[Antibiotic stewardship programs in the Spanish emergency services: PROA-URG Study]. / Programas de optimización del uso de antimicrobianos en los servicios de urgencias españoles: Estudio PROA-URG.

OBJECTIVE: Antimicrobial stewardship programs (ASP) have become a key tool in the adaptation of these drugs to the health system. The information available on the application and indicators used in these programs in emergency departments is scarce. The objective of this study is to know the extent of ASP implementation in the emergency departments, as well as the use of antimicrobials in these units. METHODS: Multicenter retrospective study. An invitation was sent to all participants of the REDFASTER-SEFH emergency pharmacist working group. A questionnaire was used consisting of 21 items, answered by a team made up of a pharmacist, emergency room specialist, infectious disease specialist and microbiologist. RESULTS: Eighteen hospitals completed the survey. Fourteen (77.8%) had an ASP manager. The DDD value per 1000 admissions ranged between 36.5 and 400.5 (median: 100.4 [IQR:57.2-157.3]). Both carbapenem and macrolide group presented wide variability in use. Six (33.3%) hospitals had an annual report on the specific resistance profile for urine and blood cultures. The percentage of multi-drug resistant strains in urine cultures was 12.5% and in blood cultures 12.2%. The percentage of adequacy in the bacteremia treatment was 81.0% (IQR:74.6-85.0%), while in urinary tract infections was 78.0% (IQR:71.5-88.0). CONCLUSIONS: Despite the existence of ASP members in emergency services, as well as the training activity and local guidelines is common. knowledge of the use of antimicrobials and resistances is limited. Future activities must be aimed at improving information about the ASP results in these units.

Adecuación de los botiquines de antídotos de los servicios de farmacia en hospitales públicos de la comunidad autónoma de Les Illes Balears / Adequacy of poisoning antidote stocks in the pharmacies of public health service hospitals in the Spanish autonomous community of the Balearic Islands

Objetivo: Analizar la adecuación del botiquín de antídotos en los servicios de farmacia de los hospitales de la red pública de la comunidad autónoma de Les Illes Balears. Método: Estudio descriptivo y transversal que revisa la composición del botiquín de antídotos y otros fármacos para el tratamiento de intoxicaciones agudas disponible en los servicios de farmacia de los diversos hospitales públicos de la Comunidad Autónoma, mediante cumplimentación de un formulario específico por un responsable de cada centro. Los resultados obtenidos se compararon con las recomendaciones CALITOX-2006 y las recomendaciones Antidote Stocking Guidelines (ASG-2009), se analizó la disponibilidad, cantidad y ubicación. Resultados: En los 7 hospitales, la disponibilidad supera el 85% según CALITOX y el68% según ASG. Las carencias principales fueron el sulfato sódico, la apomorfina, la cianida kit oral y el suero anticrotálide. La adecuación cuantitativa media es del 83%, y lapiridoxina es el que más veces está infradotado. Hay un exceso de carbón activado y de N-acetilcisteína. Se detectó una infradotación de glucagón y de fomepizol en el hospital de referencia. Los criterios de ubicación en el servicio de urgencias se siguieron en más del 80% (hospital de nivel I), 68% (hospital de nivel II) y 94% (hospital de referencia).Conclusiones: El grado de cumplimiento de las recomendaciones consultadas en cuanto a composición, accesibilidad y dotación del botiquín de antídotos y otros fármacos para el tratamiento de intoxicaciones agudas en los hospitales públicos de Les Illes Balears es alto, con una distribución en cada una de las islas segura para garantizar su disponibilidad. La situación geográfica del hospital y su proximidad al centro de referencia más dotado de antídotos predominan sobre el grado de complejidad del hospital en los de nivel 2

Objective: To analyze whether pharmacies in public health service hospitals in the Spanish autonomous community of the Balearic Islands are stocking sufficient amounts of poison antidotes. Methods: Descriptive cross-sectional study of public hospital pharmacy stocks of antidotes and other medicines for treating acute poisoning. The head of each hospital pharmacy completed a questionnaire about stocks. The results on which antidotes were in stock, the amounts, and the storage locations were assessed for compliance with recommended quality indicators for emergency care in acute poisonings (CALITOX-2006) and the Antidote Stocking Guidelines (ASG-2009).Results: The 7 hospitals met the CALITOX-2006 availability criteria for over 85% of items and the ASG-2009 criteria for68%. Inadequate stocking mainly involved sodium sulfate, apomorphine, oral cyanide antidote kits, and crotaline snake antivenom. An average of 83% of the stocks were adequate; pyridoxine was the substance most often found to be understocked. Activated charcoal and N-acetylcysteine were the items most often overstocked. Glucagon and fomepizole were understocked in the referral hospital. Over 80% of items were stored in appropriate ocations in the emergency departments of level 1 hospitals (68% in level 2 hospitals; 94% in the referral hospital). Conclusions: Public health system hospitals are highly compliant with recommendations on stocking antidotes and other medicines to treat acute poisoning (what to stock, where, and in what amounts); the distribution of stocks safely guarantees they will be available when needed. Among level 2 hospitals, a facility's location (proximity to the best-equipped referral hospital for poisonings) had greater influence on compliance than the hospital's level of complexity