ABSTRACT
BACKGROUND: DVT is the main cause of death in hospitalized patients and thromboprophylaxis is the only way to prevent these deaths. International recommendations suggested that active monitoring of DVT/PE prophylaxis can improve the efficacy in Hospitals. METHODS: We performed a cohort study in three consecutives periods to evaluate DVT prophylaxis in 388 adults hospitalized in a General Hospital. RESULTS: 85% of the population had high risk factors for DVT. Thromboprophylaxis was in accordance with local and International guidelines (ACCP 2008) in 72.7% and 86% of the patients respectively. No significant difference could be founded between clinical and surgical patients. One every 10 patients received higher prophylaxis than suggested by guidelines and two out of ten received deficient or no prophylaxis. The worst 2 groups of patients were those with moderate/low risk of DVT and the group with a contraindication to pharmacologic prophylaxis. We observed a progressive improvement of the DVT prophylaxis in the 3 periods of evaluation. CONCLUSIONS: Although the rate of recommended thromboprophylaxis is higher than many other reports in the region we still have some areas where we need to improve. Regular audits like these are very helpful to find out what specific areas of the hospital needs some careful attention in order to have a better quality of assistance.
ABSTRACT
Antecedentes. La anfotericina B es un fármaco efectivo para el tratamiento de la histoplasmosis. La caspofungina es activa contra especies de Candida y Aspergillus. Estudios in vitro han demostrado el efecto inhibitorio de este fármaco en Histoplasma capsulatum. Objetivo. Evaluar la eficacia de la caspofungina comparada con la anfotericina B para el tratamiento de histoplasmosis en un modelo experimental en hámster. Métodos. Se utilizaron tres cepas de Histoplasma capsulatum var. capsulatum. El tratamiento comenzó una semana tras la inoculación y los animales fueron distribuidos aleatoriamente en 6 grupos, según los fármacos utilizados: anfotericina B 6mg/kg/día, caspofungina en dosis de 2, 4 y 8mg/kg/día, solución fisiológica y dextrosa al 5%. Se tomaron muestras semanales para hemocultivos a partir del séptimo día postinfección y a los 7 días de finalizado el tratamiento los animales fueron sacrificados, realizándose cultivos del bazo. Resultados. Los resultados obtenidos de los hemocultivos realizados al finalizar el tratamiento fueron negativos en un 100% en el grupo tratado con anfotericina B, frente al 30% en el grupo tratado con caspofungina y el 32% en el grupo control (p=0,59). Los cultivos de bazo fueron negativos en el grupo de anfotericina B, mientras que en el grupo de caspofungina los valores fluctuaron entre el 25 y el 100%, y en el grupo control entre el 35 y el 94,8% (p=0,07). En el análisis estadístico del cultivo de la suspensión de bazo sin diluir el uso de anfotericina B fue el único predictor independiente de cultivos negativos (p=0,001). Conclusiones. La anfotericina B es un fármaco efectivo para el tratamiento de la histoplasmosis. La administración de caspofungina no demostró mayor eficacia en comparación con el grupo control(AU)
Background. Treatment with amphotericin B is highly effective in histoplasmosis. Caspofungin has shown good activity against Candida and Aspergillus spp. In vitro studies have demonstrated that Histoplasma capsulatum is inhibited by caspofungin. Objectives. The purpose of this study was to evaluate the effectiveness of caspofungin in the treatment of histoplasmosis in an animal experimental model. Methods. Three strains of Histoplasma capsulatum var. capsulatum were used. Treatment started one week post-inoculation and the animals were randomly assigned to six groups: amphotericin B 6mg/Kg/d, caspofungin 2mg/Kg/d, 4mg/Kg/d, 8mg/Kg/d and the other two groups received saline solution and dextrose solution. Blood samples for culture were obtained once a week, from day 7 to 35 post-inoculation. One week after the end of the treatment the animals were sacrificed and spleen cultures were performed. Results. Blood cultures were negative in all the hamsters which received amphotericin B (100%, P<0.001); those treated with caspofungin and the control animals presented 30 and 32% of positive cultures respectively (P=0.59). Spleen cultures were negative in the animals treated with amphotericin B, while the percentage of positive spleen cultures in the caspofungin groups varied from 25 to 100%, and in the control groups from 35 to 94.8% (P=0.07). The statistical analysis of the undiluted cultures showed the use of amphotericin B as the only independent predictor of negative culture (P<0.001). Conclusions. The efficacy of amphotericin B is well known for the treatment of histoplasmosis, though we could not demonstrate that caspofungin is better than control(AU)
Subject(s)
Animals , Male , Female , Mice , Histoplasmosis/drug therapy , Amphotericin B/therapeutic use , Models, Animal , Culture Media/metabolism , Histoplasmosis/complications , Histoplasmosis/diagnosis , Animal Experimentation/statistics & numerical data , Animal Experimentation/standards , Cricetinae/microbiology , Cricetinae/parasitologyABSTRACT
BACKGROUND: Treatment with amphotericin B is highly effective in histoplasmosis. Caspofungin has shown good activity against Candida and Aspergillus spp. In vitro studies have demonstrated that Histoplasma capsulatum is inhibited by caspofungin. OBJECTIVES: The purpose of this study was to evaluate the effectiveness of caspofungin in the treatment of histoplasmosis in an animal experimental model. METHODS: Three strains of Histoplasma capsulatum var. capsulatum were used. Treatment started one week post-inoculation and the animals were randomly assigned to six groups: amphotericin B 6mg/Kg/d, caspofungin 2mg/Kg/d, 4mg/Kg/d, 8mg/Kg/d and the other two groups received saline solution and dextrose solution. Blood samples for culture were obtained once a week, from day 7 to 35 post-inoculation. One week after the end of the treatment the animals were sacrificed and spleen cultures were performed. RESULTS: Blood cultures were negative in all the hamsters which received amphotericin B (100%, P<0.001); those treated with caspofungin and the control animals presented 30 and 32% of positive cultures respectively (P=0.59). Spleen cultures were negative in the animals treated with amphotericin B, while the percentage of positive spleen cultures in the caspofungin groups varied from 25 to 100%, and in the control groups from 35 to 94.8% (P=0.07). The statistical analysis of the undiluted cultures showed the use of amphotericin B as the only independent predictor of negative culture (P<0.001). CONCLUSIONS: The efficacy of amphotericin B is well known for the treatment of histoplasmosis, though we could not demonstrate that caspofungin is better than control.
