ABSTRACT
OBJECTIVES: To assess the level and factors of compliance of carbapenem prescriptions with guidelines and to determine the impact of an antibiotic stewardship team in a university hospital. PATIENTS AND METHODS: Five-month prospective study in the intensive care, surgery, and medicine units to measure the compliance of carbapenem prescriptions with guidelines from French scientific societies; compliance was assessed by an infectious disease specialist warned by the pharmacy, and the prescribers' compliance with the infectious disease specialist's advice was then assessed. RESULTS: One hundred and four treatment initiations for 94 patients were included. Prescriptions were mostly empirical (64%), for pulmonary (35%), urinary tract (23%), and intra-abdominal (17%) infections. Prescriptions were mostly made in an intensive care unit (50%), by a junior physician (66%), with the use of imipenem (74%), and were followed by an objective reassessment (80%). Compliance with guidelines (82%) was significantly higher for empirical than documented prescriptions (91% vs 65%, P<0.001). Compliance was higher in intensive care units than medicine units (87% vs 61%, P=0.037). No change in the compliance rate was observed during the study. Compliance with the infectious disease specialist's advice (68%) improved, although not significantly (P=0.066). CONCLUSIONS: Because of a higher than expected compliance of carbapenem prescriptions with guidelines and a lower than expected inclusions in the study, we did not show any impact. The diffusion of guidelines and long-term control of carbapenem prescriptions seem to be possible and necessary in hospitals to limit their ecological impact.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Carbapenems/therapeutic use , Cross Infection/drug therapy , Drug Prescriptions/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Antimicrobial Stewardship , Carbapenems/administration & dosage , Drug Resistance, Microbial , Drug Resistance, Multiple, Bacterial , Female , France , Guideline Adherence , Hospital Departments/statistics & numerical data , Hospitals, University/statistics & numerical data , Humans , Inappropriate Prescribing/statistics & numerical data , Intensive Care Units/statistics & numerical data , Internal Medicine , Male , Middle Aged , Practice Guidelines as Topic , Prospective Studies , Surgery Department, Hospital/statistics & numerical data , Young Adult , beta-Lactamases/metabolismABSTRACT
The subcutaneous route is a widely used route of administration in routine clinical practice, particularly in elderly patients, when the intravenous route cannot be used. This review of the literature highlights the lack of randomized studies and the lack of pharmacokinetic data on the use of this route of administration. Three antibiotics administered subcutaneously can be used for severe infections, with acceptable pharmacokinetic and pharmacodynamic data, when the intravenous administration is not possible: ceftriaxone, ertapenem, and teicoplanin.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Bacterial Infections/drug therapy , Injections, Subcutaneous , Age Factors , Anti-Bacterial Agents/blood , Anti-Bacterial Agents/pharmacokinetics , Bacterial Infections/blood , Ceftriaxone/administration & dosage , Ceftriaxone/pharmacokinetics , Clinical Trials as Topic , Cohort Studies , Ertapenem/administration & dosage , Ertapenem/pharmacokinetics , Humans , Infusions, Intravenous , Injections, Intravenous , Microbial Sensitivity Tests , Teicoplanin/administration & dosage , Teicoplanin/pharmacokineticsSubject(s)
Anemia, Hemolytic/chemically induced , Anemia, Hemolytic/diagnosis , Artemether, Lumefantrine Drug Combination/adverse effects , Adult , Anemia, Hemolytic/pathology , Delayed Diagnosis , Diagnosis, Differential , Female , Humans , Late Onset Disorders/chemically induced , Late Onset Disorders/diagnosisABSTRACT
The widespread use of bisphosphonates, especially in osteoporosis, has led to a greater number of reports of side effects. We describe for the first time a case of a 75-year-old female patient with a history of indolent sicca syndrome who developed multiple cranial neuropathies after zoledronic acid infusion. In this case, the elimination of the main causes of multiple cranial neuropathies, the chronology with zoledronic acid infusion, the absence of secondary complications of the Sjögren's syndrome, reported cases of similar peripheral nerve injuries with interferon infusions, the spontaneous remission of this multiple cranial neuropathy in parallel with the induced flu-like syndrome, argue for its iatrogenic origin, probably by a great release of inflammatory mediators in this particular background of primary Sjögren's syndrome.
