Alliance for the development of the Argentinian Hip Fracture Registry.

Age expectancy has significantly increased over the last 50 years, as well as some age-related health conditions such as hip fractures. The development of hip fracture registries has shown enhanced patient outcomes through quality improvement strategies. The development of the Argentinian Hip Fracture Registry is going in the same direction. INTRODUCTION: Age expectancy has increased worldwide in the last 50 years, with the population over 64 growing from 4.9 to 9.1%. As fractures are an important problem in this age group, specific approaches such as hip fracture registries (HFR) are needed. Our aim is to communicate the Argentinian HFR (AHFR) development resulting from an alliance between Fundación Trauma, Fundación Navarro Viola, and the Argentinian Network of Hip Fracture in the elderly. METHODS: Between October 2020 and May 2021, an iterative consensus process involving 5 specialty-focused meetings and 8 general meetings with more than 20 specialists was conducted. This process comprised inclusion criteria definitions, dataset proposals, website deployment with data protection and user validation, the definition of hospital-adjusted registry levels, implementation planning, and sustainability strategies. RESULTS: By June 2021, we were able to (1) outline data fields, including epidemiological, clinical, and functional dimensions for the pre-admission, hospitalization, discharge, and follow-up stages; (2) define three levels: basic (53 fields), intermediate (85), and advanced (99); (3) identify 21 benchmarking indicators; and (4) make a correlation scheme among fracture classifications. Simultaneously, we launched a fundraising campaign to implement the AHFR in 30 centers, having completed 18. CONCLUSION: AHFR development was based on four pillars: (1) representativeness and support, (2) solid definitions from onset, (3) committed teams, and (4) stable funding. This tool may contribute to the design of evidence-based health policies to improve patient outcomes, and we hope this experience will help other LMICs to develop their own tailored-to-their-needs registries.

Insuficiencia renal aguda en pacientes tratados con aminoglucósidos / Acute kidney injury in patients treated with aminoglycosides

Introducción: El riesgo de desarrollo de insuficiencia renal asociada al uso de aminoglucósidos es muchas veces una limitación para su uso en muchos profesionales de la salud. El objetivo de este trabajo fue conocer la frecuencia de insuficiencia renal en pacientes tratados con aminoglucósidos y los posibles factores asociados a su aparición. Materiales y métodos: Estudio descriptivo, longitudinal y prospectivo. Se incluyeron pacientes que recibieron aminoglucósidos por al menos 72 horas. Se realizó dosaje de creatinina basal y cada 48 horas durante el tratamiento antibiótico y luego de siete días de finalizado el mismo o posterior. Se definió insuficiencia renal aguda como el aumento de creatinina de 0,3 mg/dl con respecto a la basal. Resultados: Se analizaron datos de 107 pacientes y se halló una frecuencia de insuficiencia renal de 10,3%, siendo 5,8% durante el tratamiento aminoglucósido y 4,5% luego de la suspensión del mismo. Los pacientes que desarrollaron insuficiencia renal tenían mayores dosis de aminoglucósidos con respecto al grupo que no presentó dicho evento, siendo esta diferencia estadísticamente significativa. Conclusiones: La frecuencia de insuficiencia renal en pacientes tratados con aminoglucósidos resultó dentro de los intervalos descritos en la literatura y la mayoría de los pacientes presentaron recuperación completa de la función renal. Consideramos que la insuficiencia renal no supone un efecto adverso clínicamente significativo si los aminoglucósidos se usan con las precauciones adecuadas. Esto, sumado a sus buenos resultados clínicos y al bajo impacto en la ecología bacteriana, los convierte hoy en día en antibióticos de uso frecuente en nuestro hospital

The risk of developing renal failure associated with the use of aminoglycosides is often a limitation for its use in many health professionals. The objective of this study was to know the frequency of renal failure in patients treated with aminoglycosides and the possible factors associated with their appearance. Materials and methods: descriptive, longitudinal and prospective study. Patients who received aminoglycosides for at least 72 hours were included. Basal creatinine was measured and every 48 hours during the antibiotic treatment and after 7 days or more of its suspension. Acute renal failure was defined as an increase in creatinine of 0.3 mg/dl compared to baseline. Results: data from 107 patients were analyzed, and the frequency of renal failure was 10.3%, being 5.8% during the treatment with aminoglycoside and 4.5% after its suspension. The patients who developed renal failure had higher doses of aminoglycoside respect to the group that did not present this event, being this difference statistically significant. Conclusions: the frequency of renal failure in patients treated with aminoglycosides was within the ranges described in the literature and the majority of patients had complete recovery of renal function. We believe that renal failure does not represent a clinically significant adverse effect if aminoglycosides are used with adequate precautions. This, added to their good clinical results and low impact on bacterial ecology, makes them very used antibiotics today in our hospital