Suspensión de antibióticos a través de un programa de optimización de tratamiento antibiótico en pacientes atendidos en Urgencias con baja sospecha de infección / Antibiotic discontinuation through an antibiotic treatment optimization program in emergency department patients with low suspicion of infection

Introducción: Una de las estrategias más importantes de los PROA en los Servicios de Urgencias (SU) es el diagnóstico adecuado de infección para evitar la prescripción inadecuada. Nuestro objetivo es evaluar a los pacientes que reciben antibiótico a pesar de no tener datos objetivos de infección. Métodos: Realizamos un estudio transversal de los pacientes ingresados en el SU del Hospital Universitario Fundación Alcorcón durante 2 meses (mayo del 2019 y marzo del 2021) en los que se recomendó suspender el antibiótico a través del PROA. Se analizaron las características clínicas y epidemiológicas, y el seguimiento a 30 días para valorar los reingresos y la mortalidad. Resultados: Se analizaron 145 pacientes. Se recomendó suspender el antibiótico en 25. El 44% de ellos tenían diagnóstico de infección urinaria. La recomendación de suspensión se aceptó en el 88%. Ningún paciente falleció y uno reingresó. Conclusiones: Un porcentaje importante de pacientes tenían prescrito antibiótico a pesar de no tener criterios de infección, siendo la evolución clínica tras la de prescripción favorable.(AU)

Introduction: One of the most important strategies of PROA in the Emergency Department (ED) is the accurate diagnosis of infection to avoid inappropriate prescription. Our objective is to evaluate patients who receive antibiotics despite not having objective data of infection. Methods: We carried out a cross-sectional study of patients admitted to the ED of the Hospital Universitario Fundación Alcorcón in which it was recommended to suspend the antibiotic through the PROA. Clinical and epidemiological characteristics and 30-day follow-up were analyzed to assess readmissions and mortality. Results: 145 patients were analyzed. It was recommended to suspend the antibiotic in 25. 44% of them had a diagnosis of urinary infection. The suspension recommendation was accepted by 88%. No patient died and one was readmitted. Conclusions: An important percentage of patients are prescribed antibiotics despite not having infection criteria, the clinical evolution after suspension of antibiotics was favorable.(AU)

Drug Allergy Alert System in a Spanish University Hospital: Description and Dynamics of Use.

INTRODUCTION: The drug allergy alert system reduces the frequency of adverse drug events, although it is subjected to collateral effects, since 80-90% of alerts are not real, and a large percentage of alerts are overridden (46.2-96.2%). We reviewed how the alert system is used at University Hospital Fundación Alcorcon (HUFA). METHODS: Data were obtained from the drug allergy alert and the alert overriding notification forms (both in the period 2011-20). We also recorded drug allergy diagnoses at HUFA, drug consumption in primary care in 2016. We calculated the incidence of drug allergy alert activation, temporal trends in use, and correlations between the number of drugs in several datasets. RESULTS: We collected 15,535 alerts. NSAIDs and penicillins were the drugs with the highest number of drug allergy alerts (36.55% and 26.91%, respectively). A correlation was found between the number of drug alerts and the type of drug allergy in HUFA in 2016. Only 6.83% of the alerts were removed, and, of these, 21.77% were reactivated. Approximately 100 overrides were recorded per year from 2016 (6.8% of 8,434 activated alerts during 2014-2020). CONCLUSIONS: The number of drug allergy alerts recorded via the drug allergy alert system of HUFA correlates with the distribution of drug allergy diagnoses in the hospital, although many of the alerts could be false positives (as per current published evidence). We detected a very low frequency of removed alerts (6.83%), a relevant frequency of reactivations (one quarter), and a very low frequency of overrides (6.8%).

Response to inhaled granulocyte-macrophage colony-stimulating factor in patient with mild-to-moderate autoimmune pulmonary alveolar proteinosis-24 months of follow-up.

INTRODUCTION: Autoimmune pulmonary alveolar proteinosis (aPAP) is a disease caused by IgG antibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF). Whole lung lavage (WLL) allows to remove the lipo-proteinaceous material accumulated by the poor clearance of alveolar surfactant. However, it is a complex technique that is not exempt from complications, and in some cases, the patients are refractory, requiring the performance of several WLLs spaced apart in time. MATERIALS AND METHODS: We present the clinical, functional, and radiological evolution after 24 months of follow-up of a patient diagnosis of aPAP refractory to WLL, with performed three therapeutic WLLs spaced 16 and 36 months and serious potentially fatal complications in the last one. RESULTS AND DISSCUSION: After 24 months, no adverse effects have appeared and the great clinical, functional and radiological response is maintained. The patient has been successfully treated with inhaled recombinant human GM-CSF sargramostim.

Antibiotic discontinuation through an antibiotic treatment optimization program in emergency department patients with low suspicion of infection.

INTRODUCTION: One of the most important strategies of PROA in the Emergency Department (ED) is the accurate diagnosis of infection to avoid inappropriate prescription. Our objective is to evaluate patients who receive antibiotics despite not having objective data of infection. METHODS: We carried out a cross-sectional study of patients admitted to the ED of the Hospital Universitario Fundación Alcorcón in which it was recommended to suspend the antibiotic through the PROA. Clinical and epidemiological characteristics and 30-day follow-up were analyzed to assess readmissions and mortality. RESULTS: 145 patients were analyzed. It was recommended to suspend the antibiotic in 25. 44% of them had a diagnosis of urinary infection. The suspension recommendation was accepted by 88%. No patient died and one was readmitted. CONCLUSIONS: An important percentage of patients are prescribed antibiotics despite not having infection criteria, the clinical evolution after suspension of antibiotics was favorable.

Experiencia con el uso de dalbavancina en la infección profunda de pie diabético / Experience in the use of dalbavancin in diabetic foot infection

Objetivo: Describir la experiencia clínica con dalbavancina en el tratamiento de la infección de pie diabético en una unidad multidisciplinar de un hospital de segundo nivel. Métodos: Estudio descriptivo retrospectivo de pacientes con infección de pie diabético tratados con dalbavancina en la Unidad de Pie Diabético del Hospital Universitario Fundación Alcorcón de septiembre de 2016 a diciembre de 2019. Se recogieron parámetros demográficos y comorbilidades, características de la infección y del tratamiento con dalbavancina. Se estimó la tasa de curación a los 90 días tras finalizar el tratamiento. Resultados: Un total de 23 pacientes con infección de pie diabético (osteomielitis) fueron tratados con dalbavancina; 19 eran hombres con una edad media de 65 años. Los microorganismos más frecuentemente aislados fueron Staphylococcus aureus (11) y Corynebacterium striatum (7). En 22 casos se usó dalbavancina como terapia de segunda elección, en 11 debido a toxicidad de otros antibióticos. La mediana de duración del tratamiento fue de 5 (4-7) semanas; la dosis más frecuente de dalbavancina (8 pacientes) fue de 1.000mg seguido de 500mg semanales durante 5 semanas. Tres pacientes presentaron efectos secundarios leves (náuseas y molestias gastrointestinales). A los 90 días de finalizar el tratamiento, el 87% (20) de los pacientes se curaron (IC95%: 65,2-94,52%). Conclusión: Los pacientes con osteomielitis por microorganismos grampositivos que recibieron como parte del tratamiento multidisciplinar antibioterapia con dalbavancina tuvieron una elevada tasa de curación, con una adecuada tolerancia y escasos efectos secundarios. Dalbavancina ofrece una alternativa segura en el tratamiento de la infección profunda de pie diabético.(AU)

Objective: To describe the clinical experience with dalbavancin in the treatment of diabetic foot infection in a multidisciplinary unit of a second level hospital. Methods: A retrospective, descriptive study was made with all patients with diabetic foot infection treated with dalbavancin in the Diabetic Foot Unit of Hospital Universitario Fundación Alcorcón, covering the period from September 2016 to December 2019. Demographic parameters and comorbidities, characteristics of the infection and treatment with dalbavancin were recorded. The cure rate was estimated at 90 days after finishing the treatment. Results: A total of 23 patients with diabetic foot infection (osteomyelitis) started treatment with dalbavancin, 19 were men and the mean age was 65 years. The microorganisms most frequently isolated for the indication of treatment with dalbavancin were Staphylococcus aureus (11) and Corynebacterium striatum (7). Dalbavancin was used as a second choice therapy in 22 cases, in 11 due to toxicity from other antibiotics. The median duration of treatment was 5 (4-7) weeks; the most frequent dose of dalbavancin (8 patients) was 1000mg followed by 500mg weekly for 5 weeks. 3 patients presented mild side effects (nausea and gastrointestinal discomfort). At 90 days after completion of dalbavancin therapy, 87% (20) of the patients were cured (95% CI: 65.2%-94.52%). Conclusion: Patients with osteomyelitis due to gram-positive microorganisms who received as part of the multidisciplinary antibiotic treatment with dalbavancin, had a high rate of cure with adequate tolerance and few side effects. Dalbavancin offers a safe alternative in treating deep diabetic foot infection.(AU)

Experience in the use of dalbavancin in diabetic foot infection.

OBJECTIVE: To describe the clinical experience with dalbavancin in the treatment of diabetic foot infection in a multidisciplinary unit of a second level hospital. METHODS: A retrospective, descriptive study was made with all patients with diabetic foot infection treated with dalbavancin in the Diabetic Foot Unit of Hospital Universitario Fundación Alcorcón, covering the period from September 2016 to December 2019. Demographic parameters and comorbidities, characteristics of the infection and treatment with dalbavancin were recorded. The cure rate is estimated at 90 days after finishing the treatment. RESULTS: A total of 23 patients with diabetic foot infection (osteomyelitis) started treatment with dalbavancin, 19 were men and the mean age was 65 years. The microorganisms most frequently isolated for the indication of treatment with dalbavancin were Staphylococcus aureus (11) and Corynebacterium striatum (7). Dalbavancin was used as a second choice therapy in 22 cases, in 11 due to toxicity from other antibiotics. The median duration of treatment was 5 (4-7) weeks; the most frequent dose of dalbavancin (8 patients) was 1000 mg followed by 500 mg weekly for 5 weeks. 3 patients presented mild side effects (nausea and gastrointestinal discomfort). At 90 days after completion of dalbavancin therapy, 87% (20) of the patients were cured (95% CI: 65.2%-94.52%). CONCLUSION: Patients with osteomyelitis due to gram-positive microorganisms who received as part of the multidisciplinary antibiotic treatment with dalbavancin, had a high rate of cure with adequate tolerance and few side effects. Dalbavancin offers a safe alternative in treating deep diabetic foot infection.

Incidencia y características de las caídas de pacientes hospitalizados: estudio de cohortes / Incidence and characteristics of falls in hospitalized patients: A cohort study

Objetivo: Estimar la incidencia de caídas y conocer sus características en cuanto a localización, temporalidad y lesiones producidas, y analizar las características sociodemográficas y clínicas de los pacientes que sufren caídas. Método: Se llevó a cabo un estudio observacional de cohortes retrospectivo, en un hospital de nivel 2 del Servicio Madrileño de Salud. Se estudiaron las caídas de pacientes hospitalizados entre el 1 de julio de 2018 y el 30 de junio de 2019. Se estimó la tasa de incidencia de caídas por 1.000 días de estancia considerando una distribución de Poisson. Se describen las características de las caídas: temporalidad, lesiones producidas, localización de las lesiones y pauta de fármacos. Se registraron características sociodemográficas y clínicas de los pacientes que sufrieron una caída. Se realizó un análisis univariante para comparar los resultados por sexos. Todos los datos se han obtenido de registros de la historia clínica electrónica. Resultados: Se estudiaron 132 caídas, que suponen una tasa de 1,61 caídas por 1.000 días de estancia. Hombres, edad avanzada e ingreso a cargo de una especialidad médica presentaron una tasa de caída significativamente mayor. Los pacientes que sufrieron una caída tienen una edad media de 77,5 años (DE 11,7), y tuvieron pautados una mediana de 12,5 fármacos (RIC 9,25-15). El 63,6% de las caídas no presentan lesión alguna. Solo se encontró diferencia en cuanto al género en la situación en la que se produce la caída. Conclusiones: Nuestros datos notifican una incidencia de caídas similar a la de centros de nuestro entorno. El perfil del paciente que sufre una caída es el de un hombre mayor, ingresado a cargo de una especialidad médica, con estancias hospitalarias más largas, con alguna comorbilidad y polimedicado, sin una asociación temporal evidente.(AU)

Objective: To estimate the incidence of falls and to know their characteristics in terms of location, temporality and injuries produced, and to analyse the sociodemographic and clinical characteristics of the patients who suffer falls. Methodology: A retrospective observational cohort study was carried out in a level 2 hospital of the Madrid Health Service. Falls in hospitalized patients between July 1, 2018 and June 30, 2019 were studied. The incidence rate of falls per 1,000 days of stay was estimated considering a Poisson distribution. The characteristics of the falls are described: temporality, injuries produced, location of the injuries and prescribed drugs. Sociodemographic and clinical characteristics of patients who suffered a fall were registered. A univariate analysis was performed to compare the results by gender. All data were obtained from the electronic medical record. Results: One hundred and thirty-two falls were studied, which represent a rate of 1.61 falls per 1,000 days of stay. Men, older age, and admission to a medical specialty showed a significantly higher fall rate. The patients who suffered a fall had a mean age of 77.5 years (SD 11.7), and had a median of 12.5 drugs prescribed (IQR: 9.25-15). Of the falls, 63.6% did not present any injury. Difference in gender was only found in the situation in which the fall occurred. Conclusions: Our data report an incidence of falls similar to other institutions in our environment. The profile of the patient who suffers a fall is an older man, admitted under the charge of a medical specialty, with longer hospital stay, with associated comorbidity and polymedicated, without an obvious temporal feature.(AU)

Incidence and characteristics of falls in hospitalized patients: A cohort study.

OBJECTIVE: To estimate the incidence of falls and to know their characteristics in terms of location, temporality and injuries produced, and to analyse the sociodemographic and clinical characteristics of the patients who suffer falls. METHODOLOGY: A retrospective observational cohort study was carried out in a level 2 hospital of the Madrid Health Service. Falls in hospitalized patients between July 1, 2018 and June 30, 2019 were studied. The incidence rate of falls per 1000 days of stay was estimated considering a Poisson distribution. The characteristics of the falls are described: temporality, injuries produced, location of the injuries and prescribed drugs. Sociodemographic and clinical characteristics of patients who suffered a fall were registered. A univariate analysis was performed to compare the results by gender. All data were obtained from the electronic medical record. RESULTS: One hundred and thirty-two falls were studied, which represent a rate of 1.61 falls per 1,000 days of stay. Men, older age, and admission to a medical specialty showed a significantly higher fall rate. The patients who suffered a fall had a mean age of 77.5 years (SD: 11.7), and had a median of 12.5 drugs prescribed (IQR: 9.25-15). Of the falls, 63.6% did not present any injury. Difference in gender was only found in the situation in which the fall occurred. CONCLUSIONS: Our data report an incidence of falls similar to other institutions in our environment. The profile of the patient who suffers a fall is an older man, admitted under the charge of a medical specialty, with longer hospital stay, with associated comorbidity and polymedicated, without an obvious temporal feature.

Experience in the use of dalbavancin in diabetic foot infection. / Experiencia con el uso de dalbavancina en la infección profunda de pie diabético.

OBJECTIVE: To describe the clinical experience with dalbavancin in the treatment of diabetic foot infection in a multidisciplinary unit of a second level hospital. METHODS: A retrospective, descriptive study was made with all patients with diabetic foot infection treated with dalbavancin in the Diabetic Foot Unit of Hospital Universitario Fundación Alcorcón, covering the period from September 2016 to December 2019. Demographic parameters and comorbidities, characteristics of the infection and treatment with dalbavancin were recorded. The cure rate was estimated at 90 days after finishing the treatment. RESULTS: A total of 23 patients with diabetic foot infection (osteomyelitis) started treatment with dalbavancin, 19 were men and the mean age was 65 years. The microorganisms most frequently isolated for the indication of treatment with dalbavancin were Staphylococcus aureus (11) and Corynebacterium striatum (7). Dalbavancin was used as a second choice therapy in 22 cases, in 11 due to toxicity from other antibiotics. The median duration of treatment was 5 (4-7) weeks; the most frequent dose of dalbavancin (8 patients) was 1000mg followed by 500mg weekly for 5 weeks. 3 patients presented mild side effects (nausea and gastrointestinal discomfort). At 90 days after completion of dalbavancin therapy, 87% (20) of the patients were cured (95% CI: 65.2%-94.52%). CONCLUSION: Patients with osteomyelitis due to gram-positive microorganisms who received as part of the multidisciplinary antibiotic treatment with dalbavancin, had a high rate of cure with adequate tolerance and few side effects. Dalbavancin offers a safe alternative in treating deep diabetic foot infection.

Hepatitis tóxica por linagliptina / Linagliptin-induced liver toxicity

No disponible

Secreción inadecuada de hormona antidiurética secundaria a tratamiento antiparkinsoniano / Inappropriate antidiuretic hormone hypersecretion associated with treatment of Parkinson's disease

No disponible

Octreotida subcutánea para el tratamiento del síndrome del Blue Rubber Bled Nevus: a propósito de un caso / Treatment of Blue Rubber Bled Nevus syndrome with subcutaneous octreotide: a case report

No disponible