ABSTRACT
OBJECTIVE: The implementation of antimicrobial stewardship programs (ASPs) has become a usual practice in hospital settings. However, the method for monitoring antimicrobial use in accident and emergency departments (ED) is not yet adequately defined. Thus, the objective of this review is to describe antimicrobial use indicators used by ASPs implemented in ED. METHODS: A systematic review was performed based on studies found in the following academic research databases: MEDLINE, EMBASE, Web of Science, and Scopus (Period: January 2000 to December 2019). Controlled clinical trials, before-and-after studies, interrupted time series, and repeated measures studies assessing the impact of ASPs on antimicrobial use in ED were included; studies published in languages other than English or Spanish were excluded from this review. RESULTS: Twenty-six studies met the inclusion criteria and were included in this systematic review. In total, 15 (62.5%) studies described the ASP team members who collaborated with the ED staff. Most (21; 80.8%) studies used the percentage of patients with an antibiotic prescription as an indicator. Four (15.4%) studies included defined daily dose data. The antibiotic treatment duration was reported in four (15.4%) studies. Only two studies assessed the impact of the ASP using microbiological indicators, both of which used the incidence of infection with Clostridioides difficile as the indicator. CONCLUSIONS: The reports of experiences in implementing ASPs in ED show heterogeneous antimicrobial use indicators, which makes it difficult to compare results. Therefore, antimicrobial use indicators for ASPs must be standardised between hospital units.
Subject(s)
Anti-Infective Agents , Antimicrobial Stewardship , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/therapeutic use , Emergency Service, Hospital , Hospitals , HumansABSTRACT
Objetivo La inmunoglobulina específica frente a citomegalovirus ha demostrado su eficacia en la prevención y tratamiento de la infección en el trasplante de órganos sólidos. Distintos estudios indican una eficacia similar respecto a las presentaciones de Ig inespecíficas. El objetivo de este estudio es determinar la titulación de inmunoglobulina anti-citomegalovirus de una de las presentaciones de inmunoglobulinas inespecíficas autorizadas en España. Método Estudio observacional en el que se analizó la titulación de anticuerpos anti-citomegalovirus de distintos lotes de Flebogamma® 5% 5g utilizados en el Hospital Universitari Vall dHebron durante los años 2008 y 2009.ResultadosSe analizaron 27 lotes, que incluyeron 18.944 viales de Flebogamma® 5%. En función del origen, la concentración mediana de inmunoglobulina anti-citomegalovirus fue de 28UPEI/ml y 22UPEI/ml para los viales de origen norteamericano y español, respectivamente (IC 95 % para la diferencia de las medianas de 5 a 6UPEI/ml; p<0 001ConclusionesLa concentración de anticuerpos anti-citomegalovirus de los lotes de inmunoglobulina inespecífica analizados es ligeramente inferior respecto a las especialidades de inmunoglobulinas específicas. Estas diferencias pueden compensarse mediante un ajuste posológico (AU)
Objective Specific immunoglobulin against cytomegalovirus has demonstrated its effectiveness in preventing and treating infections in solid organ transplantation. Several studies indicate that non-specific immunoglobulin is just as effective. This study aims to determine anti-cytomegalovirus immunoglobulin titres from one of the non-specific immunoglobulin presentations authorised in Spain. Method This was an observational study, in which we analysed the anti-cytomegalovirus antibody titres from different batches of Flebogamma® 5% 5g used at the Hospital Universitari Vall d'Hebron during 2008 and 2009.ResultsWe analysed 27 batches, which included 18,944 vials of Flebogamma® 5%. Depending on the origin, the median concentration of anti-cytomegalovirus immunoglobulin was 28PEI-U/ml and 22PEI-U/ml per vial of North American and Spanish origin, respectively (CI 95% for the difference of the medians 5 to 6PEI-U/ml; p<0 001ConclusionsThe anti-cytomegalovirus antibody concentration of the non-specific immunoglobulin batches analysed was slightly lower than in the specific immunoglobulin preparations. These differences can be compensated by adjusting the dosage (AU)
Subject(s)
Humans , Immunoglobulins/isolation & purification , Cytomegalovirus/isolation & purification , Organ Transplantation/adverse effects , Biomarkers/analysis , Risk FactorsABSTRACT
OBJECTIVE: Specific immunoglobulin against cytomegalovirus has demonstrated its effectiveness in preventing and treating infections in solid organ transplantation. Several studies indicate that non-specific immunoglobulin is just as effective. This study aims to determine anti-cytomegalovirus immunoglobulin titres from one of the non-specific immunoglobulin presentations authorised in Spain. METHOD: This was an observational study, in which we analysed the anti-cytomegalovirus antibody titres from different batches of Flebogamma(®) 5% 5g used at the Hospital Universitari Vall d'Hebron during 2008 and 2009. RESULTS: We analysed 27 batches, which included 18,944 vials of Flebogamma(®) 5%. Depending on the origin, the median concentration of anti-cytomegalovirus immunoglobulin was 28PEI-U/ml and 22PEI-U/ml per vial of North American and Spanish origin, respectively (CI 95% for the difference of the medians 5 to 6PEI-U/ml; p<0.001). CONCLUSIONS: The anti-cytomegalovirus antibody concentration of the non-specific immunoglobulin batches analysed was slightly lower than in the specific immunoglobulin preparations. These differences can be compensated by adjusting the dosage.
