Implementation of a Pharmacist-Driven Vancomycin and Aminoglycoside Dosing Service in a Pediatric Hospital.

OBJECTIVE: Pharmacy-driven antibiotic dosing services have been shown to improve clinical outcomes in adult patients. This study evaluated the effect of a pharmacist-driven antimicrobial dosing service on the percentage of therapeutic serum concentrations achieved following initial vancomycin or aminoglycoside dosing regimens. A secondary objective was to determine the effect of the dosing service on nephrotoxicity in pediatric patients. METHODS: This single-center, retrospective study used data obtained from an electronic medical record to evaluate the utility of a pharmacist-driven vancomycin or aminoglycoside dosing protocol. Assessments of target, subtherapeutic, and supratherapeutic serum concentrations were evaluated. The occurrence of changes in serum creatinine and presentation of acute kidney injury (AKI) were also determined. RESULTS: The incidence (n [%]) of a therapeutic initial serum concentration was not statistically significant between pre-protocol and post-protocol groups (21 [46.7%] vs 22 [48.9%], respectively; p = 0.834). The incidence of initial supratherapeutic concentrations (19 [42.2%] vs 7 [15.6%]; p = 0.005) and the average number of supratherapeutic concentrations per antibiotic course (0.76 vs 0.26; p = 0.01) were higher in the pre-protocol group compared with the post-protocol group. The incidence of AKI was significantly lower in the post-protocol group (2.2% vs 13.3%; p = 0.049). CONCLUSIONS: Implementation of a pharmacist-driven dosing service did not affect the likelihood of achieving an initial therapeutic concentration. However, it did reduce the likelihood of both supratherapeutic concentrations and AKI. Additional studies in pediatric patients are needed to affirm the use of pharmacist dosing services.

Rainfall, groundwater, and surface water isotope data from extreme tropical cyclones (2016-2019) within the Caribbean Sea and Atlantic Ocean basins.

Under a changing climate, projections estimate that over the next thirty years, extreme Tropical Cyclones (TCs) will increase in frequency, with two to three times more Category 4 and 5 hurricanes in the Atlantic basin between 20°N and 40°N. In recent years, the Caribbean Sea and Atlantic Ocean basins have experienced several extreme TCs, resulting in extensive human, ecological, and economic damage [1], [2], [3]. To improve understanding of TCs and their potential impacts in the face of climate change, physically based understanding of past climate and modern TC dynamics is necessary. Despite the well-known Atlantic hurricane season, surface observations of the isotopic evolution of TC's moisture and the propagation of isotopically distinct pulses across surface and subsurface water reservoirs are lacking. In this data article, we provide novel high frequency sampling of surface rainfall isotope compositions (δ18O, δ2H, and d-excess in ‰) for Hurricanes Otto (Costa Rica, 2016), Nate (Costa Rica, 2017), Irma (Cuba and The Bahamas, 2017), Maria (Cuba and The Bahamas, 2017), and Dorian (The Bahamas, 2019). These five TCs were characterized by unprecedented impacts during continental and maritime landfalls and passages. In total, 161 surface rainfall samples were collected in passive devices [4] with event-based and daily frequencies, resulting in the first surface isotopic tempestology anatomy across the Caribbean Sea and Atlantic Ocean basins to date. Derived rainfall from TCs often results in large input amounts of isotopically distinct water over an area from few hours to several days, and therefore this unique isotope composition is propagated through surface and shallow subsurface reservoirs. Our data also include spring (N=338) and surface water (N=334) isotope compositions following the impact of Hurricane Otto and Tropical Storm Nate in central Costa Rica. As this region is well-known for its diverse rainfall dynamics and as a climate change 'hot spot' [5], [6], [7], our data provide an opportunity to improve and complement modern and past climate interpretations often derived from satellite products and calcite-δ18O paleoclimatic archives in light of climatic forcing, TC rainfall amounts and recharge rates, and the hypothesized climatic-induced decline of past Mesoamerican civilizations.

Deciphering key processes controlling rainfall isotopic variability during extreme tropical cyclones.

The Mesoamerican and Caribbean (MAC) region is characterized by tropical cyclones (TCs), strong El Niño-Southern Oscillation events, and climate variability that bring unique hazards to socio-ecological systems. Here we report the first characterization of the isotopic evolution of a TC (Hurricane Otto, 2016) in the MAC region. We use long-term daily rainfall isotopes from Costa Rica and event-based sampling of Hurricanes Irma and Maria (2017), to underpin the dynamical drivers of TC isotope ratios. During Hurricane Otto, rainfall exhibited a large isotopic range, comparable to the annual isotopic cycle. As Hurricane Otto organized into a Category 3, rapid isotopic depletion coupled with a decrease in d-excess indicates efficient isotopic fractionation within ~200 km SW of the warm core. Our results shed light on key processes governing rainfall isotope ratios in the MAC region during continental and maritime TC tracks, with applications to the interpretation of paleo-hydroclimate across the tropics.