RESUMO
Antibiotic stewardship programs (ASP) have already demonstrated clinical benefits. We aimed to describe the Point Prevalence Surveys (PPS) methodology implemented in our hospital as an efficient tool to guide ASP strategies. Annually repeated PPS were conducted from 2012 to 2019 at a 750-bed university hospital in South Spain. Key quality indicators and inappropriateness of antimicrobial treatment, defined strictly according to local guidelines, were described. Variables associated with inappropriate treatment were identified by bi/multivariable analysis. A total of 1,600 patients were included. We found that 49% of the prescriptions were inappropriate due to unnecessary treatment (14%), not first line drug recommended (14%), inadequate drug according to microbiological results (9%), unsuitable doses (8%), route (3%) or duration (7%). Samples collection presented a significant protective effect together with sepsis presentation at onset and intensive care unit admission. However, age, receiving an empirical treatment and an unknown or urinary source of the infections treated were independent risk factors for inappropriateness. Site and severity of infection were documented in medical charts by prescribers (75 and 61% respectively). PPS may allow identifying the main risk factors for inappropriateness. This simple methodology may be useful for ASP to select modifiable factors to be prioritized for targeted interventions.
RESUMO
OBJECTIVE: The increase of HIV-patients life expectancy leads to a new model of patient with chronic diseases and polymedicated. For this reason we ought to know in clinical practice the prevalence of polypharmacy and drug-drug interactions between the antiretroviral drugs and comedication in our patients in order to identify and prevent them. METHOD: A retrospective, descriptive study carried out in > 50 years old patients on antiretroviral treatment. Results: We included 242 patients of whom 148 (61%) were receiving concomitant treatment. 243 potential interactions were detected, where 197 are considered moderate and 46 severe, affecting 110 patients. 35 (76%) interactions were related to boosted protease inhibitors. The main consequence of these interactions was the increase in plasma concentrations of comedication (48%). Statins were the comedication most involved in severe drug-druginteractions (24%), followed by inhaled corticosteroids (15%). CONCLUSIONS: Polypharmacy was found in about half of our study population and the prevalence of drug-drug interactions was high. Hospital pharmacists may play a crucial role in their detection, management and early communication.
Objetivo: El aumento de la esperanza de vida conduce a un nuevo modelo de paciente VIH positivo, con enfermedades crónicas y, en ocasiones, polimedicado. Pretendemos con este estudio conocer la complejidad de los tratamientos e identificar potenciales interacciones entre antirretrovirales y medicación domiciliaria de nuestros pacientes, con objeto de tenerlas identificadas y poder prevenirlas.Método: Estudio descriptivo, retrospectivo, en una cohorte de pacientes con tratamiento antirretroviral mayores de 50 años en un hospital de tercer grado. Resultados: Se incluyeron 242 pacientes, de los que 148 (61%) recibían algún otro tratamiento. Detectamos 243 potenciales interacciones: 197 consideradas moderadas y 46 graves; afectando a 110 pacientes. De las graves, 35 (76%) se relacionaron con inhibidores de proteasa potenciados. La principal consecuencia fue un aumento de las concentraciones plasmáticas del tratamiento domiciliario (48%). Las estatinas (24%) fueron el grupo especialmente implicado en las interacciones graves, seguidas de los corticoides inhalados (15%). Conclusiones: Prácticamente la mitad de los pacientes estaban polimedicados, observándose un elevado número de potenciales interacciones moderadas o graves. El farmacéutico de hospital debe jugar un papel crucial en su detección, manejo y comunicación precoz.