ABSTRACT
OBJECTIVE: Antimicrobial stewardship programs (ASP) have become a key tool in the adaptation of these drugs to the health system. The information available on the application and indicators used in these programs in emergency departments is scarce. The objective of this study is to know the extent of ASP implementation in the emergency departments, as well as the use of antimicrobials in these units. METHODS: Multicenter retrospective study. An invitation was sent to all participants of the REDFASTER-SEFH emergency pharmacist working group. A questionnaire was used consisting of 21 items, answered by a team made up of a pharmacist, emergency room specialist, infectious disease specialist and microbiologist. RESULTS: Eighteen hospitals completed the survey. Fourteen (77.8%) had an ASP manager. The DDD value per 1000 admissions ranged between 36.5 and 400.5 (median: 100.4 [IQR:57.2-157.3]). Both carbapenem and macrolide group presented wide variability in use. Six (33.3%) hospitals had an annual report on the specific resistance profile for urine and blood cultures. The percentage of multi-drug resistant strains in urine cultures was 12.5% and in blood cultures 12.2%. The percentage of adequacy in the bacteremia treatment was 81.0% (IQR:74.6-85.0%), while in urinary tract infections was 78.0% (IQR:71.5-88.0). CONCLUSIONS: Despite the existence of ASP members in emergency services, as well as the training activity and local guidelines is common. knowledge of the use of antimicrobials and resistances is limited. Future activities must be aimed at improving information about the ASP results in these units.
Subject(s)
Anti-Infective Agents , Antimicrobial Stewardship , Humans , Retrospective Studies , Anti-Infective Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , HospitalsABSTRACT
Ruptured cerebral arteriovenous malformations (AVMs) usually require treatment to avoid re-bleeding. Depending on the angioarchitecture and center strategy, the treatment can be surgical, endovascular, radiosurgical or combined methods. The classic endovascular approach is transarterial, but sometimes it is not always applicable. The transvenous approach has been described as an alternative for the endovascular treatment of small AVMs when arterial access or another therapeutic method is not possible. This approach can be considered when the nidus is small and if there is a single draining vein. We present a technical note on a transvenous approach for the treatment of a ruptured AVM in a young patient.
Subject(s)
Cerebral Hemorrhage/therapy , Cerebral Veins , Embolization, Therapeutic/methods , Femoral Vein , Intracranial Arteriovenous Malformations/therapy , Adult , Cerebral Angiography , Cerebral Hemorrhage/diagnostic imaging , Humans , Intracranial Arteriovenous Malformations/diagnostic imaging , Tomography, X-Ray ComputedSubject(s)
Central Nervous System/immunology , Stiff-Person Syndrome/immunology , Aged , Female , Humans , Immunoglobulin G/cerebrospinal fluid , Immunoglobulin M/cerebrospinal fluid , Immunoglobulins, Intravenous/therapeutic use , Oligoclonal Bands/cerebrospinal fluid , Stiff-Person Syndrome/cerebrospinal fluid , Stiff-Person Syndrome/therapy , Treatment OutcomeABSTRACT
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