Nonadherence to treatment recommendations is a factor contributing to the clinical failure of daptomycin: Cohort study in Brazil

To evaluate the clinical outcomes of daptomycin therapy and adherence to treatment recommendations, a retrospective cohort study was conducted with patients that received daptomycin during the period of the study. The adherence and nonadherence to clinical guidelines were assessed through organism identification, dose and time of treatment, management of bacteremia, and vancomycin treatment failure. A multiple logistic regression model analyzed the association between independent variables and clinical success (dependent variable), considering 5% of statistical significance. The study presented 52 patients who received daptomycin for the treatment of bacteremia (21.1%) or infections (osteomyelitis [63.5%], synovial fluid [15.4%]). Most patients (86.5%) received daptomycin as the second line of treatment, and 51.9% achieved clinical success. The patients had a better chance of clinical success when they followed the guideline indications (OR = 16.86; 95% CI = 1.45-195.88) and the medication was prescribed by a specialist in infectious diseases (OR = 4.84; 95% CI = 1.11-21.09). The study demonstrated lower clinical success than that described in the literature because of patients who were not eligible according to the clinical guidelines. Adherence to recommendations and appropriate prescription of reserve antibiotics is important in limiting early resistance, and avoiding clinical failure and unnecessary expenditure.

O autocuidado em adolescentes infectados pelo HIV: avaliação da enfermagem / the self-care performed by adolescents infected with HIV

O presente estudo tem como objetivos: caracterizar o perfil socioeconômico e clínico de adolescentes infectados pelo HIV; avaliar o autocuidado realizado pelos adolescentes infectados pelo HIV; Testar uma proposta de consulta de enfermagem para o autocuidado de adolescentes infectados pelo HIV. Metodologia: Trata-se de uma pesquisa com abordagem quantitativa e descritiva. A população do estudo foi de 48 pacientes tendo uma amostra de 24 adolescentes infectados pelo HIV atendidos nos ambulatórios de dois hospitais universitários do município do Rio de Janeiro no período de janeiro a junho de 2012. Para a coleta de dados foi utilizado um roteiro de consulta de enfermagem e outro para análise nos prontuários. Os aspectos éticos foram respeitados conforme a resolução 196/96 do Conselho Nacional de Saúde...