Incidence and risk factors for mortality in patients treated with combined ceftaroline for Gram-positive infective endocarditis.

BACKGROUND: Ceftaroline is a fifth-generation cephalosporin and represents an alternative in the treatment of infective endocarditis (IE). The main objective of this study was to describe the incidence of in-hospital and 42-day mortality in patients with IE treated with ceftaroline. METHODS: An observational retrospective study included adult patients with IE admitted during a 3.5-year period (January 2018-June 2021) and treated with ceftaroline in a single center. All cases were definite or possible IE according to the modified Duke criteria. RESULTS: Seventy cases were analyzed. The mean age was 67.35 ± 16.62 (16-89) and 39 (55.7%) were males. The mean number of days of treatment with ceftaroline was 21.26 ± 16.17 (1-75). Overall mortality at 42 days was 30%, 20.7% in the first line, and 36.6% in rescue therapy. Predictors of 42 days-mortality were increased Charlson comorbidity index (CCI) (OR of 1.7 per 1 point increment, 95% CI 1.2-2.4, P 0.001), presence of methicillin-resistance (OR 6.8, 95% CI 1.3-36.8, P 0.026) and evidence of septic shock (OR 8.6 95% CI 1.7-44.2, P 0.01). Predictors of 42 days of therapeutic failure were the increase in the CCI (OR of 1.6 per 1 point increment, 95% CI 1.3-2.1, P 0.000) and septic shock (OR 4.5 95% CI 1.1-18 P 0.036). Adverse effects were described in 6/70 (8.6%) of the patients, precipitating in 4/70 (5.7%) the definitive withdrawal of the antibiotic. CONCLUSIONS: The incidence of in-hospital and 42 day-mortality of IE patients treated with ceftaroline remains similar to literature data. Increased CCI, septic shock, and methicillin resistance are associated with poor prognosis.

[Quality perceived by outpatients at the pharmaceutical care clinic]. / Calidad percibida por los pacientes externos en la consulta de atención farmacéutica del servicio de farmacia.

OBJECTIVE: To know the satisfaction degree manifested by outpatients presenting in the hospital pharmacy department pharmaceutical care clinic, and to identify organizational improvement items. METHOD: A survey with 8 close-ended questions and 1 open-ended question was designed where patients recorded their suggestions or comments on the service provided. A sample size of 591 surveys was estimated, which allowed to estimate parameters of interest with a 95% confidence interval and a +/- 5% accuracy, adjusting by a 40% potential losses percentage. RESULTS: Overall response rate was 70%; 23.6% of patients considered that finding the PD was difficult or very difficult. Waiting time was normal for 51.8%, but long or excessive for 18.4% of patients. Fifty-six percent of individuals considered the information received useful or very useful, and 81.1% considered that staff friendliness was good or very good. Care timetable was inadequate for 18.1%; 47.7% pointed out that the attending pharmacist did not identify him or herself. Overall satisfaction extent was 7.51 (of 10). A plan for improvement activities was designed and implemented regarding: care timetable, pharmacy department signaling, and general information on clinic matters. CONCLUSIONS: The survey allowed to identify organizational weaknesses. Overall score was very satisfactory, yet improvable. Future surveys are required for result comparisons and continual improvement assessment.

Prevention of nosocomial infection in critically ill patients by selective decontamination of the digestive tract. A randomized, double blind, placebo-controlled study.

OBJECTIVE: To evaluate the effect of a method of Selective Decontamination of the Digestive Tract (SDD) on colonization, nosocomial infection (NI), bacterial resistance, mortality and economic costs. DESIGN: Randomized, double blind, placebo controlled study. SETTING: Polyvalent intensive care unit (ICU) of a tertiary care hospital with 27 beds. PATIENTS: 101 patients with > 3 days of mechanical ventilation and > 5 days of stay, without infection at the start of the study. 47 belonged to the Treated Group (TG) and 54 to the Placebo Group (PG). INTERVENTIONS: The TG was given Cefotaxime i.v. (6 g/day) for the first four days and an association of Polymyxin E, Tobramycin and Amphotericin B at the oropharyngeal and gastrointestinal level throughout the whole stay. RESULTS: In the TG, colonization by gram-negative agents at oropharyngeal, tracheal and gastrointestinal level fell significantly. There was a significant drop in the overall, respiratory and urinary NI (26% vs 63%, p < 0.001; 15% vs 46%, p < 0.001; 9% vs 31%, p < 0.01). The overall mortality and NI related mortality was less in the TG (21% vs 44%, p < 0.05; 2% vs 20%, p < 0.01). The economic costs, mechanical ventilation time and length of stay were similar. The percentage of bacterial isolations resistant to Cefotaxime and Tobramycin was greater in the TG (38% vs 15% and 38% vs 9%, p < 0.001). CONCLUSIONS: colonization by gram-negative bacilli, NI and the mortality related to it can be modified by SDD. Continuous bacteriological surveillance is necessary.

Influencia de las pruebas de resistencias a antirretrovirales sobre la efectividad del tratamiento en pacientes con infección por VIH y fracaso virológico / No disponible

Objetivo: El objetivo de este trabajo es conocer la influencia de los test de resistencias a antirretrovirales sobre la negativización del VIH (< 400 copias/ml) en pacientes con fracaso virológico que requieren un cambio de tratamiento antirretroviral.Método: Estudio observacional retrospectivo de cohortes en pacientes adultos. Se definieron 2 grupos: casos (grupo A) en el que la prescripción de antirretrovirales se basó en test de resistencia y controles (grupo B) en los que no se realizó dicho test. Cada grupo se dividió en dos subgrupos según fuese el primer cambio de tratamiento (A1 y B1) o sucesivos (A2 y B2). La variable principal se definió como la proporción de pacientes con carga viralnegativa (< 400 copias/ml) al tercer mes de tratamiento; variables secundarias fueron la proporción de pacientes con carga viral negativa (< 400 copias/ml) al sexto mes y la variación media del nivel de CD4 al tercer y sexto mes de dicho cambio.Resultados: Se incluyó un total de 152 pacientes en el estudio, 59 del grupo de casos y 93 del de controles. No se encontraron diferencias en el estadio de la enfermedad en el momento del cambio del tratamiento. Un 59,3% de los pacientes del grupo A y un 47,3% de los pacientes del grupo B negativizaron la carga viral VIH al tercer mes, sin que esta diferencia fuese estadísticamente significativa (p = 0,149). No se encontraron diferencias estadísticamente significativas en las variables secundarias.Conclusiones: La utilización de las pruebas de resistencia a antirretrovirales permitió una mayor efectividad en la respuesta altratamiento antirretroviral seleccionado en el grupo a estudio, sibien no se obtuvieron diferencias significativas en comparación con el grupo de pacientes en los que no se realizaron dichas pruebas (AU)

Objective: The objective of this study is to determine the influence of antiretroviral-resistance tests on the suppression ofHIV (< 400 copies/mL) in patients with virological failure who require an alternative antiretroviral treatment.Method: A retrospective observational study on cohorts of adult patients. Two groups were defined: cases in which the prescription of antiretrovirals was based on resistance tests (group A),and controls in which no such test was performed (group B). Eachgroup was divided into two sub-groups according to the number of changes in treatment: first treatment change (A1 and B1); a subsequent change (A2 and B2). The main variable was defined asthe proportion of patients with negative viral load (< 400copies/mL) at the third month of treatment; secondary variables were the proportion of patients with negative viral load at the sixth month and an average variation in the CD4 level at the thirdand sixth months after this change.Results: A total of 152 patients were included in this study,59 in group A and 93 in group B (control). No differences were found in the stage of the disease at the time of administering analternative treatment. 59.3% of the patients in group A and47.3% of the patients in group B had suppressed the HIV viralload at the third month, although this difference was not statisticallysignificant (p = 0.149). No statistically significant differences were found in the secondary variables.Conclusions: The use of antiretroviral-resistance tests increased effectiveness in the response to the selected antiretroviral treatment in the study group, although we did not obtain significant differences for the group of patients in which these tests were not performed (AU)

Calidad percibida por los pacientes externos en la consulta de atención farmacéutica del servicio de farmacia / Quality perceived by outpatients at the pharmaceutical care clinic

Objetivo: Conocer el grado de satisfacción manifestado por los pacientes externos que acuden a las consultas de atención farmacéutica del servicio de farmacia de hospital (SF) e identificar los elementos de mejora de la organización. Método: Se diseñó una encuesta de 8 preguntas cerradas y una abierta, en donde el paciente realizó alguna sugerencia ocomentario sobre el servicio recibido. Se calculó un tamaño muestral de 591 encuestas, que permitió estimar los parámetros de interés con un nivel de confianza del 95% y una precisión de ± 5%, ajustando por un porcentaje de posibles pérdidas del 40%. Resultados: El porcentaje global de respuestas fue del 70%. El 23,6% de los pacientes consideró que la localización del SF fue difícil o muy difícil. El tiempo de espera fue normal para el 51,8%, pero largo o excesivo para el 18,4%. El 56% opinó que la información recibida fue útil o muy útil, y el 81,1% consideró que el trato recibido resultó bueno o muy bueno. El horario de atención fue inadecuado para el 18,1%. El 47,7% indicó que el farmacéutico que lo atendió no se identificó. El nivel de satisfacción global fue de 7,51 (sobre 10). Se diseñó e implantó un plan de acciones de mejora en: horario de atención, señalización del servicio de farmacia e información general sobre funcionamiento de la consulta. Conclusiones: La encuesta permite identificar los puntos débiles de la organización. La puntuación global es muy satisfactoria, pero mejorable. Es necesario realizar futuras encuestas que permitan comparar los resultados y evaluar la mejora continua

Objective: To know the satisfaction degree manifested by outpatients presenting in the hospital pharmacy department pharmaceutical care clinic, and to identify organizational improvementitems. Method: A survey with 8 close-ended questions and 1 openended question was designed where patients recorded their suggestions or comments on the service provided. A sample size of 591 surveys was estimated, which allowed to estimate parameters of interest with a 95% confidence interval and a ± 5% accuracy, adjusting by a 40% potential losses percentage. Results: Overall response rate was 70%; 23.6% of patients considered that finding the PD was difficult or very difficult. Waiting time was normal for 51.8%, but long or excessive for 18.4% of patients. Fifty-six percent of individuals considered the information received useful or very useful, and 81.1% considered that staff friendliness was good or very good. Care timetable was inadequate for 18.1%; 47.7% pointed out that the attending pharmacist did not identify him or herself. Overall satisfaction extent was 7.51 (of 10). A plan for improvement activities was designed and implemented regarding: care time table, pharmacy department signaling, and general information on clinic matters. Conclusions: The survey allowed to identify organizational weaknesses. Overall score was very satisfactory, yet improvable. Future surveys are required for result comparisons and continual improvement assessment