[Work of a multidisciplinary team in the control of the prescription of ertapenem]. / Actuación de un equipo multidisplinario en el control de la prescripción de ertapenem.

OBJECTIVE: To determine the effectiveness of the intervention of a multidiscipline antimicrobial control group in the correct prescription of Ertapenem. METHOD: A four-month long, prospective study into prescriptions for Ertapenem was carried out in a third-level hospital. Assessment into the degree of suitability of each prescription according to the infections commission usage criteria. In the situation where prescriptions were not suitable, recommendations were given and acceptance of this was recorded. The effectiveness of the antimicrobial treatment used was assessed and treatment was considered effective when there was remission of the signs and symptoms of the infection when the treatment was completed. The treatment was considered to have failed when the signs and symptoms of infection persisted or progressed, requiring the addition of another antimicrobial agent, changing antibiotics or the prolongation of the treatment for longer than 2 weeks. Lastly, the differences in the average length of stay and the duration of the antibiotic treatment between groups were analysed. RESULTS: Forty-eight prescriptions were assessed. The usage criterion was adequate in 48 % of cases, with 78 % effectiveness in this group. In the cases where the prescription was not adequate, but a change in prescription was accepted, the effectiveness was 92 %, with 55.5 % of those cases not accepting recommendation for change. The average stay was higher in this last group (p = 0.07). The duration of the antibiotic treatment in the patients who accepted the change in prescription was significantly less than in those who did not accept it (2 vs 7.4 days, p < 0.0001). CONCLUSIONS: The control of Ertapenem prescriptions by a multidisciplinary team was effective.

Actuación de un equipo multidisplinario en el control de la prescripción de ertapenem* / Work of a multidisciplinary team in the control of the prescription of ertapenem

Objetivo: Determinar la efectividad de la intervención de un grupo multidisciplinario de control antimicrobiano en la correcta prescripción de ertapenem. Método: Estudio prospectivo, durante un período de 4 meses, de las prescripciones de ertapenem realizadas en un hospital de tercer nivel. Evaluación del grado de adecuación de cada prescripción a los criterios de utilización de la comisión de infecciones. En las situaciones en las que no se adecuaban, se emitió una recomendación y se registró la aceptación de éstas. Se evaluó la efectividad del tratamiento antimicrobiano utilizado; para ello, se consideró tratamiento efectivo cuando hubo remisión de los signos y los síntomas de la infección al finalizar el tratamiento. Se consideró fracaso del tratamiento cuando los signos y los síntomas de la infección persistieron o progresaron, requiriendo la adición de otro antimicrobiano, la sustitución por otro/s antibiótico/s o la prolongación del tratamiento más allá de 2 semanas. Finalmente, se analizaron las diferencias de estancia media y duración de tratamiento antibiótico entre los grupos. Resultados: Se evaluaron 48 prescripciones. Se adecuaron a los criterios de uso un 48 % de éstas, con una efectividad del 78 % en este grupo. En los casos en los que la prescripción no se adecuó, pero se aceptó un cambio de tratamiento, la efectividad fue del 92 %, y fue del 55,5 % en los casos en los que no se aceptó esta recomendación. La tendencia de la estancia media fue mayor en este último grupo (p = 0,07). La duración del tratamiento antibiótico en los pacientes en los que se aceptó el cambio fue significativamente menor que en los que no se aceptó (2 frente a 7,4 días; p < 0,0001). Conclusiones: El control de las prescripciones de ertapenem por un equipo multidisciplinario fue efectivo (AU)

Objective: To determine the effectiveness of the intervention of a multidiscipline antimicrobial control group in the correct prescription of Ertapenem.Method: A four-month long, prospective study into prescriptions for Ertapenem was carried out in a third-level hospital. Assessment into the degree of suitability of each prescription according to the infections commission usage criteria. In the situation where prescriptions were not suitable, recommendations were given and acceptance of this was recorded. The effectiveness of the antimicrobial treatment used was assessed and treatment was considered effective when there was remission of the signs and symptoms of the infection when the treatment was completed. The treatment was considered to have failed when the signs and symptoms of infection persisted or progressed, requiring the addition of another antimicrobial agent, changing antibiotics or the prolongation of the treatment for longer than 2 weeks. Lastly, the differences in the average length of stay and the duration of the antibiotic treatment between groups were analysed.Results: Forty-eight prescriptions were assessed. The usage criterion was adequate in 48 % of cases, with 78 % effectiveness in this group. In the cases where the prescription was not adequate, but a change in prescription was accepted, the effectiveness was 92 %, with 55.5 % of those cases not accepting recommendation for change. The average stay was higher in this last group (p = 0.07). The duration of the antibiotic treatment in the patients who accepted the change in prescription was signifi cantly less than in those who did not accept it (2 vs 7.4 days, p < 0.0001).Conclusions: The control of Ertapenem prescriptions by a multidisciplinary team was effective (AU)

[Meningitis by Cryptococcus neoformans in patients with HIV infection]. / Meningitis por Cryptococcus neoformans en pacientes con infección por el VIH.

OBJECTIVE: To review a serie of patients with cryptococcal meningitis and immunodeficiency syndrome (AIDS) treated in our hospital in the last two years. PATIENTS AND METHODS: Retrospective study of 25 patients infected with the human immunodeficiency virus (HIV) and affected by Cryptococcus neoformans meningitis. The factors analysed were epidemiological data, clinical manifestations, biochemical and microbiological characteristics of cerebrospinal fluid (CSF), radiological abnormalities, treatment, adverse reactions and outcomes. RESULTS: Eighty-four percent of patients had less than 200 CD4/microliter. Cryptococcal infection was the AIDS defining illness in 24% of cases. Patients typically presented with neurologic symptoms such as: headache (88%), fever (68%) and somnolence (68%); 20% presented seizures and 28% focal deficits. There were no CSF biochemical alterations in 25% of them. CSF culture and indian ink stain were positive in 76%. CSF cryptococcal antigen test was positive in 68% of the cases. TC showed abnormalities in 48%. CSF of all patients treated with amphotericin B (AB) plus flucytosine (5FC) whose CSF culture was monitored became negative in the first two weeks, meanwhile those treated only with AB or fluconazol had negative control culture in 60% and 50% respectively. Six patients died within the initial 10 weeks. Death was due to bacterian sepsis in 3 patients and high intracranial pressure was the cause in 2 cases. One happened before treatment was administered. CONCLUSIONS: It's essential to consider the possibility of cryptococcal meningitis in patients infected with HIV and any compatible symptom regardless of CSF biochemical results and immunodepression level (CD4). Although our study was non randomized and so we can't propose a therapeutical schedule based on it, we can say that patients treated with AB plus 5FC showed an earlier conversion from positive to negative CSF cultures without more adverse reactions.