ABSTRACT
INTRODUCTION: The main objective of the study was to assess the adequacy of antibiotic therapy for urinary tract infections (UTI) in a French hospital medical department. The secondary objective was to identify factors associated with inadequacy of the antibiotic therapy. METHODS: A retrospective single centre cohort study was performed in the Post-Emergency Medicine Department (PEMD) of the university hospital of Lille. All patients presenting with an UTI from May 2012 to April 2014 were included. Adequacy of antibiotic therapy was assessed with reference to local guidelines. Factors associated with inadequacy of antibiotic prescription were determined using a multivariate logistic regression model. RESULTS: Two hundred and twenty-eight patients were included. The antibiotic prescription was fully adequate in 173 patients (76%) with appropriate use of a single or a combination antibiotic therapy in 96%, appropriate drug in 80%, appropriate dosage in 89% and appropriate route of administration in 95%. The risk for antibiotic inadequacy was significantly higher in patients with cystitis than in those with pyelonephritis (OR 12.01; 95% CI 4.17-34.65), when antibiotics were prescribed in the Emergency Department (OR 6.84; 95% CI 2.29-20.47) or before hospital admission (OR 382.46; 95% CI 19.61≥999.99) compared to when antibiotics were first administered in the PEMD, and in patients with severe UTI (OR 19.55; 95% CI 2.79-137.01). CONCLUSION: Adequacy of antibiotic therapy for UTI is relatively high in our study, reflecting the effective dissemination of antibiotic guidelines. However, antibiotic therapy is still inappropriate in cystitis, severe UTI and in case of prescription before the admission in the PEMD.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Guideline Adherence , Inappropriate Prescribing/statistics & numerical data , Practice Guidelines as Topic , Urinary Tract Infections/drug therapy , Aged , Cohort Studies , Cystitis/drug therapy , Emergency Service, Hospital , Female , France , Hospitals, University , Humans , Male , Retrospective Studies , Severity of Illness IndexSubject(s)
Acute Kidney Injury/chemically induced , Kidney/drug effects , Platelet Aggregation Inhibitors/adverse effects , Ticlopidine/adverse effects , Antigens, CD/drug effects , Fibrinogen/antagonists & inhibitors , Humans , Integrin beta3 , Integrins/antagonists & inhibitors , Nephritis, Interstitial/chemically induced , Platelet Aggregation Inhibitors/pharmacology , Platelet Glycoprotein GPIb-IX Complex/antagonists & inhibitors , Platelet Membrane Glycoproteins/drug effects , Receptors, Cell Surface/antagonists & inhibitors , Renal Circulation/drug effects , Ticlopidine/pharmacologyABSTRACT
UNLABELLED: We report two cases of nephrotic syndrome with minimal glomerular change complicating alpha-interferon therapy. CASE REPORTS: The first patient was a 60-year-old man with Waldenström's disease who was given 1 million units of alpha-interferon three times a week for 22 months. Acute renal failure developed when a second protocol was started. Renal biopsy revealed intraglomerular deposits and no cellular proliferation. Total remission could not be achieved with corticosteroids. The second case was a 46-year-old man given high dose alpha-interferon (15 million units 3 times a week) for lymph node metastasis of a malignant melanoma. A nephrotic syndrome without renal failure developed during the third month of treatment. Minimal glomerular involvement was seen. Symptomatic treatment led to resolution of the nephrotic syndrome. DISCUSSION: Nine other cases of nephrotic syndrome complicating alpha-interferon therapy have been reported in the literature.
Subject(s)
Antineoplastic Agents/adverse effects , Interferon-alpha/adverse effects , Nephrotic Syndrome/chemically induced , Acute Kidney Injury/chemically induced , Humans , Male , Middle AgedABSTRACT
The authors report a case of tubulo-interstitial nephritis with acute renal failure due to vancomycin used to treat a patient with enterococcus endocarditis. Rechallenge with vancomycin several days after stopping the drug resulted in the appearance of a maculopapular rash and rapid onset of acute oligo-anuric renal failure. Renal biopsy revealed acute interstitial nephritis. This feature is suggestive of cellular mediated hypersensitivity.
