Physician response to implementation of genotype-tailored antiplatelet therapy.

Physician responses to genomic information are vital to the success of precision medicine initiatives. We prospectively studied a pharmacogenomics implementation program for the propensity of clinicians to select antiplatelet therapy based on CYP2C19 loss-of-function variants in stented patients. Among 2,676 patients, 514 (19.2%) were found to have a CYP2C19 variant affecting clopidogrel metabolism. For the majority (93.6%) of the cohort, cardiologists received active and direct notification of CYP2C19 status. Over 12 months, 57.6% of poor metabolizers and 33.2% of intermediate metabolizers received alternatives to clopidogrel. CYP2C19 variant status was the most influential factor impacting the prescribing decision (hazard ratio [HR] in poor metabolizers 8.1, 95% confidence interval [CI] [5.4, 12.2] and HR 5.0, 95% CI [4.0, 6.3] in intermediate metabolizers), followed by patient age and type of stent implanted. We conclude that cardiologists tailored antiplatelet therapy for a minority of patients with a CYP2C19 variant and considered both genomic and nongenomic risks in their clinical decision-making.

[An episode of hospital infection due to Klebsiella pneumoniae in a neonatal department]. / Episod de infectie spitaliceasca într-un serviciu de nou-nascuti determinat de Klebsiella pneumoniae.

Enterotoxin-producing Klebsiella pneumoniae was implicated in the induction of intrahospital infections in new-born babies. A total of 46 children and 4 adults (hospital personnel) were involved. Most of the subjects (82.6%) had median and light forms of gastroenterocolitis, and recovered following biological re-equilibration. In 17.39% of the cases the evolution was more severe due to advanced dehydration and secondary dissemination of the infection. Two children (approximately 4%) died. Factors that favored the dissemination of the infection were hygiene deficiencies and ignorance of functioning rules of materno-infantile units, and these included: admission to the hospital of working personnel with acute phenomena of enterocolitis; administration of sweetened solutions that were prepared without control and stored at room temperature; the "critical" point represented by the special room for "the accommodation" of the newborns, a "key-point" where infection was disseminated to other wards following dispersion of "adapted babies".