Predictors of inappropriate antimicrobial prescription: Eight-year point prevalence surveys experience in a third level hospital in Spain.

Antibiotic stewardship programs (ASP) have already demonstrated clinical benefits. We aimed to describe the Point Prevalence Surveys (PPS) methodology implemented in our hospital as an efficient tool to guide ASP strategies. Annually repeated PPS were conducted from 2012 to 2019 at a 750-bed university hospital in South Spain. Key quality indicators and inappropriateness of antimicrobial treatment, defined strictly according to local guidelines, were described. Variables associated with inappropriate treatment were identified by bi/multivariable analysis. A total of 1,600 patients were included. We found that 49% of the prescriptions were inappropriate due to unnecessary treatment (14%), not first line drug recommended (14%), inadequate drug according to microbiological results (9%), unsuitable doses (8%), route (3%) or duration (7%). Samples collection presented a significant protective effect together with sepsis presentation at onset and intensive care unit admission. However, age, receiving an empirical treatment and an unknown or urinary source of the infections treated were independent risk factors for inappropriateness. Site and severity of infection were documented in medical charts by prescribers (75 and 61% respectively). PPS may allow identifying the main risk factors for inappropriateness. This simple methodology may be useful for ASP to select modifiable factors to be prioritized for targeted interventions.

Interacciones potenciales en una cohorte de pacientes VIH positivos de edad avanzada / Potential interactions in a cohort of elderly HIV-positive patients

Objetivo: El aumento de la esperanza de vida conduce a un nuevo modelo de paciente VIH positivo, con enfermedades crónicas y, en ocasiones, polimedicado. Pretendemos con este estudio conocer la complejidad de los tratamientos e identificar potenciales interacciones entre antirretrovirales y medicación domiciliaria de nuestros pacientes, con objeto de tenerlas identificadas y poder prevenirlas. Método: Estudio descriptivo, retrospectivo, en una cohorte de pacientes con tratamiento antirretroviral mayores de 50 años en un hospital de tercer grado. Resultados: Se incluyeron 242 pacientes, de los que 148 (61%) recibían algún otro tratamiento. Detectamos 243 potenciales interacciones: 197 consideradas moderadas y 46 graves; afectando a 110 pacientes. De las graves, 35 (76%) se relacionaron con inhibidores de proteasa potenciados. La principal consecuencia fue un aumento de las concentraciones plasmáticas del tratamiento domiciliario (48%). Las estatinas (24%) fueron el grupo especialmente implicado en las interacciones graves, seguidas de los corticoides inhalados (15%). Conclusiones: Prácticamente la mitad de los pacientes estaban polimedicados, observándose un elevado número de potenciales interacciones moderadas o graves. El farmacéutico de hospital debe jugar un papel crucial en su detección, manejo y comunicación precoz

Objective: An increased life expectancy leads to a new model of HIV patient with chronic diseases and occasionally polymedicated. With this study, we intend to understand treatment complexity and to identify any potential interactions between antiretroviral drugs and home medication in our patients, in order to identify and prevent them. Method: A retrospective, descriptive study carried out in a cohort of > 50-year-old patients on antiretroviral treatment in a tertiary hospital. Results: We included 242 patients; 148 (61%) of them were receiving some concomitant treatment. We detected 243 potential interactions: 197 considered moderate and 46 severe, in 110 patients. Of the severe interactions, 35 (76%) were related to boosted protease inhibitors. The main consequence of these interactions was an increase in the plasma concentrations of the home medication (48%). Statins (24%) were the group most involved in severe interactions, followed by inhaled corticosteroids (15%). Conclusions: Practically half of patients were polymedicated, and a high number of potential moderate or severe interactions were observed. The Hospital Pharmacist must play an essential role in their detection, management and early communication

Potential interactions in a cohort of elderly hiv-positive patients.

OBJECTIVE: The increase of HIV-patients life expectancy leads to a new model of patient with chronic diseases and polymedicated. For this reason we ought to  know in clinical practice the prevalence of polypharmacy and drug-drug  interactions between the antiretroviral drugs and comedication in our patients in  order to identify and prevent them. METHOD: A retrospective, descriptive study carried out in > 50 years old patients on antiretroviral treatment. Results: We included 242 patients of whom 148 (61%) were receiving concomitant treatment. 243 potential interactions were detected,  where 197 are considered moderate and 46 severe, affecting 110 patients. 35  (76%) interactions were related to boosted protease inhibitors. The main  consequence of these interactions was the increase in plasma concentrations of  comedication (48%). Statins were the comedication most involved in severe  drug-druginteractions (24%), followed by inhaled corticosteroids (15%). CONCLUSIONS: Polypharmacy was found in about half of our study population and the prevalence of drug-drug interactions was high. Hospital pharmacists may  play a crucial role in their detection, management and early communication.

Objetivo: El aumento de la esperanza de vida conduce a un nuevo modelo de  paciente VIH positivo, con enfermedades crónicas y, en ocasiones, polimedicado. Pretendemos con este estudio conocer la complejidad de los tratamientos e  identificar potenciales interacciones entre antirretrovirales y medicación  domiciliaria de nuestros pacientes, con objeto de tenerlas identificadas y poder  prevenirlas.Método: Estudio descriptivo, retrospectivo, en una cohorte de pacientes con  tratamiento antirretroviral mayores de 50 años en un hospital de tercer grado. Resultados: Se incluyeron 242 pacientes, de los que 148 (61%) recibían algún  otro tratamiento. Detectamos 243 potenciales interacciones: 197 consideradas  moderadas y 46 graves; afectando a 110 pacientes. De las graves, 35 (76%) se  relacionaron con inhibidores de proteasa potenciados. La principal consecuencia  fue un aumento de las concentraciones plasmáticas del tratamiento domiciliario  (48%). Las estatinas (24%) fueron el grupo especialmente implicado en las  interacciones graves, seguidas de los corticoides inhalados (15%). Conclusiones: Prácticamente la mitad de los pacientes estaban polimedicados, observándose un elevado número de potenciales interacciones moderadas o graves. El farmacéutico de hospital debe jugar un  papel crucial en su detección, manejo y comunicación precoz.