PRESENTATION HIGHLIGHTS

       Appropriate Antimicrobial Therapy  

PNEUMONIA:

·        #1 infection in the hospital; mostly community acquired

·        Healthcare Associated pneumonia is acquired in the hospital and then the patient returns after discharge

·        Nosocomial acquired  

RESISTANCE:

• 1953 first case of PCN resistance which led to the development of methicillin
• 1990’s PCN resistance S. Pneumoniae
  •  15-20% in parts of the country
• 2006 2/3 Community acquired pneumonia methicillin resistant
• S. pneumoniae and S. aureus evolving
  • Change in vaccination to include every 5 yrs and special vaccine for <18 mos of age

• Recent antibiotic use within last month
• >65 yrs
• Multiple medical comorbidities (malignancy, COPD, DM, renal failure, and CHF)
• Alcoholism
• Exposure to a child in Daycare
• Immunocompromised (steroids, Remicade)
• Patients who fail  treatment with a macrolide or beta lactam more likely to be infected with resistant strain of S. pneumoniae

• Macrolide resistance 24% (Azithromycin 30%)
• PCN 15-20%
• Bactrim resistance 26%
• Rocephin 1.6%
• Levaquin 0.9

• S. pneumoniae
• H. influenza
• M. pneumoniae

• P. aerginosa (R/T pseudomonas)
• S. aureus

• CXR only shows geography not etiology
• Sputum culture more definitive
• Serum mycoplasm worthless in adults

• 99% Susceptibility for S. pneumonia to Levaquin according to CDC
• No new treatment for gram negative organisms
• Maintain by using appropriate period of time and not excessively

• Evidence based
• Effective
• Safe
• Cost Effective
• Optimal dose/duration

• Evidence based: randomized double blind trial that is multicentered; timely and costly
• Adaptive trial: Better identifies responders to a drug by changing the protocol; quicker and less expensive but potential for bias

• Levaquin
• Avelox
• Cipro
• Rocephin with Clarithromycin

• Levaquin:  renal excretion (750 mg daily x 5 days as effective as 500 mg daily x 10 days)

• Cipro: cost least but not as effective for community acquired pneumonia; caution-may cause achilles rupture
• Avelox: increased cardiac events

• Increasing
• Occuring in people with no obvious exposure
• Often occurs with the most commonly used antibiotic
• 10-12% relapse rate which increases to 25-50% with each relapse
• Flagyl has a 14 % failure rate (considered failure if not responding in 7 days)
• 2% failure rate with Vancomycin
• IV Vancomycin given po is less expensive. Infusion center can compound into 250 mg qid.
• Xifaxin is anecdotal if albumin <2

Business Meeting

• President Kathy Sharp opened the meeting by thanking our Procara representative and Dr. Anton Maki, Jr.
• Secretary’s Report:
  • The minutes were posted on the website and a motion was made by Kay Bone to approve them. A second was made by Paula Countiss and the minutes were approved by a unanimous vote. 
• Treasurer’s Report:
  • Current balance $12,888.89. 

Old Business:

• There is still an opportunity for one of our members to take advantage of the opportunity to attend the 22nd annual AANP conference in Indianapolis, IN on June 20-24. None of our officers will be able to utilize this free registration, so we would like to offer this to one of our members. If you are interested, please let one of the executive committee know.  Since we may receive more than 2 requests, we will look at those names and evaluate them based on attendance and service to the organization.
• May 8th is the Nurses Day Awards Banquet in at the Holiday Inn in Johnson City. The theme for this year is Nursing: A profession and a passion. We need to have someone to man the display table before the Awards banquet to talk to those present about our organization and our mission. Amy Kaplan is putting together a display board. Kay Bone and Kelly Mayden agreed to help man the table.
• NP of the Year is to be presented at the May 8th Nurses Day celebration. Nominations have been received for KAY BONE, TRACY LUTHER, AND WENDY VOGEL. Ballots have been sent out and can be returned to Kathy Sharp at mulekat@charter.net. These are due by May 1, 2007.  Criteria to consider include active membership, mentorship, and legislative participation.
• The TNA is actively seeking nominations for several positions that will be open this fall. Persons will be needed for secretary (2 yr position), 3 positions for nominating committee (2 yr term) and delegates for ANA and the Center for American Nurses. Anyone interested, please go to www.tna.online.org for info.
• There is a survey available online regarding the DNP.  Please go to www.npjournal.org to participate.

New Business:

• Kathy Sharp announced that she received evaluations from last month’s meeting and would like to thank Margery Wilson for tabulating these. She has also received letters and emails regarding pharmaceutical sponsorship for the NETNPA meetings and whether this is ethical. This issue was brought before the members for discussion.
  • ? Ethical
  • Biased and not representative of balanced treatment options
  • APN’s educated enough to review information and make informed choices
  • Members may not come and support their profession if responsible for their own dinners
  • We could temporarily sponsor our own meetings, but not indefinitely without raising money to do so
  • Members from each specialty rotate a program discussion reviewing a recent article or “hot topic”
  • Open forum with periodic  Q & A sessions to be answered by various APN’s in different areas of practice
• After much discussion, a motion was made by Kelly Hodge to keep pharmaceutical sponsored meetings “as is.”  Paula Countiss seconded this motion and it was passed with an unanimous vote. 

Educational Program:

• 5th Annual Diabetes Symposium on May 10th at BRMC.  Registration at 7:30 am. This is a free symposium and 7.5 CEU’s from ANCC will be included!!

Job Opportunities:

• None

Next Meeting:  Boston with Takeda, who represents Amitizawill be sponsoring our meeting Thursday 5/17/07 at 6:30 pm at The Chop House, Eastman Rd., Kingsport.  Our speaker is still being arranged, but will be one of three gastroenterologists.  This is a timely subject, since Zelnorm has fallen out of favor and is being written only under special circumstances now.  Please RSVP to kayandpatbone@aol.com.

Submitted by Tracy Luther, Secretary