Publications by authors named "A E Newsome"

103 Publications

Avoiding cost avoidance.

Am J Health Syst Pharm 2021 Sep 6. Epub 2021 Sep 6.

Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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http://dx.doi.org/10.1093/ajhp/zxab364DOI Listing
September 2021

Time to blood, respiratory and urine culture positivity in the intensive care unit: Implications for de-escalation.

SAGE Open Med 2021 19;9:20503121211040702. Epub 2021 Aug 19.

Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.

Objectives: Concern for late detection of bacterial pathogens is a barrier to early de-escalation efforts. The purpose of this study was to assess blood, respiratory and urine culture results at 72 h to test the hypothesis that early negative culture results have a clinically meaningful negative predictive value.

Methods: We retrospectively reviewed all patients admitted to the medical intensive care unit between March 2012 and July 2018 with blood cultures obtained. Blood, respiratory and urine culture results were assessed for time to positivity, defined as the time between culture collection and preliminary species identification. The primary outcome was the negative predictive value of negative blood culture results at 72 h. Secondary outcomes included sensitivity, specificity, positive predictive value and negative predictive value of blood, respiratory and urine culture results.

Results: The analysis included 1567 blood, 514 respiratory and 1059 urine cultures. Of the blood, respiratory and urine cultures ultimately positive, 90.3%, 76.2% and 90.4% were positive at 72 h. The negative predictive value of negative 72-h blood, respiratory and urine cultures were 0.99, 0.82 and 0.97, respectively. Antibiotic de-escalation had good specificity, positive predictive value and negative predictive value for finalized negative cultures.

Conclusion: Negative blood and urine culture results at 72 h had a high negative predictive value. These findings have important ramifications for antimicrobial stewardship efforts and support protocolized re-evaluation of empiric antibiotic therapy at 72 h. Caution should be used in patients with clinically suspected pneumonia, since negative respiratory culture results at 72 h were weakly predictive of finalized negative cultures.
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http://dx.doi.org/10.1177/20503121211040702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381457PMC
August 2021

Assessment of Electrolyte Replacement in Critically Ill Patients During a Drug Shortage.

Hosp Pharm 2021 Aug 24;56(4):296-301. Epub 2019 Dec 24.

Augusta University, GA, USA.

The purpose of this study was to determine if national drug shortages of electrolyte replacement products negatively impact patient care. This study was a single-center, retrospective, observational cohort of adults admitted to the medical, surgical, or trauma intensive care unit (ICU) that were ordered or would have qualified for the general or continuous renal replacement therapy electrolyte replacement protocol (ERP) between April 2017 and August 2018. In October 2017, ERP use was suspended and enteral replacement was promoted due to inability to maintain consistent inventory of intravenous replacement products. The primary objective was to compare the percentage of patient days that at least 1 critically low value of potassium, magnesium, and/or phosphorus existed between protocolized and nonprotocolized electrolyte replacement. Secondary objectives included characterizing the ratio of enteral replacement to duration of critically low electrolyte values during protocolized and nonprotocolized electrolyte replacement. A total of 288 patients were included. The mean percentage of ICU days with low electrolyte levels in the protocolized period was significantly higher than in the nonprotocolized period (21.4% vs 17.5%, = .0238). There was a negative relationship between the total electrolyte replacement that was given enterally and the percentage of patient days with critically low values indicating that as enteral replacement increased, percentage of days with low values decreased. The association between percentage of enteral replacement and days with critically low electrolyte values was significantly lower in the protocolized period. Intravenous electrolyte replacement product shortages did not result in an increased incidence of critically low electrolyte values. Enteral replacement was associated with a decreased incidence of low electrolyte values.
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http://dx.doi.org/10.1177/0018578719893375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326855PMC
August 2021

Therapeutic Anticoagulation With an Ultra-Low Concentration Argatroban-Based Purge Solution for Percutaneous Ventricular Assist Device in Patient With Heparin-Induced Thrombocytopenia.

Hosp Pharm 2021 Aug 7;56(4):241-246. Epub 2019 Dec 7.

The University of Georgia College of Pharmacy, Augusta, USA.

Percutaneous left ventricular assist devices (pVADs) require a continuous purge solution containing heparin to prevent pump thrombosis and device failure. Data regarding alternative options in patients who have suspected heparin-induced thrombocytopenia (HIT) are limited. In this report, we describe a 68-year-old white man with cardiogenic shock with an Impella CP device managed with a low concentration argatroban-based purge solution secondary to a suspected diagnosis of HIT. The purge solution was initiated as argatroban in dextrose 10% at a concentration of 0.12 mg/mL and was subsequently decreased twice to 0.06 and 0.015 mg/mL based on the patient's clinical course. This case report describes the safe and effective use of argatroban purge solution necessary for anticoagulation although further studies are needed to confirm these findings.
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http://dx.doi.org/10.1177/0018578719888905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326858PMC
August 2021

Matters of Life and Death.

Am J Pharm Educ 2021 Jul 22:8636. Epub 2021 Jul 22.

University of North Carolina Medical Center, Chapel Hill, North Carolina.

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http://dx.doi.org/10.5688/ajpe8636DOI Listing
July 2021
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