ABC [Afrezza with Basal Combination]: A Phase 4
Project Faculty: CJ Jacobson (SubI/RC), Brittney Migliozzi (RC), Kevin Codorniz
- Looking at use of inhaled insulin in combiniation with automated insulin delivery systems vs inhaled insulin with basal insulin vs control.
Adult Iatrogenic Withdrawal Study in the ICU
Project Faculty: Justin Kinney, Scott Bolesta (PI)
- Withdrawal from opioids and sedatives administered for medical purposes (i.e. iatrogenic withdrawal) often goes unrecognized in the critically ill, but its prevalence is high. Reports describing what is being implemented at the bedside to prevent iatrogenic withdrawal are lacking, and how patients are monitored and assessed for withdrawal has not been adequately studied. Therefore, our overall objective is to determine the current analgesia and sedation weaning practices in adult ICUs. In order to accomplish our objective, we plan to conduct a prospective, observational, point prevalence trial.
Aminoglycoside Dosing Recommendations in Patients Receiving Home Hemodialysis – MCS Approach
Project Faculty: Soo Min Jang, Bruce Mueller (PI)
- MCS were used to determine optimal dosing regimen for gentamicin and amikacin in patients receiving home hemodialysis.
Antibiotic optimal dosing in Asian critically ill patients receiving renal replacement therapies – MCS Approach
Project Faculty: Soo Min Jang, Susan Lewis, Sandy Rhee (PI)
- In collaboration with University of Findlay and Ewha Womens University in South Korea, we are developing optimal drug dosing regimens for different antibiotics in Asian critically ill patients receiving renal replacement therapies.
Beta-lactam Dosing Recommendations in Patients Receiving Home Hemodialysis – MCS Approach
Project Faculty: Soo Min Jang, Bruce Mueller (PI)
- Monte Carlo Simulation (MCS) were used to determine optimal dosing regimen for cefepime, ceftazidime, cefazolin, meropenem and imipenem and a in patients receiving home hemodialysis.
Characterizing the anaerobic organisms unidentified by the Verigene Blood Culture Nucleic Acid Test
Project Faculty: Jacinda Abdul-Mutakabbir, Karen Tan, Anna Zhou
- Positive cultures unidentified by the Verigene Gram-Positive (GP) and Gram-Negative (GN) blood nucleic acid tests are often encountered in clinical practice. Few studies evaluating the concordance of Verigene and automated organism identification systems have found that the majority of the Verigene offpanel results were anaerobic isolates. Limited susceptibility results for off-panel anaerobic blood cultures are available to help guide therapeutic management. The aims of this study were to characterize the Verigene off-panel blood cultures and the susceptibility profile of select antimicrobials with anaerobic activity.
Characterizing Safety and Clinical Outcomes Associated with High-Dose Micafungin Utilization in Patients with Proven Invasive Candidiasis
Project Faculty: Jacinda Abdul-Mutakabbir, Karen Tan, Anna Zhou
- Micafungin is the empiric antifungal agent of choice for the treatment of invasive candidiasis (IC). Pathophysiologic changes that occur in obese and/or critically ill patients can alter micafungin serum concentrations and the probability of target attainment. Although high doses of micafungin have been shown to be safe, clinical outcomes have not been widely evaluated. We conducted a single-center, retrospective observational study evaluating safety and clinical outcomes among adult patients treated with ≥200 mg of micafungin for ≥3 days for proven IC from 1 September 2013 through 1 September 2021.
Characterization of Trends in the Microbiology and Treatment of Extended Spectrum Beta-lactamase Urinary Tract Infections in the Emergency Department
Project Faculty: Jacinda Abdul-Mutakabbir, Karen Tan, Anna Zhou
- Urinary tract infections are one of the leading indications for antimicrobial therapy and are most commonly caused by Enterobacterales. Uncomplicated urinary tract infections are commonly managed on an outpatient basis and treated with oral antimicrobial agents, however increasing rates of extended spectrum beta-lactamase (ESBL) producing Enterobacterales in the United States threatens to complicate the treatment of these infections. Furthermore, differences in the prescribing patterns of multiple provider disciplines contribute to differences in ESBL treatment. Oral treatment options for ESBL producing infections are limited as ESBL enzymes confer resistance to all currently available beta-lactams and acquisition of an ESBL enzyme is often associated with other resistance mechanisms limiting the availability of alternative agents, including fluoroquinolones and trimethoprim/sulfamethoxazole. The purpose of this project is to characterize the causative pathogens and treatment of urinary tract infections at a large health system in southern California.
Determining the Mediators of Resistance to SPR206, a Novel Polymyxin Derivative, in Acinetobacter baumannii
Project Faculty: Jacinda Abdul-Mutakabbir, Hansel Fletcher
- Multidrug-resistance (MDR) in non-fermenting Gram-negative organisms, such as Acinetobacter baumannii, is an increasingly serious problem in various clinical settings. Resistance to the carbapenem antibiotics that previously retained activity against MDR A. baumannii, has been declared “priority one” by the World Health Organization. The long-term goal of this research project is to mitigate the dissemination of resistance to novel antimicrobial agents, via a comprehensive understanding of their mechanism(s) of resistance.
Effect of an interdisciplinary care model on Direct Oral Anticoagulant Dosing in Patients with Non-valvular atrial fibrillation
Project Faculty: Huyentran N. Tran
Enteral antipseudomonal fluoroquinolones for ventilator-associated tracheobronchitis in children with pre-existing tracheostomy
Project Faculty: Caroline Sierra
- This study evaluated the effectiveness and safety of enteral antipseudomonal fluoroquinolones for ventilator-associated tracheobronchitis (VAT) in children with pre-existing tracheostomy. Of 76 identified treatment courses representing 60 children, 65 (86%) were successfully treated with a fluoroquinolone. Most tracheostomy cultures were polymicrobial; the most commonly isoled organism was Pseudomonas aeruginosa. Tendonitis and tendon rupture were not noted.
Evaluation of VERIGENE® Gram-Negative Blood Culture Test Performance at a Large Academic Medical Center
Project Faculty: Jacinda Abdul-Mutakabbir, Karen Tan, Anna Zhou
- The incidence of extended spectrum beta-lactamase-producing Enterobacterales (ESBL-E) infections in the United States continues to increase.1 The blaCTX-M enzyme is the predominant gene conferring the ESBL phenotype.2 ESBL-E can result in a breadth of infections, including bacteremia, leading to poor clinical outcomes3 Conventional antimicrobial susceptibility testing platforms, such as MicroScan, provide results in approximately 15-42 hours from gram stain; thus, delaying the confirmation of an ESBL-E microorganisms4 VERIGENE® Gram-negative blood culture test (BC-GN) is a rapid diagnostic tool that detects a panel of pathogens and drug resistance markers, including CTX-M, within 2 hours.5 Currently, the unestablished concordance between VERIGENE® and MicroScan at the Loma Linda University Medical Center (LLUMC) limits its applicability to rapidly escalate and/or de-escalate antibiotic therapy.
Fluoroquinolone Dosing Recommendations in Patients Receiving Home Hemodialysis – MCS Approach
Project Faculty: Soo Min Jang, Bruce Mueller (PI)
- MCS were used to determine optimal dosing regimen for levofloxacin and ciprofloxacin and a in patients receiving home hemodialysis.
Identifying the Role for a Pharmacist on an Outpatient Parenteral Antimicrobial Therapy (OPAT) Team in an Academic Teaching Hospital
Project Faculty: Jacinda Abdul-Mutakabbir, Karen Tan, Anna Zhou
- Outpatient parenteral antimicrobial therapy (OPAT) is currently an emerging practice to continue effective treatment after hospital discharge for patients requiring parenteral (IV) treatment. Infectious Disease Society of America (IDSA) 2018 OPAT guidelines currently provides guidance and recommendations on appropriate patient selection, optimal antibiotics for OPAT and monitoring parameters.1 There is currently limited guidance on the potential utility of an OPAT pharmacist in a setting that does not have an established OPAT service.
INOCULATED: Inland Empire of California United Local/Academic Team Ending Disparities
Project Faculty: Jacinda Abdul-Mutakabbir, Bridgette Peteet
- Historically, Black Americans have been disproportionately affected by vaccine-preventable respiratory infectious diseases. Coronavirus disease-19 (COVID-19) has followed the same trajectory, as Black individuals account for more than 30% of COVID-19 deaths, despite only representing 13.4% of the U.S. population. In the Inland Empire (IE) of Southern California, comprised of vast rural and urban areas, Black individuals represent more than 50% of COVID-19 related mortalities yet only 31.2% of have been fully vaccinated compared to 59.9% of the IE population and 72.9% in California overall. Consequently, vaccine hesitancy and inadequate access to the vaccinations have been identified as limitations to vaccine uptake among Black Americans. Building on their long-standing history of close community engagement, Loma Linda University faculty in collaboration with Black interfaith leaders developed a pilot program to overcome the observed inequities in the COVID-19 deaths and vaccination rates of Black individuals. The pilot program included community engagement, providing trustworthy information about the vaccines, and the completion of low-barrier vaccine clinics within the targeted Black communities. While 1,101 COVID-19 vaccine doses have been delivered to Black individuals through this community-academic partnership, there is a critical need to expand the current efforts. Using a hybrid type 2 effectiveness design that is guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, this study proposes a phased approach for designing and implementing an intervention designed to decrease COVID-19 vaccine hesitancy and promote uptake within urban and rural IE Black communities. The overall goal of this proposal is to promote positive vaccine attitudes to increase vaccine uptake rates and intentions.
Ketamine use in the ICU
Project Faculty: Justin Kinney, Christine Groth (PI)
- The Ketamine-ICU study group was initiated from an American College of Clinical Pharmacy (ACCP) practice-based research network to expand our understanding of ketamine’s use and its impact on pain/sedation scores as well as the influence it has on exposure to other opioids.
Medication Literacy Tool in Dialysis Patients
Project Faculty:
- I have developed a medication literacy tool where it is used to assess patients’ ability to comprehend over the counter and prescription medication labels in dialysis patients and primary care settings.
“Medtronic Use of the Guardian™ Connect system
Project Faculty: CJ Jacobson (SubI/RC), Brittney Migliozzi (RC), Kevin Codorniz (PI)
- The purpose of this study is to collect sensor, insulin, sleep, activity and food/meal data for a minimum of 90 days of device wear (Phase 1) and up to a maximum of 9 months of device wear (Phase 2) with optional insulin injection video capture and/or menstrual cycle tracking and/or cardiac monitoring in subjects with insulin requiring diabetes 2-80 years of age.
The incidence, clinical management, and clinical course of acute kidney disease
Project Faculty: Tomona Iso
- The purpose of this study is to estimate the prevalence of AKD among patients who were admitted to the Loma Linda University Medical Center, and to describe standard of care for prevention and treatment of AKD, risk factors, and clinical outcomes among these patients.
The Utility of Verigene® Gram-Positive Blood Culture Nucleic Acid Test (BC-GP) and Concordance with MicroScan Conventional Panels at a Large Academic Medical Center
Project Faculty: Jacinda Abdul-Mutakabbir, Karen Tan, Anna Zhou
- Verigene® Gram-Positive Blood Culture Nucleic Acid Test (BC-GP) is a multiplexed, automated nucleic acid test for the identification of genus, species, and antimicrobial resistance determinants that can provide results within 2.5 hours of blood culture in comparison to conventional methods which may take 2-4 days.1 Studies have shown excellent concordance between Verigene® results and conventional automated susceptibility testing (AST) methods such as VITEK® for monomicrobial blood cultures. However, differences between AST methods limits the external validity of these studies to other AST methods such as MicroScan which there is limited data for.2,3 Loma Linda University Medical Center (LLUMC) utilizes both Verigene® and MicroScan, however, the unknown concordance between Verigene® and MicroScan susceptibility results prevents clinicians to take timely action.
Twice weekly prophylaxis with trimethoprim/ sulfamethoxazole for Pneumocystis jirovecii pneumonia in pediatric oncology patients
Project Faculty: Caroline Sierra, Khaled Bahjri
- This study evaluated the efficacy of two consecutive days per week of trimethoprim/sulfamethoxazole (TMP/SMX) for prevention of Pneumocystis jirovecii pneumonia (PJP) in pediatric oncology patients. Out of 322 patients who received this regimen, four had confirmed PJP (1.3%). Neutropenia remains a barrier for TMP/SMX use for PJP prophylaxis.
Research