Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 5 de 5
Filtrar
1.
Clin Microbiol Infect ; 26(3): 358-365, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31323260

RESUMO

OBJECTIVES: Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. METHODS: We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends. RESULTS: The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) = -3.0%, p < 0.001. Total antimicrobial consumption decreased (QPC = -0.9%, p < 0.001), specifically carbapenems, amoxicillin/clavulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased. While the incidence of MDR showed a sustained decreasing trend (QPC = -1.8%; p 0.002), the mortality of patients with bloodstream infections remained stable (QPC = -0.2%, p 0.605). CONCLUSIONS: To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.


Assuntos
Gestão de Antimicrobianos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Anti-Infecciosos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Farmacorresistência Bacteriana Múltipla , Hospitais , Humanos , Incidência , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Vigilância em Saúde Pública , Espanha/epidemiologia
2.
Epidemiol Infect ; 146(14): 1870-1877, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30070190

RESUMO

Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013-14 and 2014-15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1-53.8%) of patients without ICU admission and was associated with absence of renal failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15-1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25-2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1-56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03-7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Pneumonia/tratamento farmacológico , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Espanha
3.
Rev Clin Esp ; 201(10): 563-7, 2001 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-11817221

RESUMO

OBJECTIVE: To examine the availability of information in the clinical records (CR) to evaluate care quality in ischemic heart disease. MATERIAL AND METHODS: A total of 722 clinical records of patients admitted because of ischemic heart disease were evaluated. Based upon a bibliographic review and the criteria of an expert panel necessary data to evaluate care quality were selected. A CR was considered adequate when at least 80% of data considered necessary by the expert panel were available. RESULTS: 78.5% of CR had adequate data. The elderly, clinical presentation as ischemic equivalent and one of the hospitals studied had most deficient CR. CONCLUSIONS: The CR is valid to retrospectively evaluate medical care. Differences between hospitals were important and should be taken into consideration before studies on clinical quality are performed.


Assuntos
Isquemia Miocárdica/terapia , Indicadores de Qualidade em Assistência à Saúde/normas , Estudos Transversais , Humanos , Reprodutibilidade dos Testes , Espanha
4.
Med Clin (Barc) ; 112 Suppl 1: 74-8, 1999.
Artigo em Espanhol | MEDLINE | ID: mdl-10618803

RESUMO

BACKGROUND: The systematic literature reviews have been proposed as a method of scientific evidence identification since they protect the final product from the subjectivity of each primary source reviewer. However, it is not known whether the different ways of evidence synthesis accomplish suitable criteria of objectivity, reliability and biases protection so as to be considered scientifically valid. An experiment of reliability and validity of a systematic literature review about coronary heart disease was carried out. MATERIAL AND METHODS: Study of blind concordance between two independent reviewers for the identification, selection, retrieval and quality evaluation of the articles by using the same protocol. The concordance was analysed by the kappa index for two observers in different categories. The validity was evaluated throughout the acceptability of the review users. RESULTS: The concordance for their identification capacity was poor although they used the same key words (869 versus 476). But the concordance improved when considering selection (26.6% versus 29.2%), retrieval (agreement = 76%) classification by kind of article (kappa = 0.60) and scoring by strength of the evidence (kappa = 0.87). The acceptability was high among review users. CONCLUSIONS: It would be assumed that, even under tight rules of performance, the systematic literature reviews are not completely protected against some biases which could damage their validity in a non easily controllable form. The implication of reviewers, experts in documentation and users of the literature, together with pilot studies performed previous to the review, seems to be the best way to yield better results.


Assuntos
Isquemia Miocárdica , Revisões Sistemáticas como Assunto , Humanos , Angina Pectoris , Bibliografias como Assunto , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , MEDLINE , Variações Dependentes do Observador , Controle de Qualidade , Qualidade da Assistência à Saúde , Reprodutibilidade dos Testes , Espanha
5.
Eur J Epidemiol ; 12(3): 257-62, 1996 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8884193

RESUMO

This article reports data concerning a serosurvey carried out in Southern Spain to assess the current epidemiological status of a population exposed to risk of leptospirosis. Microagglutination and IgM-EIA tests were carried out on sera from a sample of workers in agriculture-related occupations, exposed to marsh waters. A cohort of 197 workers were followed for a year in an active surveillance program to evaluate seroconversion (laboratory confirmed leptospirosis). The results have shown for the cohort a density of incidence: 6.4 x 100 persons per year, and for the reference population an accumulated incidence of 41.25/100,000. Prevalence rates (P) were 21.3 x 100 and 144 x 10(5) for the cohort and population respectively. Rates were higher in cray-fishers (P: 62.7%), rice-workers, and butchers. This is the first report identifying cray-fishers as a high risk group for leptospirosis, and the reporting of human contamination by Australis serogroup in Spain.


Assuntos
Leptospirose/epidemiologia , Doenças Profissionais/epidemiologia , Exposição Ocupacional , Adolescente , Adulto , Estudos de Coortes , Feminino , Seguimentos , Água Doce/microbiologia , Humanos , Incidência , Leptospira/imunologia , Leptospira/isolamento & purificação , Leptospirose/transmissão , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/sangue , Prevalência , Estudos Prospectivos , Estudos Soroepidemiológicos , Espanha/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...