Impact of A Collaborative Strategy to Reduce the Inappropriate Use of Acid Suppressive Therapy in Non-Intensive Care Unit Patients.

BACKGROUND: Stress ulcer prophylaxis (SUP) is inappropriately prescribed in more than 30% of non-intensive care unit (ICU) patients, leading to unnecessary adverse events as well as increases in economic burden. OBJECTIVE: There was an increasing trend in the prophylactic use of acid suppressive therapy (AST) in non-critically ill patients at our institution, which prompted this initiative aimed at reducing the inappropriate use of AST in non-ICU patients. METHODS: This was a retrospective interventional study that consisted of formulation of a guideline, education to the hospitalist service, and intervention by clinical pharmacists. All adult non-ICU patients admitted to the hospitalist service who were newly initiated on AST were considered for inclusion. The primary outcome was a comparison of the proportion of inpatient days with inappropriate AST. Secondary outcomes included a comparison of patients discharged on inappropriate AST and drug acquisition costs, successful pharmacy interventions, hospitalist interventions, incidence of Clostridium difficile infection (CDI) or gastrointestinal (GI) bleeding, and drug costs averted through pharmacy intervention. RESULTS: There were 61 patients in the historical group and 81 patients in the interventional group. This intervention resulted in a 31% absolute reduction in inappropriate patient days of AST and a 24% absolute reduction in patients discharged on inappropriate AST. There were 23 successful interventions. There were no cases of CDI and 1 GI bleed. This intervention resulted in an 87% reduction in drug acquisition costs per patient. CONCLUSIONS: A collaboration between clinical pharmacists and a hospitalist service can significantly reduce the inappropriate use of AST in non-ICU patients.

High prevalence of Pneumocystis jiroveci colonization among young HIV-infected patients.

BACKGROUND: Pneumocystis colonization in young HIV-infected patients has been poorly studied. The aim of this study was to analyze the prevalence of P jiroveci colonization in a cohort of young HIV-infected patients. MATERIAL AND METHODS: We designed a basal cross-sectional study in 20 young HIV-infected patients to determine the prevalence of P jiroveci colonization in oropharyngeal wash samples studied by nested polymerase chain reaction (PCR). Subsequently, patients were followed up during 50 weeks to observe the development of Pneumocystis pneumonia (PCP). RESULTS: P jiroveci colonization was detected in eight (40%) of the 20 oropharyngeal wash samples. Genotype 85C/248C was the most frequent. After 50 weeks of follow-up, one colonized patient with advanced immunodepression developed PCP. CONCLUSIONS: We have found a high prevalence of P jiroveci colonization in young HIV-infected patients with a major prevalence of genotype 1 (85C/248C). Further studies are necessary to clarify if Pneumocystis colonization could be a potential risk factor of developing PCP in young HIV infected patients.

Proteína C reactiva sérica: asociación con parto pretérmino / Seric C reactive protein: association with preterm labor

El objetivo fué analizar los niveles de proteína C reactiva elevados y su asociación a la amenaza de parto pretérmino, rotura prematura de membranas y coriooamnionitis. Se seleccionaron 56 pacientes del Hospital General del Oeste, divididas en dos grupos: grupo estudio y grupo control. El grupo estudio estaba conformado por 28 pacientes que consultaron por presentar amenaza de parto pretermino o RPM. Se determinaron niveles de proteína C reactiva en ambos grupos. Sólo recibieron tratamiento tocolítico las pacientes con membranas intactas. Las pacientes con niveles de proteína C reactiva elevados (mayor de 6 mg) parieron antes de los siete días de hospitalización en comparación con las gestantes que presentaban niveles de PCR, normales (100 vs 14,2) (p<0.05) hubo dos casos coriomnionitis. El 88 de los recién nacidos provenientes de madres con niveles elevados de PCR, tuvieron un peso de 2500 g (p<0.05). Los niveles elevados de PCR, estan asociados con parto pretérmino y fracaso del tratamiento tocolítico. La PCR, puede ser útil como predictor del exito o fracaso de la terapia tocolítica en la amenaza de parto pretérmino