[Evolution of Belgian hospital pharmacy]. / L'évolution de la Pharmacie hospitalière belge.

During the last 30 years, Hospital Pharmacy has undergone a significant evolution. It has progressively evolved from a purchase, production and distribution oriented institutional logistical support activity towards a patient oriented activity through the application of the complementary skills acquired by the various pharmacists active in the field. This evolution, particularly marked during the seventies and eighties, was recognized in 1991 through the adoption by the health authorities of hospital pharmaceutical centers acceptance norms specifically targeting activities of multidisciplinary teams centered around the patient. All these new skills progressively became the object of practical and theoretical training sessions dispensed in the framework of a Hospital Pharmacy DES. The content of this DES is regularly adapted in accordance with the evolution of observed necessities.

An outbreak of Ochrobactrum anthropi bacteraemia in five organ transplant patients.

Nosocomial bacteraemia caused by Ochrobactrum anthropi occurred over a 1-month period in five organ transplant recipients, four of whom were in the same renal and pancreatic transplant unit. Bacteraemia occurred with cyclosporin A, azathioprine and steroids, and with a rabbit anti-thymocyte globulin (RATG) during the induction phase. RATG appeared to be the only common factor among the five cases. Over the period described, 71.4% of all patients receiving RATG developed O. anthropi bacteraemia. Three patients presented with fever and chills during or shortly after RATG infusion. Analysis of residues of the infusion, and the used vials of RATG, showed the presence of O. anthropi in concentrations of between 20 and 1000 cfu ml-1 in 5.3% of samples. Unused vials were found to be heavily contaminated with either O. anthropi or Microbacterium spp. in 23.5% of samples. All positive vials were of one particular lot number suggesting a malfunction in the manufacturing process. Many parenteral drugs such as the RATG used here do not contain preservatives and, although aseptically prepared, will not withstand thermal sterilization. Bacterial contamination of these small volume medications is not always easily detectable by conventional methods. This outbreak highlights the need for accurate quality control testing to detect small inocula that may occur during or after the manufacturing process.