[Cefazolin and coagulation disorders: a case report]. / Céfazoline et troubles de la coagulation : à propos d'un cas.

We report the case of a 79-year-old patient, admitted to the department of infectious diseases at Bretagne Sud Hospital Center for a right calcaneal osteitis, complicated by a pacemaker leads infectious endocarditis. Meticillin sensitive Staphylococcus aureus was documented by blood culture. Antibiotic treatment was established using intravenous cefazolin for an initial 6 weeks period. Prothrombin time (PT) decreased as well as vitamin K dependent factors, without anticoagulation therapy, at day 7 of cefazolin treatment. After bleeding occurred on calcaneal osteitis, the VAC® therapy system was removed and intravenous vitamin K 10 mg (then 5 mg per day for 5 days per os) was administered. Vitamin K allowed PT and vitamin K dependent factors to return to normal values. Literature review does not explicitly mention the effects on vitamin K dependent factors after cefazolin administration. Four severe haemorrhagic episodes under cefazolin have been declared in France so far since February 2017. The goal of this article is to alert clinicians and clinical pathologists from the potential appearance of coagulation disorders in patients treated by cefazolin.

Potential clinical impact of medication discrepancies at hospital admission.

BACKGROUND: Medication errors at the interfaces of care are highly prevalent. This study aims to identify unintentional medication discrepancies at hospital admission and to explore their potential clinical impact in elderly patients. METHOD: The study was conducted in an Internal Medicine Department. Patients ≥ 65 years admitted through the emergency department were eligible. Best possible medication histories, obtained from different sources by pharmacists, were compared to admission medication prescriptions to identify and correct unintentional discrepancies. A three-category scale was used to rate errors for their potential to cause harm: Level (L) 1 "no potential harm", L2 "monitoring or intervention potentially required to preclude harm", and L3 "potential harm". This scale was also designed to take into account patient's clinical characteristics and high-risk drugs. RESULTS: 256 patients were included. Mean age was 82.2 ± 7.2 years old. 85 patients (33.2%) had ≥ 1 unintentional discrepancies. Overall, there were 173 unintentional discrepancies. The 3 most common drug classes involved in errors were nervous system (22.0%), gastrointestinal (20.0%) and cardiovascular (18.0%) medications. The most common types of errors were "omission" (87.9%) and "incorrect dose" (8.1%). Among the unintentional discrepancies, 20.8% had the potential to require increased monitoring or intervention to preclude harm (L2) and 6.4% had the potential to cause clinical deterioration (L3). CONCLUSION: More than 25% of the identified errors presented a potential clinical impact. These results show that a combined intervention of pharmacists and physicians in a collaborative medication reconciliation process has a high potential to reduce clinical relevant errors at hospital admission.