BACKGROUND:Unfractionated heparin (UFH) is widely used for treatment of acute venous thromboembolism (VTE); however, its anticoagulant response is highly variable. Delays in achieving therapeutic anticoagulation have been associated with increased mortality, suggesting a potential role for predictive modeling to guide dosing. OBJECTIVE:To develop predictive models to estimate probability of therapeutic or supratherapeutic level attainment at the time of first activated partial thromboplastin time (aPTT) and the UFH infusion rate at the time of first therapeutic aPTT. METHODS:This retrospective, cohort study included hospitalized patients with a new diagnosis of VTE receiving protocolized UFH (80 units/kg bolus followed by 18 units/kg/h infusion). Patients were excluded for protocol deviations, anticoagulation reversal, hypothermia, or pregnancy. The primary outcome was development of a predictive model for attainment of therapeutic or supratherapeutic aPTT at first follow-up. A secondary model was developed that predicted heparin infusion rate at the time of first therapeutic aPTT. Multivariable logistic and linear regression models were developed with variable selection using least absolute shrinkage and selection operator. Model performance was assessed using discrimination and calibration. RESULTS:Among 398 included patients, 83.2% achieved a therapeutic or supratherapeutic aPTT at initial follow-up. Eleven predictors were included in the primary model (age, sex, race, white blood cell count, creatinine clearance, body mass index, total bilirubin, albumin, platelets, propofol exposure, and coagulopathy) and demonstrated moderate discrimination (area under the curve [AUC] = 0.744) with acceptable calibration for predicting UFH response. Prediction of heparin dose at initial therapeutic aPTT incorporated a subset of these variables along with additional predictors (weight, Glasgow Coma Scale, baseline aPTT, active viral infection, and aspartate aminotransferase) and demonstrated substantial performance (R2 = .714). CONCLUSION AND RELEVANCE:Clinical and laboratory factors influence UFH response and dosing requirements. These models may support individualized dosing strategies to improve time to therapeutic anticoagulation, although external validation is needed before clinical application.

In the acute care setting, consensus is lacking on whether patients initially treated with parenteral anticoagulation for venous thromboembolism (VTE) should complete the full high-intensity period (HIP) of apixaban or rivaroxaban. This study examines HIP prescribing patterns following parenteral anticoagulation and assesses the influence of patient, provider, and facility characteristics. Patients initiating rivaroxaban or apixaban for VTE after parenteral anticoagulation were identified from the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) database between November 2015 and March 2024. Those with an indeterminate duration of parenteral treatment were excluded. Patients were categorized into full HIP and shortened HIP cohorts based on DOAC dose and duration. Demographics and comorbidities were compared using Student’s t-test and Chi-squared or Fisher’s exact tests. Variables with p < 0.3 were included in a logistic regression model, with stepwise selection at a 0.1 significance threshold. Among 816 patients, 687 (84.2

BACKGROUND:Inappropriate antibiotic treatment of asymptomatic bacteriuria (ASB) remains common in hospitalized patients. This study evaluated the impact of 2 electronic stewardship interventions across 5 hospitals. METHODS:This multicenter, retrospective study included adult patients (≥ 18 years old) admitted between January 2020 and January 2026 with confirmed ASB. Patients were excluded for death within 48 hours, neutropenia, receipt of antibiotics for an active infection, or urologic procedure with mucosal involvement. Two electronic interventions were implemented 1 year apart: a best practice advisory (BPA) prompting appropriate urine culture ordering, followed by a microbiology nudge at the time of urine culture results to encourage reassessment of therapy. Patients were categorized into pre-BPA, BPA, and BPA plus nudge (BPAN) cohorts. The primary outcome was antibiotic treatment for more than 24 hours. RESULTS:A total of 903 patients were included (pre-BPA n = 572, BPA n = 112, BPAN n = 219). Antibiotic treatment beyond 24 hours occurred in 53.7% of patients in the pre-BPA cohort, compared to 34.8% in the BPA cohort and 45.7% in the BPAN group (P < .01). CONCLUSIONS:Electronic stewardship interventions reduced unnecessary antibiotic treatment of ASB. Active alerts at the time of urine culture ordering were more effective than passive reminders introduced later in care. Interventions that require immediate action appeared to be more effective than passive reminders.

Background:No standardized nomogram has been established to reduce hypoglycemia events while optimizing clinical outcomes for patients with diabetic ketoacidosis (DKA). Objective:To evaluate the safety and effectiveness of two DKA nomograms. Methods:We conducted a multicenter, retrospective cohort study in adult patients (≥18 years) treated with IV insulin for DKA. Cohorts were categorized based on the insulin nomogram utilized: Standard Incremental Nomogram with Glucose-Level Evaluation (SINGLE) and Multiple Algorithm Nomogram using Insulin Change and Rate Estimate (MULTIPLE). Patients were excluded if they were experiencing pregnancy, euglycemic DKA, or hyperosmolar hyperglycemic state. The primary outcome was hypoglycemic events (BG < 70 mg/dL). Secondary outcomes included time to DKA resolution and DKA recurrence. Results:A total of 234 patients were included (SINGLE n = 117, MULTIPLE n = 117). Hypoglycemia occurred in eight patients in the MULTIPLE group (6.8%) versus 25 patients in the SINGLE group (21.4%) (P< 0.01) after controlling for confounders, hypoglycemia remained highest in the SINGLE cohort versus the MULTIPLE cohort (OR 3.0 [95% CI 1.2-7.2], P < 0.01). After controlling for confounders, hypoglycemia remained highest in the SINGLE cohort versus the MULTIPLE cohort (OR 3.0 [95% CI 1.2-7.2], P < 0.01). Significant differences were not observed between the two nomograms in time to DKA resolution (16.4 hours [IQR 10.2-28.3] vs 16.1 [IQR 10.0-22.8], P = 0.19), recurrence rates (11.1% vs 15.4%, P = 0.34) or ICU LOS (P = 0.06). Conclusion:The MULTIPLE nomogram had fewer hypoglycemia events with no difference in time to DKA resolution. Additional studies are needed to evaluate varying nomograms to determine the optimal approach.

This quality improvement study examines whether an aspirin deprescription intervention is associated with a sustained decrease in aspirin use among patients receiving warfarin for venous thromboembolism and/or atrial fibrillation.

Verigene® is a molecular rapid diagnostic test (mRDT) that iden-tifies certain organisms and resistance markers within 2.5 hours of blood culture positivity and can potentially aid in reducing the time to appropriate antibiotic therapy, thus improv-ing patient outcomes. However, Verigene® is not calibrated to detect all organisms and resistance markers. To assess outcomes of patients with bacteremia in whom Verigene® identified organisms (BOI) and compare them to patients with bacteremia in whom Verigene® did not identify an organism (BON). Single-center, retrospective cohort study evaluating inpatients admitted between May 2020 to June 2021. The primary outcome was to compare the inpatient mortality rates of patients with BOI with patients with BON. Secondary outcomes include 30-day read-mission rate, reason for readmission, appropriateness of antibiotic therapy at time of final blood culture result, time to appropriate antibiotic therapy, and length of stay (LOS). 100 and 79 patients were included in the BOI and BON groups, respectively. Mortality was significantly higher in the BON group compared to the BOI group (31.6% vs 14 %, respectively, p < 0.01). A significantly shorter time to appropriate antibiotics was observed in the BOI group compared to the BON group (0.6 + 1.1 days vs 0.9 + 1.1 days, respectively, p= 0.04). This observation was larger in the critically ill population. In conclusion, our study found a significant difference in mortality and time to appropriate antibiotics between groups when Verigene® could and could not identify the organism.

Background:Direct oral anticoagulants (DOACs) are commonly used for the treatment of atrial fibrillation (AF) and venous thromboembolism (VTE) but increase the risk of bleeding. Objectives:We aimed to evaluate the distribution of bleeding events after anticoagulant initiation. Methods:Adult patients in the Michigan Anticoagulation Quality Improvement Initiative registry on DOAC for AF or VTE were followed from anticoagulant start to identify any bleeding event within 12 months. The primary outcome was any bleeding; secondary outcomes were bleeding subtypes. Monthly event rates were compared by Poisson and proportion tests. Results:A total of 2663 patients (mean age 66.9 years, 49% male sex [as recorded in the electronic health record], 72.1% AF) who were starting DOACs were followed. Bleeding event rates were highest after anticoagulant initiation. For VTE, patients experienced 110, 55, and 36 bleeding events per 100 patient-years the first 3 months of anticoagulation, respectively. For AF, patients experienced 66, 43, and 33 bleeding events per 100 patient-years the first 3 months of anticoagulation, respectively. After adjustment for covariates, bleeding was higher for patients with VTE compared with AF, with 51 vs 34 bleeds per 100 patient-years (rate ratio, 0.68; 95% CI, 0.58-0.80; P < .001), largely driven by differences in the first month of anticoagulation (141 vs 75 bleeds per 100 patient-years; rate ratio, 0.53; 95% CI, 0.38-0.74; P < .001). Conclusion:Bleeding rates were highest during the first 3 months of oral anticoagulation; bleeding was higher for patients with VTE compared with AF. These findings emphasize the need for careful management and monitoring after DOAC initiation.

Rivaroxaban dosing for nonvalvular atrial fibrillation (NVAF) is based on Cockcroft–Gault creatinine clearance using actual body weight (CG-CrCl-ABW) per FDA labeling. Recent recommendations support utilizing the race-free CKD-EPI 2021 equation for estimating kidney function. However, it is unknown whether substituting estimated glomerular filtration rate (eGFR) for CG-CrCl-ABW would alter dosing recommendations. The purpose of this study was to evaluate differences in rivaroxaban dosing when renal function is estimated using CG-CrCl-ABW versus CKD-EPI 2021. This retrospective statewide cohort study included adults (≥ 18 years) with NVAF identified from the Michigan Anticoagulation Quality Improvement Initiative registry. The primary outcome was rivaroxaban dosing disagreements, defined as a difference in dose between CG-CrCl-ABW and CKD-EPI 2021 with body surface area (BSA) adjustment using the Du Bois formula. Agreement between methods was assessed using Cohen’s kappa. A total of 476 NVAF patients were included. The mean age was 69.7 years, weight was 95.6 kg and serum creatinine was 0.96 mg/dL. Dosing disagreement occurred in 4.8

Introduction: Hypoglycemia in critically ill patients increases morbidity and mortality. Subcutaneous long-acting insulin (LAI) in patients without diabetes is associated with hypoglycemia in the SICU. However, limited evidence exists in patients with diabetes. Methods: This was a single-center, retrospective cohort study evaluating patients with T2DM who were admitted to the SICU for 24 h and received LAI in combination with sliding scale insulin (LAI + SSI) or sliding scale insulin (SSI) alone. The primary outcome was the incidence of hypoglycemia (BG < 70 mg/dL) in patients who received LAI + SSI or SSI. Secondary outcomes evaluated the number of glucose values across defined categories: hypoglycemia (54-70 mg/dL), severe hypoglycemia (<54 mg/dL), euglycemia (70-180 mg/dL), hyperglycemia (>180 mg/dL) and glycemic variability. Results: A total of 228 patients were included in the final analysis. The incidence of hypoglycemia occurred in 17.5% of patients in the LAI + SSI cohort and 18.4% in the SSI cohort (p = .86). After controlling for confounders, no differences were observed with LAI + SSI versus SSI for hypoglycemia (OR 1.09, 95% CI 0.46-2.6, p = .85). Secondary outcomes demonstrated no difference in total hypoglycemia (37 vs 31, p = .80), severe hypoglycemia (15 vs 34, p = .17) and euglycemia (1622 vs 1780, p = .22) in the LAI + SSI cohort compared to SSI alone. Hyperglycemia occurred more frequently with LAI + SSI. However, after adjusting for confounders there was no difference in hyperglycemia (OR 1.8, 95% CI 0.7-4.6, p = .22). No difference was observed in glycemic variability between LAI + SSI and SSI (26.5 vs 24.5, p = .21). Conclusion and Relevance: The addition of LAI to SSI in SICU patients with T2DM was not associated with an increased risk of hypoglycemia.

BACKGROUND:In 2019, the Food and Drug Administration issued a warning regarding the risk of respiratory depression with gabapentin use, especially when combined with opioids or other central nervous system depressants. While prior inpatient studies have observed increased respiratory risks in postoperative patients, data are limited in hospitalized patients with renal dysfunction. OBJECTIVE:The objective of the study is to evaluate the association between gabapentinoid use and respiratory depression in hospitalized patients with chronic kidney disease (CKD). METHODS:This single-center retrospective cohort study included adult inpatients receiving a multimodal pain regimen with or without gabapentinoid and CKD stage III, IV, or V. Patients were excluded if they had a history of epilepsy, generalized anxiety disorder, restless leg syndrome, acute respiratory conditions, hepatic disease, or were initially admitted to the intensive care unit. The primary outcome was a composite measure of respiratory depression, including use of high-flow nasal cannula, bilevel positive airway pressure, mechanical ventilation, oxygen escalation, naloxone or flumazenil administration, or rapid response/code activation. Secondary outcomes included altered mental status, falls, and individual components of the primary outcome. RESULTS:A total of 320 patients were included. In the unadjusted analysis, respiratory depression occurred in 35.6% of gabapentinoid users versus 24.1% of nonusers (P = 0.10). After controlling for confounders, gabapentinoid use was associated with a significantly higher risk of respiratory depression (odds ratio: 1.71; 95% confidence interval: 1.02-2.89). A dose-dependent relationship was observed with respiratory depression: gabapentin >1400 mg/d (83.3%), 800 to 1400 mg/d (42.3 %), and 100 to 700 mg/d (29.7%); pregabalin >150 mg/d (66.7%) and ≤150 mg (26.3%). Secondary outcomes were not significantly different between groups. CONCLUSION AND RELEVANCE:Gabapentinoid use in hospitalized CKD patients was associated with respiratory depression. These findings support the need for careful dosing and monitoring of gabapentinoids in this high-risk population.

BACKGROUND:Evusheld®, a combination of monoclonal antibodies Tixagevimab and Cilgavimab, was developed for pre-exposure prophylaxis (PrEP) of coronavirus disease 2019 (COVID-19) in immunocompromised patients. However, real-world long-term data on its effectiveness against SARS-CoV-2 Omicron variants remain limited. METHODS:A retrospective cohort was conducted on patients ≥18 years old who received the Evusheld from December 1, 2021, to January 31, 2023, at six Ascension hospitals in Southeast Michigan. Patients included were those with active solid tumor and hematologic malignancies or undergoing immunosuppressive treatment, including CAR-T therapy, biologic agents, or high-dose corticosteroids (≥20 mg prednisone or equivalent per day for ≥2 weeks). Data collected included patient demographics, development of COVID-19 post-Evusheld, ICU length of stay (LOS), hospital LOS, ventilation requirement and duration, and mortality within six months post-therapy. RESULTS:Among 663 patients screened, 316 were included after excluding duplicates and patients that did not receive the ordered Evusheld regimen. Among them, 204 patients received two doses of Evusheld and 112 received only one dose. In the two-dose group, 18 (8.8%) tested positive for COVID-19 within 180 days post-Evusheld, while 11 (9.8%) in the one-dose group tested positive. Notably, none of the COVID-positive patients in either group required hospitalization, mechanical ventilation, or succumbed to the disease. CONCLUSIONS:Within six months of Evusheld administration, immunocompromised patients showed no episodes of rehospitalization, mechanical ventilation, or death, and experienced low rates of severe COVID-19.

Abstract Background Evusheld® is a combination of two monoclonal antibodies, Tixagevimab and Cilgavimab. It was developed for the pre-exposure prophylaxis (PrEP) and treatment of COVID-19 illness for those who are immunocompromised. There is paucity of long-term real-world data on the use of Evusheld among the immunosuppressed patients against the SARS-CoV-2 Omicron variants. Methods A retrospective cohort chart review of patients 18 years and older who received the two dose Evusheld regimen from December 1, 2021 to January 31, 2023 at a community teaching institution was performed to evaluate the effectiveness of Evusheld as PrEP of COVID-19 patients. Evusheld as PrEP was indicated for patients with active solid tumor and hematologic malignancies or those receiving immunosuppressive treatment including CART therapy, biologic agents and high-dose corticosteroids (i.e., ≥ 20 mg prednisone or equivalent per day when administered for ≥ 2 weeks). The following data was collected: patient demographic, development of COVID19 after receiving Evusheld®, intensive care unit (ICU) length of stay (LOS), hospital LOS, ventilation requirement, duration of ventilation, and mortality among these patients within six months of receiving Evusheld therapy. Results Of the 663 patients screened, 459 were excluded primarily for duplicate patients. The mean age of the 204 included patients was 68.3 years and 97 (47.5%) were female. Eighteen (8.8%) patients had a positive COVID-19 test within 180 days of receiving Evusheld. None of the COVID positive patients were admitted to the hospital or required mechanical ventilation. All COVID positive patients survived. Conclusion Our study shows that Evusheld was effective in preventing COVID-19 among the immunocompromised patients during the six-month follow-up period. This study also showed that patients who developed COVID-19 after Evusheld did not develop severe disease or require hospitalization. Disclosures All Authors: No reported disclosures

Introduction: Serial complete blood count (CBC) tests can identify potentially significant lab abnormalities for patients using the direct oral anticoagulants (DOACs). This includes low hemoglobin values, hematocrit abnormalities, and abnormal platelet values. While various CBC monitoring strategies have been proposed, the optimal CBC monitoring strategy has not been defined. It is unclear whether monitoring should differ based on factors like age, comorbidity, and indication for anticoagulation. CBC testing can be important to identify anemia. Patients found to have anemia may need further diagnostic evaluation (e.g., endoscopy to assess for bleeding) and/or treatment (e.g., iron replacement for iron deficiency anemia). We sought to evaluate CBC utilization for patients on DOACs. For patients who had CBCs done, we sought to determine the prevalence and incidence of low hemoglobin values. In addition, we sought to explore the incidence of abnormal platelet and hematocrit values. Methods: We used the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) DOAC registry data, which includes chart abstracted data from six health systems in Michigan. We included patients from 1/2010 to 12/2024 on long term anticoagulation for atrial fibrillation (AF), and/or venous thromboembolism (VTE). Patients with less than 6 months of follow-up, on dialysis, or receiving chemotherapy were excluded. Records were reviewed up to 6 months before anticoagulation initiation to determine the baseline hemoglobin. Anemia was defined as a hemoglobin <12.0 g/dL for females and <13.5 g/dL for males, using the most recent CBC before anticoagulant initiation. Patients were classified as having baseline anemia, a normal baseline hemoglobin, or missing data based on this review. After starting anticoagulation, CBC results were reviewed at 6-month intervals. In addition to hemoglobin abnormalities (defined above), platelets were abnormal if <150,000 or >400,000 platelets per microliter, and hematocrit was abnormal when above or below 40-54% for men and 36-48% for women. Descriptive statistics and prevalences are reported. Results: A total of 3,677 patients met the inclusion criteria. Before the initiation of anticoagulation, 1,247 (33.9%) patients had anemia, while no record of a baseline CBC was available for 380 patients (10.3%). Of the initial study cohort, 2,579/3,677 (70.1%) patients had at least one CBC within the first 6 months of follow-up. Among patients with normal baseline CBC testing, with CBCs tested in the first 6 months, 25.9% had one or more abnormality. Labs showed abnormal platelet values, hematocrit, and low hemoglobin values for 9.2%, 8.2%, and 9.9% of CBCs respectively. A total of 1,775/3,295 (53.9%) patients had at least one CBC between 6-12 months after DOAC initiation. Among patients with normal baseline CBC testing, with CBCs tested between 6-12 months, 29.5% of CBCs had one or more abnormality. Labs showed abnormal platelet values, hematocrit, and low hemoglobin values for 9.3%, 10.2%, and 12.0% of CBCs respectively. A total of 1,706/2,466 (69.2%) patients had at least one CBC between 12-24 months after DOAC initiation. Among patients with normal baseline CBC testing, with CBCs tested between 12-24 months, 31.4% of CBCs had one or more abnormality. Labs showed abnormal platelet values, hematocrit, and low hemoglobin values for 11.4%, 10.7%, and 13.4% of CBCs respectively. The median (interquartile range) of time to initial CBC after enrollment was 4 months (3.9 months). A total of 256/3,295 patients (7.8%) did not have a CBC checked during the initial 12 months after starting anticoagulation. Within the first 12 months of anticoagulation, 5,780 normal CBCs were resulted, 72% for patients with AF. The anticoagulant prescriber for patients with normal CBCs were most commonly cardiologists (37.0%), internal medicine (24.4%), and other providers (15.0%) while hematologists were less often prescribers for patients with normal CBCs (0.6%). Conclusions: Most patients have a baseline CBC before DOAC initiation for AF and/or VTE with nearly one-third being anemic. In follow-up, the majority of patients had CBC monitoring, with this testing often revealing abnormalities. The rate of CBC abnormality at baseline among patients without testing and the response to new CBC abnormalities needs further investigation.

Abstract Background Acinetobacter baumannii (ABM) is a gram-negative coccobacillus associated with infections in healthcare facilities and has a high mortality rate. Guidelines recommend nine grams ampicillin/sulbactam (amp/sulb) every eight hours for moderate to severe ABM infections. We assessed the dosing and effectiveness of amp/sulb in the treatment of ABM pneumonia and bacteremia. Methods We conducted a retrospective cohort study of patients receiving high dose (≥ 3.1 gms q4h or CrCl < 30mL/min) compared to low dose (< 3.1gms q6h or if CrCl ≥ 30 mL/min) amp/sulb for ABM bacteremia and pneumonia infections from 2017-2022. Patients were also included in the high dose group if CrCl < 30 ml/min and were receiving 3.1 gms q4h. The primary outcome was all cause mortality during hospitalization. The secondary outcome was ventilator free days. Results Of the 277 patients screened; 173 did not receive amp/sulb, 38 did not have ABM infection, 10 had penicillin allergy and 4 were duplicate patients. Of the 52 included patients, 18 (34.6%) received low dose and 34 (65.3%) received high dose. The mean age of the patients was 64.8 and 71.1% were males. The most common infection was pneumonia 27(51.9%) followed by 25 (48.1%) treated for bacteremia. Of the low dose group three patients (16.6%) died compared to four patients (11.7%) in the high dose group during their admission. Four patients (22.2%) and five patients (14.7%) in low dose and high dose groups were discharged to hospice respectively. Eleven of the 18 patients (61.1%) and 25 of 34 (73.6%) patients were discharged to home following resolution of ABM infection in the low and high dose groups respectively. Conclusion No difference was found between the low and high dose amp/sulb for the treatment of ABM pneumonia and bacteremia in patient outcomes. Further studies are needed to confirm these findings. Disclosures All Authors: No reported disclosures

BackgroundThe use of artificial intelligence (AI)–based large language model chatbots such as ChatGPT has become increasingly popular in many disciplines. However, concerns exist regarding ethics, legal considerations, accuracy, and reproducibility with its use in health care practice, education, and research. ObjectiveThis study aimed to assess current perceptions and use of AI chatbots in pharmacy practice from the perspective of pharmacist preceptors and determine factors that may influence the use of AI chatbots in practice. MethodsA cross-sectional survey of pharmacy practice preceptors from Indiana, Illinois, and Michigan was conducted using the validated Technology Acceptance Model Edited to Assess ChatGPT Adoption (TAME-ChatGPT) survey tool to collect information regarding current use of AI chatbots and factors associated with use, including ease of use, perceived risk, technology or social influences, anxiety, and perceived usefulness. ResultsA total of 194 responses (194/1877, 10.34% response rate) were received. Approximately one-third (n=59, 30.4%) of respondents reported having used an AI chatbot, with 51.5% (n=100) indicating that they planned to start or would continue using chatbots in the future. In practice, common uses for AI chatbots included summarizing information (n=90, 46.4%), letter of recommendation writing (n=64, 32.9%), and obtaining disease state information (n=63, 32.5%). The 2 main constructs associated with the use of chatbots identified from the TAME-ChatGPT tool included perceived risk of using AI and attitude toward AI. Factors that predicted pharmacists’ current use of AI chatbots included positive attitude toward technology (odds ratio [OR] 3.64, 95% CI 2.08-6.36), coworker use of AI (OR 7.41, 95% CI 2.64-20.8), and working in academia (OR 5.62, 95% CI 1.30-24.23). ConclusionsMost pharmacist respondents had not used an AI chatbot and were unlikely to make patient care decisions based on information from a chatbot. The TAME-ChatGPT survey is validated for assessing chatbot use and attitudes among pharmacists, and future studies using this survey tool can guide the implementation of chatbots into pharmacy practice.

Use of artificial intelligence (AI) based large language model chatbots, such as ChatGPT, have become increasingly popular in many disciplines. However, concerns exist regarding ethics, legal considerations, accuracy, and reproducibility with its use in healthcare practice, education, and research. This study aims to assess current perceptions and use of artificial intelligence (AI) chatbots in pharmacy practice from the perspective of a pharmacist preceptor and to determine factors that may influence the use of AI chatbots in practice. A cross-sectional survey of pharmacy practice preceptors from Indiana, Illinois, and Michigan was conducted using the validated Technology Acceptance Model Edited to Assess ChatGPT Adoption (TAME-ChatGPT) survey tool to collect information regarding current use of AI chatbots and factors associated with use including ease of use, perceived risk, technology or social influences, anxiety, and perceived usefulness. A total of 194 responses (10.3% response rate) were received. Approximately one third (n=59, 30.5%) of respondents reported having used an AI chatbot, with 51.6% (n=100) indicating that they plan to start or will continue using chatbots in the future. In practice, common uses for AI chatbots included summarizing information, letter of recommendation writing, and obtaining disease state information. The two main constructs associated with use of chatbots identified from the TAME-ChatGPT tool included perceived risk of using AI and attitude towards AI. Factors that predicted pharmacists' current use of AI chatbots included positive attitude towards technology, coworker use of AI, and working in academia. The majority of pharmacist respondents had not used an AI chatbot and were unlikely to make patient care decisions based on information from a chatbot. The TAME-ChatGPT survey is validated for assessing chatbot use and attitudes among pharmacists, and future studies using this survey tool can guide the implementation of chatbots into pharmacy practice.

OBJECTIVE:Aztreonam-avibactam (ATM-AVI) is used for difficult-to-treat gram-negative infections. The objective of this review is to analyze the pharmacology, safety, and clinical application of ATM-AVI. DATA SOURCES:PubMed, Embase, and ClinicalTrials.gov were searched using the terms aztreonam avibactam, PF-06947387, Emblaveo, and ATM-AVI. STUDY SELECTION AND DATA EXTRACTION:Articles written in English and published from January 1, 1985, to June 10, 2025, that related to pharmacology, safety, clinical trials, and clinical application of ATM-AVI were reviewed. DATA SYNTHESIS:The ATM-AVI has shown similar efficacy to comparator antibiotics in complicated intra-abdominal infection (cIAI) and hospital/ventilator-acquired pneumonia (HAP/VAP). The REVISIT trial showed cIAI clinical cure rates of 76.4% and 74% for the ATM-AVI and meropenem groups, respectively (treatment difference 2.4% [95% confidence interval, CI = -7.4 to 13.0]). For HAP/VAP, clinical cure rates were 45.9% and 41.7% for the ATM-AVI and meropenem groups, respectively (treatment difference 4.3% [95% CI = -15.1 to 23.1]). The ATM-AVI was generally well tolerated, with hepatic adverse effects being the most commonly reported.Relevance to patient care and clinical practice comparison to existing drugs:The ATM-AVI has demonstrated clinical efficacy for the treatment of cIAI. However, its role needs to be further studied for other infections such as HAP/VAP, urinary tract, and other serious infections. Pharmacoeconomic analysis may be needed to assess the cost-benefit impact in the United States. CONCLUSION:The ATM-AVI may be an alternative option for the treatment of cIAI and other complicated gram-negative infections. Further studies are needed to delineate the role of ATM-AVI in clinical practice.