Cost-effectiveness of taurolidine locks to prevent recurrent catheter-related blood stream infections in adult patients receiving home parenteral nutrition: a 2-year mirror-image study.

BACKGROUND & AIMS: The use of long-term taurolidine locks (LTTL) seems to be effective in preventing catheter-related blood stream infections (CRBSI), especially in patients on home parenteral nutrition (HPN). This work targets the cost-effectiveness of LTTL in a cohort of adult HPN patients. METHODS: A monocentric mirror-image design study was conducted in our referral centre among long-term HPN patients experiencing recurrent CRBSI. From 7th January 2011, LTTL were started after the third CRBSI episode within 12 months. CRBSI data was prospectively collected until 7th January 2013, in the same way as it had retrospectively been done before initiating LTTL. A cost-effective analysis was conducted to estimate the incremental costs and effects on CRBSI with LTTL. The efficacy of LTTL on CRBSI rate was assessed over 1000 days of catheter use. RESULTS: A total of 31,100 catheter days were analysed in 37 patients (median [interquartile range (IQR)]) aged 58 [42-68] years. The mean ± SD proven CRBSI rate was 3.18 ± 3.51 per 1000 catheter days before the introduction of LTTL and 0.39 ± 1.50 per 1000 catheter days after its introduction (p < 0.0001). Considering both proven and probable CRBSI requiring hospital management, LTTL reduced by (mean [bootstrap CI 95%]) -2.63 [-3.26 to -2.06] infections per patient (from 2.89 [2.31 to 3.49] before to 0.26 [0.13 to 0.41] after) as well as incremental costs by -7 258 [-10 450 to -4 016] € (from 11 176 [8 004 to 14 968] € before to 3 918 [2 390 to 5 445] € after). CONCLUSION: Implementing LTTL to prevent recurrent CRBSI is cost-effective by dramatically decreasing their incidence.

Assessment of anti-infective medication adherence in pediatric outpatients.

The objective of this pilot study was to assess the overall adherence rate of the pediatric population to anti-infective drugs prescribed for acute infection at hospital discharge and to identify risk factors for non-adherence behavior. Pediatric patients discharged from a French university hospital with at least one oral drug prescription for acute infection were included for 3 months. Medication adherence and antibiotic knowledge were assessed through data collected by calling the parents. Overall adherence was assessed according to seven items: medication order filling, administered dose, time of intake, frequency of doses, medication omission, dose modification, and length of treatment. Seventy-five patients were included, and 63 interviews were exploited. The median age was 1.4 years, IQR = [0.7; 3.3]. Overall adherence to anti-infective agents concerned 34.9% of patients. The most frequently prescribed antibiotics were amoxicillin (29.3%), amoxicillin associated with clavulanic acid (25.3%), cotrimoxazole (18.7%), and cefixime (12.0%). A lack of parents' anti-infective knowledge was associated with non-adherence to anti-infective drugs.Conclusion: Two-thirds of outpatients were non-adherent to anti-infectives in acute infectious diseases. The misunderstanding of anti-infective treatment could be a risk factor for non-adherence. Implementation of preventive actions such as therapeutic education or pharmaceutical counseling at hospital discharge could improve adherence to anti-infective agents. What Is Known: • Non-adherence to anti-infective drugs involves the emergence and spread of antibiotic resistance. • Very few studies have assessed medication adherence in acute infectious diseases in pediatrics after hospital discharge. What Is New: • Only 35% of children were overall adherent to anti-infective drugs in acute infectious disease after hospital discharge. • Most patients (89%) had a good primary adherence but very few (40%) had good secondary adherence mainly due to dose omission and dose modification.

Environmental Contamination with Cyclophosphamide, Ifosfamide, and Methotrexate: A Study of 51 Canadian Centres.

BACKGROUND: Occupational exposure to hazardous drugs may lead to adverse reproductive effects. There is no safe exposure limit for health care professionals. OBJECTIVES: To monitor levels of cyclophosphamide, ifosfamide, and methotrexate contamination in oncology pharmacy and patient care areas in Canadian health care institutions. METHODS: The study was conducted in 2014. Hospitals with at least 50 acute care beds were invited to participate. At each participating centre, 12 standardized sites (6 in pharmacy areas and 6 in patient care areas) were sampled. The samples were analyzed for the presence of cyclophosphamide, ifosfamide, and methotrexate by ultra-performance liquid chromatography tandem mass spectrometry technology. The limits of detection were 0.36 pg/cm(2) for cyclophosphamide, 0.95 pg/cm(2) for ifosfamide, and 0.97 pg/cm(2) for methotrexate. Descriptive statistical analyses were performed to determine the median, 75th percentile, and maximum levels. RESULTS: Fifty-one hospitals participated in this descriptive study, and a total of 584 samples were quantified. Overall, 294 (50%) of the samples were positive for cyclophosphamide, 125 (21%) for ifosfamide, and 54 (9%) for methotrexate. The most frequently contaminated sampling sites in pharmacy areas were the front grille inside the hood and the floor in front of the hood and, in patient care areas, the armrest and outpatient clinic counter. The 75th percentiles for surface concentration were 10.8 pg/cm(2) for cyclophosphamide, 1.59 pg/cm(2) for ifosfamide, and below the limit of detection for methotrexate. CONCLUSIONS: Relative to 3 other multicentre studies conducted in Quebec over the past few years, the proportion of positive samples remained constant. Nonetheless, the 75th percentile surface concentration of antineoplastic drugs has been decreasing and seems to have reached a plateau. Local (country-specific or region-specific) and attainable goals for surface contamination with hazardous drugs should be set annually, so long as no health-based limit is known.

CONTEXTE: L'exposition professionnelle à des médicaments dangereux peut causer des effets indésirables sur la reproduction. Aucune limite d'exposition sécuritaire n'est établie pour les professionnels de la santé. OBJECTIFS: Évaluer les taux de cyclophosphamide, d'ifosfamide et de méthotrexate dans la pharmacie d'oncologie et dans les unités de soins des établissements de santé canadiens. MÉTHODES: L'étude s'est déroulée en 2014. Les hôpitaux disposant d'au moins 50 lits de soins de courte durée ont été invités à participer. Dans chacun des établissements participants, des échantillons ont été prélevés dans 12 zones prédéterminées : 6 dans les pharmacies et 6 dans les unités de soins. On a ensuite analysé les échantillons par chromatographie liquide à très haute performance couplée à la spectrométrie de masse en tandem afin de détecter la présence de cyclophosphamide, d'ifosfamide et de méthotrexate. Le seuil de détection était de 0,36 pg/cm2 pour la cyclophosphamide, de 0,95 pg/cm2 pour l'ifosfamide et de 0,97 pg/cm2 pour le méthotrexate. Des analyses statistiques descriptives ont été effectuées afin de déterminer la médiane, le 75e percentile et les taux maximums. RÉSULTATS: Au total, 51 hôpitaux ont participé à cette étude descriptive et 584 échantillons ont été quantifiés. Dans l'ensemble, 294 (50 %) échantillons étaient positifs pour la cyclophosphamide, 125 (21 %) pour l'ifosfamide et 54 (9 %) pour le méthotrexate. Les zones les plus fréquemment contaminées étaient : en pharmacie, la grille avant dans la hotte et le sol devant la hotte; dans les unités de soins, les accoudoirs et le comptoir des cliniques de consultation externe. Le 75e percentile de la concentration de surface était de 10,8 pg/cm2 pour la cyclophosphamide, 1,59 pg/cm2 pour l'ifosfamide et sous le seuil de détection pour le méthotrexate. CONCLUSIONS: Comparativement à trois autres études multicentriques menées au Québec au cours des dernières années, la proportion de prélèvements positifs demeure la même. Toutefois, le 75e percentile de la concentration de surface d'antinéoplasiques a diminué et semble avoir atteint un plateau. Des objectifs locaux (pour le pays ou selon les régions) et réalisables de contamination de surface par des médicaments dangereux devraient être établis chaque année, et ce, tant qu'aucune limite fondée sur les critères liés à la santé ne sera pas déterminée.