Off-label drug use in an adult intensive care unit of a Brazilian hospital

Abstract The objective of this study was to determine the prevalence and describe the factors associated with off-label drug use in an adult intensive care unit (ICU) of a Brazilian hospital. An analytical, cross-sectional, prospective study was conducted in the adult ICU population from March 2018 to May 2018. Off-label use of medication was classified by indication, dosage, route of administration, type and volume of diluent, and duration of administration. Most patients were female (57.89%), non-elderly (56.14%), and had a mean age of 54.44 ± 17.15 years. The prevalence of off-label drug use was 70.31%, but was not associated with the clinical severity of the patients. A statistically significant association was observed between label use of drugs and prescribing potentially inappropriate medicines (PIM). The most common reasons for off-label drug use were therapeutic indication (19.58%) and volume of diluent (23.30%). Drug administration by enteral tubes accounted for the largest number of off-label uses due to route of administration (90.85%). There was a higher prevalence of off-label use of systemic antimicrobials (14.44%) and norepinephrine (9.28%). Our study provided a broad characterization of off-label drug use in an adult ICU and showed why it is important for health professionals to evaluate the specific risks and benefits of this practice

Hospital Cost of Complications After Kidney Transplant.

BACKGROUND: Kidney transplant is considered the best treatment of rehabilitation for chronic kidney disease, but clinical and/or surgical complications may occur after transplant. The study aimed to assess the cost of complications after kidney transplant. MATERIALS AND METHODS: This is a descriptive, retrospective, and exploratory study that used data from Hospital Information System ("Sistema de Informação Hospitalar"). We identified the patients with records of kidney transplant in the states of northern and northeastern Brazil in 2013. These patients were followed up through the records, specifically from 2013 to 2017. The variables analyzed were sex, age, and period after transplant of readmissions (early, intermediate, or late), the main complications within 4 years after the kidney transplant, and cost of hospital admissions. RESULTS: There were 893 patients with records of kidney transplant in the regions of the study. During the follow-up period, 319 patients had complications. Most hospital readmissions involved male patients (63.6%; n = 203). Mean age was 45 (SD, 15.14) years. Patients developed complications mainly in the early period after transplant (70.22%; n = 224). The number of hospital admissions was 758. The main complications were regarding urinary tract (72.02%; n = 546), infections (19.79%; n = 150), and vascular and/or pulmonary (2.90%; n = 22). The total cost for the treatment of these complications was US $528,329.51. CONCLUSIONS: By analyzing the data it was possible to identify that there is a significant cost involved in the treatment of complications after kidney transplant.