their ability to make and defend clinical decisions. Conclusion. A debate format adapted to the pedagogy of TBL was well-received by students, documented high achievement in assessment of skills, and improved students' self-reported perceptions of abilities to evaluate the literature, develop evidence-based clinical decisions, and deliver an effective oral presentation.

DNA cleavage induced by antitumor antibiotic leinamycin and its biological consequences

The natural product leinamycin has been found to produce abasic sites in duplex DNA through the hydrolysis of the glycosidic bond of guanine residues modified by this drug. In the present study, using a synthetic oligonucleotide duplex, we demonstrate spontaneous DNA strand cleavage at leinamycin-induced abasic sites through a β-elimination reaction. However, methoxyamine modification of leinamycin-induced abasic sites was found to be refractory to the spontaneous β-elimination reaction. Furthermore, this complex was even resistant to the δ-elimination reaction with hot piperidine treatment. Bleomycin and methyl methanesulfonate also induced strand cleavage in a synthetic oligonucleotide duplex even without thermal treatment. However, methoxyamine has a negligible effect on DNA strand cleavage induced by both drugs, suggesting that the mechanism of DNA cleavage induced by leinamycin might be different from those induced by bleomycin or methyl methanesulfonate. In this study, we also assessed the cytotoxicity of leinamycin against a collection of mammalian cell lines defective in various repair pathways. The mammalian cell line defective in the nucleotide excision repair (NER) or base excision repair (BER) pathways was about 3 to 5 times more sensitive to leinamycin as compared to the parental cell line. In contrast, the radiosensitive mutant xrs-5 cell line deficient in V(D)J recombination showed similar sensitivity towards leinamycin compared to the parental cell line. Collectively, our findings suggest that both NER and BER pathways play an important role in the repair of DNA damage caused by leinamycin.

Characterization of DNA damage induced by a natural product antitumor antibiotic leinamycin in human cancer cells

Leinamycin is a structurally novel Streptomyces-derived natural product that displays very potent activity against various human cancer cell lines (IC(50) values in the low nanomolar range). Previous in vitro biochemical studies have revealed that leinamycin alkylates DNA, generates apurinic (AP) sites and reactive oxygen species (ROS), and causes DNA strand breaks. However, it is not clear whether these events occur inside cells. In the present study, we have determined the endogenous amount of AP sites and DNA strand breaks in genomic DNA and the amount of oxidative stress in a human pancreatic carcinoma cell line, MiaPaCa, treated with leinamycin by utilizing the aldehyde-reactive probe assay, the comet assay, and fluorescent probes, respectively. We demonstrated that AP sites are formed rapidly following exposure to leinamycin, and the number of AP sites was increased up to seven-fold in a dose-dependent manner. However, only 25-50% of these sites remain 2 h after media containing drug molecules were aspirated and replaced with fresh media. We also observed leinamycin-induced ROS generation and a concomitant increase in apoptosis of MiaPaCa cells. Because both AP sites and ROS have the potential to generate strand breaks in cellular DNA, the comet assay was utilized to detect damage to nuclear DNA in leinamycin-treated MiaPaCa cell cultures. Both alkaline and neutral electrophoretic analysis revealed that leinamycin produces both single- and double-stranded DNA damage in drug-treated cells in a dose-dependent manner. Taken together, the results suggest that rapid conversion of leinamycin-guanine (N7) adducts into AP sites to produce DNA strand breaks, in synergy with leinamycin-derived ROS, accounts for the exceedingly potent biological activity of this natural product.