Morbi-mortality of lower respiratory tract infections in Spain, 1997-2018 / Morbimortalidad de las infecciones del tracto respiratorio inferior en España, 1997-2018

Background:Lower respiratory tract infections (LRTIs) are one of the leading causes of infectious disease mortality worldwide. The aims of the study were to determine the incidence of hospitalizations due to LRTIs, and to analyze the clinical outcomes of the hospitalized patients. Methods:An observational study of hospitalizations due to LRTIs (pneumonia and acute bronchitis/bronchio-litis) in Spain from 1997 to 2018 was carried out. Data were extracted from the national information system for hospital data. Results:Overall, 3.5 % (IQR: 3.4-3.5 %) of total hospitalizations were caused by LRTIs, with a median incidence of 31.2 (IQR: 27.8-33.0) per 10,000 inhabitants/year. The median incidence was higher for pneumonia than for acute bronchitis/bronchiolitis cases (22.2; IQR: 19.1-23.5 vs. 9.0; IQR: 8.4-9.6 per 10,000 inhabitants/year; p < 0.001) and increased by 65.7 % from 1997 to 2018. A 41.2 % of the hospitalizations due to LRTIs took place amongst people over 74 years. The median length of stay was 8.9 days (IQR: 7.6-10.4) and was higher for hospitalizations due to pneumonia than for acute bronchitis/bronchiolitis (9.5 days; IQR: 8.3-10.6 vs. 5.7; IQR: 5.5-6.2; p < 0,001). In 89.1 % of total hospitalizations due to LRTIs, patients were discharged home. In-hospital mortality was 6.8 %, with 9,380 deaths (IQR: 8,192-10,157) per year. Mortality was higher for pneumonia (9.0 vs. 1.7 %; p < 0.001) and doubled from 1997 to 2018 (5,257 deaths in 1997 and 10,514 in 2018). A 75.5 % of the deaths occurred amongst people over 74 years.Conclusions:LRTIs are associated with a high morbi-mortality in Spain. Effective measures that can contribute towards the prevention and treatment of LRTIs need to be adopted.(AU)

Fundamento: Las infecciones del tracto respiratorio inferior (ITRI) constituyen una de las principales causas de mortalidad por enfermedades infecciosas a nivel mundial. Los objetivos del estudio consistieron en determinar la incidencia de hospitalizaciones por ITRI, y en analizar los resultados clínicos de los pacientes hospitalizados. Métodos: Se llevó a cabo un estudio observacional de las hospitalizaciones por ITRI (neumonía y bronquitis/bronquiolitis aguda) en España entre 1997-2018. Los datos se extrajeron del Registro Español de Atención Sanitaria Especializada. Resultados: El 3,5% (RIC: 3,4-3,5%) del total de hospitalizaciones se debieron a ITRI, con una incidencia mediana de 31,2 (RIC: 27,8-33,0) por cada 10.000 habitantes/año. La mediana de incidencia fue superior para las neumonías que para las bronquitis/bronquiolitis agudas (22,2; RIC: 19,1-23,5 vs. 9,0; RIC: 8,4-9,6 por 10.000 habitantes/año; p<0,001), y entre 1997-2018 aumentó un 65,7%. Un 41,2% de las hospitalizaciones por ITRI ocurrieron en mayores de 74 años. La mediana de duración de las hospitalizaciones por ITRI fue 8,9 días (RIC: 7,6-10,4), superior para neumonías (9,5 días; RIC: 8,3-10,6 vs. 5,7; RIC: 5,5-6,2; p<0,001). En un 89,1% de las hospitalizaciones por ITRI los pacientes fueron dados de alta a domicilio. La mortalidad intrahospitalaria fue 6,8%, con 9.380 fallecimientos anuales (RIC: 8,192-10,157). La mortalidad fue superior para neumonías (9,0 vs. 1,7%; p<0,001) y se duplicó entre 1997 y 2018 (5.257 fallecimientos en 1997 y 10.514 en 2018). El 75,5% de las muertes ocurrieron en mayores de 74 años. Conclusiones: Las ITRI se asocian a una elevada morbimortalidad. Se requieren medidas efectivas para su prevención y tratamiento.(AU)

Morbi-mortality of lower respiratory tract infections in Spain, 1997-2018.

BACKGROUND: Lower respiratory tract infections (LRTIs) are one of the leading causes of infectious disease mortality worldwide. The aims of the study were to determine the incidence of hospitalizations due to LRTIs, and to analyze the clinical outcomes of the hospitalized patients. METHODS: An observational study of hospitalizations due to LRTIs (pneumonia and acute bronchitis/bronchiolitis) in Spain from 1997 to 2018 was carried out. Data were extracted from the national information system for hospital data. RESULTS: Overall, 3.5% (IQR: 3.4-3.5%) of total hospitalizations were caused by LRTIs, with a median incidence of 31.2 (IQR: 27.8-33.0) per 10,000 inhabitants/year. The median incidence was higher for pneumonia than for acute bronchitis/bronchiolitis cases (22.2; IQR: 19.1-23.5 vs. 9.0; IQR: 8.4-9.6 per 10,000 inhabitants/year; p<0.001) and increased by 65.7% from 1997 to 2018. A 41.2% of the hospitalizations due to LRTIs took place amongst people over 74 years. The median length of stay was 8.9 days (IQR: 7.6-10.4) and was higher for hospitalizations due to pneumonia than for acute bronchitis/bronchiolitis (9.5 days; IQR: 8.3-10.6 vs. 5.7; IQR: 5.5-6.2; p<0,001). In 89.1% of total hospitalizations due to LRTIs, patients were discharged home. In-hospital mortality was 6.8%, with 9,380 deaths (IQR: 8,192-10,157) per year. Mortality was higher for pneumonia (9.0 vs. 1.7%; p

Effect of “triple whammy” combination in hospitalization due to acute kidney injury: a protocol of a nested case-control study / Efecto de la combinación «triple whammy» en la hospitalización por fallo renal agudo: protocolo del estudio de casos y controles anidado en una cohorte

Objective: Acute kidney injury (AKI) is a life-threatening condition characterized by an abrupt deterioration in kidney function. The simultaneous use of diuretics, renin-angiotensin-aldosterone system inhibitors, and non-steroidal anti-inflammatory drugs (NSAIDs) or metamizol, known as «triple whammy» (TW), has been associated with an increased risk of AKI. The main objective of the study is to analyse the risk of hospitalization due to AKI with the TW combination versus non-exposure to TW. Additionally, hospitalization due to AKI according to the time and duration of the TW exposure, and depending on whether the TW includes NSAIDs or metamizol; mortality; and the requirement of renal replacement therapy will be determined.Methods: A case-control study nested in a cohort will be carried out. Data for the study will be extracted from the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP), managed by the Spanish Agency for Medicines and Medicine and Health Products (AEMPS). Adults admitted to hospital due to AKI between 2010 and 2018 (cases) will be matched with up to 10 controls per case. The exposure to TW during the 12 months prior to the index date will be determined. The association between the exposure to TW and the outcomes will be analysed using multivariate logistic regression models adjusting by potential confounding factors. A subgroup analysis will be performed to evaluate the risk of hospitalization due to AKI with the exposure to TW in patients older than 75 years. (AU)

Objetivo: El fallo renal agudo (FRA) se caracteriza por un deterioro abrupto de la función renal que puede aumentar el riesgo de mortalidad. El uso simultáneo de diuréticos, antihipertensivos inhibidores del sistema renina-angiotensina, y antiinflamatorios no esteroideos (AINE) o metamizol, conocido como “triple whammy” (TW), se ha visto asociado a un incremento del riesgo de FRA. El objetivo principal consiste en analizar el riesgo de hospitalización por FRA con la combinación TW frente a la no exposición a dicha combinación. Adicionalmente se analizará la hospitalización por FRA en función del momento de la exposición a TW y de su duración, y dependiendo de si la TW incluye AINE o metamizol; la mortalidad; y el requerimiento de terapia de reemplazo renal.Métodos: Se llevará a cabo un estudio de casos y controles anidado en una cohorte. Los datos para el estudio se extraerán de la Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), gestionada por la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Los adultos con hospitalización por FRA entre 2010-2018 (casos) se emparejarán con hasta 10 controles por caso. La asociación entre la exposición a TW y las variables de resultado se analizará mediante modelos de regresión logística ajustados por potenciales factores de confusión. Se realizará un análisis de subgrupos para evaluar la variable principal en pacientes mayores de 75 años. (AU)

Transparencia, equidad y acceso a los medicamentos: a propósito de la pandemia por COVID-19 / Transparency, equity and access to medicines: talking of the COVID-19 pandemic

La pandemia por COVID-19 ha generado una crisis a todos los niveles, desde el sanitario hasta el económico, laboral y social. Los sistemas sanitarios han mostrado una enorme capacidad de adaptación a las necesidades, que han requerido de rápidas actuaciones. Realizar un análisis de la situación es esencial para redimensionar las necesidades y hacer un uso más eficiente de los recursos disponibles con vistas a futuro. Algunas de las cuestiones que nos permitirán avanzar para garantizar que el sistema siga siendo sostenible y equitativo son el disponer de investigación científica de calidad y realizar una evaluación crítica de la misma, la prudencia en la práctica médica, la transparencia y el acceso a la información, la inversión pública en I+D+I, el desarrollo de nuevos modelos de financiación de medicamentos y la cooperación internacional

The COVID-19 pandemic has generated a crisis at all levels, from health sector to the economic, working and social fields. Health systems have shown an enormous capacity to adapt to the needs, which have required rapid actions. To carry out an analysis of the situation is essential to resize needs and make a more efficient use of available resources with a view to the future. Some of the issues that will allow us to make progress in ensuring that the system remains sustainable and equitable are good quality scientific research with appropriate critical appraisal, prudence in medical practice, transparency and access to information, public investment in R+D+I, development of new drug financing models and international cooperation

Evidence of clinical and economic impact of pharmacist interventions related to antimicrobials in the hospital setting.

The purpose of this paper was to review the literature regarding the clinical and economic impact of pharmacist interventions (PIs) related to antimicrobials in the hospital setting. A PubMed literature search from January 2003 to March 2016 was conducted using the terms pharmacist* or clinical pharmacist* combined with antimicrobial* or antibiotic* or anti-infective*. Comparative studies that assessed the clinical and/or economic impact of PIs on antimicrobials in the hospital setting were reviewed. Outcomes were classified as: treatment-related outcomes (TROs), clinical outcomes (COs), cost and microbiological outcomes (MOs). Acceptance of pharmacist recommendations by physicians was collected. PIs were grouped into patient-specific recommendations (PSRs), policy, and education. Studies' risk of bias was analyzed using Cochrane's tool. Twenty-three studies were evaluated. All of them had high risk of bias. The design in most cases was uncontrolled before and after. PSRs were included in every study; five also included policy and four education. Significant impact of PI was found in 14 of the 18 studies (77.8%) that evaluated costs, 15 of the 20 studies (75.0%) that assessed TROs, 12 of the 22 studies (54.5%) that analyzed COs, and one of the two studies (50.0%) that evaluated MOs. None of the studies found significant negative impact of PIs. It could not be concluded that adding other strategies to PSRs would improve results. Acceptance of recommendations varied from 70 to 97.5%. Pharmacists improve TROs and COs, and decrease costs. Additional research with a lower risk of bias is unlikely to change this conclusion. Future research should focus on identifying the most efficient interventions.