RESUMEN
BACKGROUND/AIM: Dose adjustment of vancomycin (VCM) is important in improving clinical outcomes and avoiding adverse effects such as nephrotoxicity. Although pharmacist-managed VCM therapy has been reported to optimize treatment, there are no studies focused on pharmacist expertise to date. In this study, we compared the contribution of pharmacists trained for infectious diseases and general pharmacists to dose adjustment of VCM. PATIENTS AND METHODS: We retrospectively investigated VCM trough concentration after dose adjustment by both trained (n = 67) and general (without special training for infectious diseases; n = 85) pharmacists. We also compared the incidence of nephrotoxicity during VCM treatment in both groups. RESULTS: The rate of achieving therapeutic VCM trough concentration (10-20 µg/mL) was higher in the trained group than in the control group (80.6 vs. 54.1%, p < 0.001). No significant differences in incidence of nephrotoxicity were observed between the two groups (p = 0.744). Trained pharmacists could contribute more successfully to the achievement of therapeutic VCM concentration ranges without increasing the risk of nephrotoxicity.
Asunto(s)
Antibacterianos/administración & dosificación , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Vancomicina/administración & dosificación , Adulto , Anciano , Antibacterianos/efectos adversos , Antibacterianos/farmacocinética , Infecciones Bacterianas/tratamiento farmacológico , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Incidencia , Enfermedades Renales/inducido químicamente , Enfermedades Renales/epidemiología , Masculino , Persona de Mediana Edad , Rol Profesional , Estudios Retrospectivos , Especialización , Vancomicina/efectos adversos , Vancomicina/farmacocinéticaAsunto(s)
Infecciones Bacterianas , Médula Ósea , Trasplante de Células Madre Hematopoyéticas , Sobrecarga de Hierro , Leucemia , Síndromes Mielodisplásicos , Enfermedad Aguda , Adulto , Aloinjertos , Infecciones Bacterianas/sangre , Infecciones Bacterianas/etiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/patología , Médula Ósea/metabolismo , Médula Ósea/microbiología , Médula Ósea/patología , Femenino , Humanos , Sobrecarga de Hierro/sangre , Sobrecarga de Hierro/microbiología , Sobrecarga de Hierro/patología , Sobrecarga de Hierro/terapia , Leucemia/sangre , Leucemia/microbiología , Leucemia/patología , Leucemia/terapia , Masculino , Síndromes Mielodisplásicos/sangre , Síndromes Mielodisplásicos/microbiología , Síndromes Mielodisplásicos/patología , Síndromes Mielodisplásicos/terapiaRESUMEN
In order to clarify the association between hyperglycemia during the early period after allogeneic stem cell transplantation (allo-SCT) and adverse outcomes, we retrospectively analyzed 563 consecutive patients who underwent allo-SCT at our institute between 2008 and 2015. Patients were categorized into three groups according to mean fasting blood glucose levels on days 0-7 (normoglycemia group<110 mg/dL, n=347; mild hyperglycemia group 110-149 mg/dL, n=192 and moderate/severe hyperglycemia group≥150 mg/dL, n=24). The median follow-up was 2.7 years. Patients in the moderate/severe hyperglycemia group had significantly worse characteristics. The cumulative incidences of 2-year non-relapse mortality (NRM) and the probabilities of 2-year overall survival (OS) in the normoglycemia, mild hyperglycemia and moderate/severe hyperglycemia groups were 7.5%, 19% and 29%, respectively (P<0.01), and 69%, 53% and 33%, respectively (P<0.01). In multivariate analyses, hyperglycemia was an independent predictor of high NRM (vs normoglycemia; mild hyperglycemia, hazard ratio (HR) 2.56, 95% confidence interval (CI) 1.56-4.18; moderate/severe hyperglycemia, HR 4.46, 95% CI 1.92-10.3) and poor OS (vs normoglycemia; mild hyperglycemia, HR 1.54, 95% CI 1.14-2.07; moderate/severe hyperglycemia, HR 1.61, 95% CI 0.89-2.91). In conclusion, hyperglycemia on days 0-7 after allo-SCT was associated with inferior outcomes.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas/efectos adversos , Hiperglucemia/diagnóstico , Adulto , Glucemia/análisis , Humanos , Hiperglucemia/etiología , Pronóstico , Estudios Retrospectivos , Factores de Tiempo , Trasplante Homólogo , Resultado del TratamientoAsunto(s)
Neoplasias Gastrointestinales/epidemiología , Neoplasias Hematológicas/epidemiología , Neoplasias Hematológicas/terapia , Trasplante de Células Madre Hematopoyéticas , Neoplasias de la Boca/epidemiología , Neoplasias Primarias Secundarias/epidemiología , Adolescente , Adulto , Aloinjertos , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has curative potential against hematological malignancies. However, there are concerns about the associated risk of non-relapse mortality (NRM). We performed a retrospective single-center study to assess changes in outcomes after allo-HSCT and causes of NRM over three 5-year periods. The rates of 2-year NRM and overall survival (OS) were 16% and 59%, respectively. We found a significant decrease in NRM (P<0.001), with 2-year NRM of 26, 14 and 9%, and a significant increase in OS (P=0.005), with 2-year OS of 52%, 58% and 65%, over the three periods (1998-2002, 2003-2007 and 2008-2012), respectively. Of note, a steady improvement was observed in NRM, period by period, among patients aged 50 years or older, patients who underwent HSCT from an unrelated bone marrow donor and patients who underwent HSCT with a reduced-intensity conditioning regimen. Our data showed that the improved NRM can mainly be attributed to a decreased mortality related to infection after starting systemic steroid as GVHD treatment, and a decreased mortality related to organ failure.
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Bases de Datos Factuales , Neoplasias Hematológicas/mortalidad , Neoplasias Hematológicas/terapia , Trasplante de Células Madre Hematopoyéticas , Adolescente , Adulto , Anciano , Aloinjertos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Tasa de SupervivenciaAsunto(s)
Antígenos CD34 , Neoplasias Hematológicas/terapia , Trasplante de Células Madre de Sangre Periférica , Acondicionamiento Pretrasplante , Adulto , Factores de Edad , Anciano , Aloinjertos , Femenino , Neoplasias Hematológicas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
To clarify the clinical features and outcome of Stenotrophomonas maltophilia infection among hematopoietic SCT (HCT) recipients, we retrospectively reviewed the records of 1085 consecutive HCT recipients and identified 42 episodes in 31 HCT recipients with S. maltophilia infection. We compared these recipients with 30 non-HCT patients with S. maltophilia infection. The mortality rate in HCT recipients was significantly higher than that in non-HCT patients (relative risk 5.7, P=0.04), and we identified seven patients with pulmonary hemorrhage due to S. maltophilia, exclusively in the HCT cohort. Six of these latter seven patients died within 1 day from the onset of hemorrhage and the isolate was identified after death in most cases; one patient, who received empiric therapy for S. maltophilia and granulocyte transfusion, survived for more than 2 weeks. The patients with pulmonary hemorrhage had a more severe and longer duration of neutropenia, persistent fever despite of the use of broad-spectrum antibiotics, complication by pneumonia and higher C-reactive protein levels than those without pulmonary hemorrhage. In conclusion, S. maltophilia was associated with fulminant and fatal pulmonary hemorrhage in HCT recipients. Empiric therapy with antibiotics before the onset of pulmonary hemorrhage may be effective in HCT recipients who carry the conditions identified.