ABSTRACT
Introducción: El tratamiento antimicrobiano domiciliario endovenoso (TADE) es una alternativa a la hospitalización para pacientes pediátricos bien seleccionados. Presentamos un programa TADE basado en un modelo de autoadministración e integrado en el programa de optimización del uso de antimicrobianos (PROA) de un hospital pediátrico de tercer nivel. Material y métodos: Estudio descriptivo, retrospectivo y unicéntrico que incluye todos los pacientes menores de 20años tratados con TADE prescrito en un hospital pediátrico entre 2019 y 2020. Se analizaron los datos sobre los días de ingreso ahorrados y una estimación económica del coste oportunidad que supone el programa TADE para el hospital. Resultados: Cincuenta y siete pacientes realizaron un total de 106 episodios de tratamiento. En el 74,5% hubo una evolución clínica favorable. El principal motivo de interrupción prematura fue una mala evolución de la infección (37,1%). Se liberaron 2,62 camas diarias, suponiendo un beneficio económico de 1.069.963. Conclusión: Un programa TADE integrado en el PROA pediátrico de nuestro hospital y basado en un modelo de autoadministración se ha mostrado un programa seguro y efectivo y aporta importantes ventajas a nivel económico.(AU)
Introduction: Outpatient parenteral antimicrobial treatment (OPAT) is an alternative to in-patient care in carefully selected patients. This study presents a self-administration OPAT program integrated within the pediatric antibiotic stewardship program (ASP) in a pediatric tertiary care center. Material and methods: Descriptive, retrospective and unicentric study. Data from all patients under 20years of age who were prescribed treatment by a pediatric unit during 2019 and 2020 were included. Data regarding number of saved beds and estimating the opportunity cost of the OPAT program for the hospital were analyzed. Results: Fifty-seven patients received 106 episodes of treatment. Favorable clinical outcome occurred in 74.5% of the episodes. The main cause of premature interruption was unfavorable clinical outcome of the infection (37.1%). A total of 2.62 beds/day were saved, resulting in an economic benefit of 1,069,963. Conclusion: A self-administration OPAT program integrated within the pediatric ASP has proven to be safe and effective and provides economic benefits.(AU)
Subject(s)
Humans , Male , Female , Child , Pediatrics , Drug Therapy , Anti-Infective Agents , Communicable Diseases , Antimicrobial Stewardship , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
INTRODUCTION: Outpatient parenteral antimicrobial treatment (OPAT) is an alternative to in-patient care in carefully selected patients. This study presents a self-administration OPAT program integrated within the pediatric antibiotic stewardship program (ASP) in a pediatric tertiary care center. MATERIAL AND METHODS: Descriptive, retrospective and unicentric study. Data from all patients under 20 years of age who were prescribed treatment by a pediatric unit during 2019 and 2020 were included. Data regarding number of saved beds and estimating the opportunity cost of the OPAT program for the hospital were analyzed. RESULTS: Fifty-seven patients received 106 episodes of treatment. Favorable clinical outcome occurred in 74.5% of the episodes. The main cause of premature interruption was unfavorable clinical outcome of the infection (37.1%). A total of 2.62 beds/day were saved, resulting in an economic benefit of 1,069,963 . CONCLUSION: A self-administration OPAT program integrated within the pediatric ASP has proven to be safe and effective and provides economic benefits.
Subject(s)
Anti-Infective Agents , Outpatients , Humans , Child , Anti-Bacterial Agents/therapeutic use , Retrospective Studies , Anti-Infective Agents/therapeutic use , Ambulatory Care/methodsABSTRACT
BACKGROUND: Due to the high rates of antimicrobial resistance to certain antibiotics, together with the emergence of Neisseria gonorrhoeae (NG) with reduced susceptibility and resistance to third-generation cephalosporins, gonococcal infection is becoming a public health problem. The objectives of the study were: To keep track of the antimicrobial susceptibility of NG strains obtained from January to August 2011. To study the population dynamics. METHODS: The antimicrobial susceptibility was studied by disk-diffusion and E-test. The genotyping was performed by NG-MAST method. RESULTS: Of a total of 100strains studied, 59% showed intermediate sensitivity to penicillin and 9% were resistant. According to EUCAST, we detected 3gonococci with reduced susceptibility to ceftriaxone, 10 to cefixime and one with high-level resistance to both antibiotics (MIC 1.5µg/ml). MIC50 and MIC90 to cefixime were 0.016 and 0.125µg/ml, respectively, whereas to ceftriaxone they were <0.016 and 0.064µg/ml, respectively. Almost all (99%) of the strains were resistant to doxycycline, 53% to ciprofloxacin, 3% to azithromycin, and 1% to spectinomycin. The most prevalent ST was ST1407, predominantly associated to resistance or reduced sensitivity to cephalosporins or macrolides. CONCLUSIONS: NG has developed significant rates of resistance to various antibiotics. One strain has been detected with high level resistance to third generation cephalosporins, and several strains with reduced susceptibility. An increase in MIC50 and MIC90 to these antibiotics has also been observed. NG population structure remains stable and common to the rest of Europe, although two new ST (ST7226 and ST7227) have been identified that could be selected and acquire high levels of resistance to cephalosporins.
Subject(s)
Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial , Gonorrhea/drug therapy , Gonorrhea/epidemiology , Neisseria gonorrhoeae/drug effects , Population Dynamics , Female , Humans , Male , Microbial Sensitivity Tests , SpainSubject(s)
Nalidixic Acid/pharmacology , Salmonella typhi/drug effects , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Typhoid Fever/drug therapy , Adolescent , Bacteremia/drug therapy , Bacteremia/microbiology , Bacterial Proteins/genetics , Campylobacter Infections/complications , Campylobacter Infections/drug therapy , Campylobacter jejuni , DNA Gyrase/genetics , Drug Resistance, Microbial/genetics , Gastroenteritis/drug therapy , Gastroenteritis/microbiology , Humans , Male , Mutation, Missense , Nalidixic Acid/therapeutic use , Pakistan/ethnology , Salmonella typhi/genetics , Typhoid Fever/diagnosis , Typhoid Fever/microbiologyABSTRACT
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