RESUMO
BACKGROUND: Candida bloodstream infections carry a significant mortality risk, justifying the importance of adequate antifungal therapy. This study describes trends in antifungal consumption using the Defined Daily Dose (DDD) and Days of Therapy (DOT) metrics, identifies the microbiological profile, the time to initiation of empirical therapy, the adjustment after positive blood culture results for Candida, and the impact on in-hospital mortality rate in patients with candidemia. METHODS: An analysis of antifungal consumption from 2008 to 2016, and of candidemia cases from 2012 to 2016 was carried out in a private tertiary hospital. RESULTS: A total of 11,273 admissions were identified with a prescription for at least one type of antifungal therapy. Fluconazole was the most prescribed antifungal drug in terms of general consumption. Through the DDD and DOT metrics, we observed that over time, there was an increase in the consumption of liposomal amphotericin B, micafungin and voriconazole. Candida albicans was the most isolated species in blood cultures. Regarding candidemia, we analyzed samples from 115 patients. Empirical therapy was started within 24 h of blood culture in 44.3% of the cases, and in 81.7% of the cases, the antifungal was deemed to be adequate based in antifungal susceptibility testing, both of which were not associated with the in-hospital mortality rate. CONCLUSIONS: Our study reinforces the importance of monitoring the consumption of antifungal agents, which helps in proposing actions that lead to their rational use and, consequently, reduces the appearance of resistant strains.
Assuntos
Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Candidemia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Hemocultura , Brasil/epidemiologia , Candida/isolamento & purificação , Candida/patogenicidade , Candidemia/mortalidade , Candidíase/tratamento farmacológico , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária/estatística & dados numéricosRESUMO
Hypervitaminosis D is a rarely reported condition. In general it is only perceived when hypercalcemia is not resolved. The use of vitamin D has increased in recent years because of its benefits, but as a result, intoxication cases have occurred more frequently. This report describes a patient who presented worsening of renal function and hypercalcemia. After investigation, vitamin D intoxication was confirmed and it was due to an error in compounding.
Assuntos
Hipercalcemia/induzido quimicamente , Vitamina D/intoxicação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Hipercalcemia/diagnóstico , Masculino , Erros de Medicação , Pessoa de Meia-IdadeRESUMO
Hypervitaminosis D is a rarely reported condition. In general it is only perceived when hypercalcemia is not resolved. The use of vitamin D has increased in recent years because of its benefits, but as a result, intoxication cases have occurred more frequently. This report describes a patient who presented worsening of renal function and hypercalcemia. After investigation, vitamin D intoxication was confirmed and it was due to an error in compounding.
A hipervitaminose D é pouco relatada. Geralmente, só é percebida quando o quadro de hipercalcemia não se resolve. Em razão de seus benefícios, o uso de vitamina D aumentou nos últimos anos; consequentemente, os casos de intoxicação também tiveram aumento. Este relato destacou um caso em que o paciente apresentava piora da função renal e hipercalcemia. Após investigação, ficou confirmada a intoxicação por vitamina D devido a um erro de manipulação da droga.
