RESUMEN
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.
Asunto(s)
Antiinfecciosos , Programas de Optimización del Uso de los Antimicrobianos , Humanos , Estudios Retrospectivos , Antiinfecciosos/uso terapéutico , Antibacterianos/uso terapéutico , HospitalesRESUMEN
Objetivo: Analizar si el cambio de tratamiento antirretroviral a efavirenz/emtricitabina/ tenofovir en dosis única diaria (EETu) incrementa la adherencia y mantiene la efectividad del mismo, y establecer el incremento de coste provocado por dicho cambio. Métodos Estudio observacional, retrospectivo e intrasujeto, realizado en la unidad de dispensación a pacientes externos. El periodo de estudio fue un año (seis meses antes y seis meses después del cambio). Se revisaron los registros informáticos de dispensación y los días de hospitalización durante el periodo de estudio y se calculó la diferencia de adherencia al tratamiento. Para determinar la eficacia del tratamiento, se revisaron los datos de carga viral y linfocitos CD4 antes y después del cambio. Se recogió el coste de los tratamientos previo y posterior para cada paciente y se determinó el incremento de coste anual y por paciente. Resultados Se incluyeron en el estudio 127 pacientes. La diferencia de adherencia fue del 0,6%. El porcentaje de malos adherentes fue del 35,43 y del 40,94% antes y después del cambio de tratamiento, respectivamente. Los niveles de linfocitos CD4 y carga viral no cambiaron significativamente con el tratamiento. En análisis económico reveló un incremento de 25.374,60€ anuales y 199,80€/paciente. Conclusiones El uso de EETu no mejora el control de la infección por el VIH en términos de efectividad ni de adherencia y supone un aumento del gasto farmacéutico, por lo que su elección como tratamiento antirretroviral deberá basarse en criterios diferentes a los anteriormente descritos (AU)
Objective: To analyse whether the change of antiretroviral therapy to efavirenz/emtricitabine/tenofovir in a single daily dose (EETu) increases adherence and maintains effectiveness, and establish the cost increase caused by the change. Methods: An observational, retrospective, and intra-subject study, performed in the outpatient dispensing unit. The study period was 1 year (6 months before and 6 months after the change).Computer dispensing records and days of hospitalisation during the study period were reviewed, and the difference in treatment adherence calculated. To determine the effectiveness of treatment, viral load and CD4 lymphocytes data before and after the change were reviewed. The cost before and after treatment for each patient was determined, and therefore the annual cost increase and the incremental cost per patient. Results: The study included 127 patients. The difference in adherence was 0.6%. The percentage of poor adherence was 35.4% and 40.9% before and after the treatment change, respectively. The levels of CD4 lymphocytes and viral load did not change significantly with treatment. The economic analysis revealed an annual increase of 25 374.60 and €199.80 per patient. Conclusions: The use of EETu did not improve the control of HIV infection in terms of effectiveness and adherence, and resulted in increased economic costs. Therefore, its choice as antiretroviral treatment will have to be based on criteria other than those described above (AU)
Asunto(s)
Humanos , Antirretrovirales/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Relación Dosis-Respuesta a Droga , /estadística & datos numéricos , Resultado del TratamientoRESUMEN
OBJECTIVE: To analyse whether the change of antiretroviral therapy to efavirenz/emtricitabine/tenofovir in a single daily dose (EETu) increases adherence and maintains effectiveness, and establish the cost increase caused by the change. METHODS: An observational, retrospective, and intra-subject study, performed in the outpatient dispensing unit. The study period was 1 year (6 months before and 6 months after the change). Computer dispensing records and days of hospitalisation during the study period were reviewed, and the difference in treatment adherence calculated. To determine the effectiveness of treatment, viral load and CD4 lymphocytes data before and after the change were reviewed. The cost before and after treatment for each patient was determined, and therefore the annual cost increase and the incremental cost per patient. RESULTS: The study included 127 patients. The difference in adherence was 0.6%. The percentage of poor adherence was 35.4% and 40.9% before and after the treatment change, respectively. The levels of CD4 lymphocytes and viral load did not change significantly with treatment. The economic analysis revealed an annual increase of 25,374.60 and 199.80 per patient. CONCLUSIONS: The use of EETu did not improve the control of HIV infection in terms of effectiveness and adherence, and resulted in increased economic costs. Therefore, its choice as antiretroviral treatment will have to be based on criteria other than those described above.
Asunto(s)
Adenina/análogos & derivados , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/métodos , Desoxicitidina/análogos & derivados , Infecciones por VIH/tratamiento farmacológico , Organofosfonatos/uso terapéutico , Oxazinas/uso terapéutico , Cooperación del Paciente , Adenina/administración & dosificación , Adenina/efectos adversos , Adenina/uso terapéutico , Adulto , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/economía , Terapia Antirretroviral Altamente Activa/economía , Recuento de Linfocito CD4 , Desoxicitidina/administración & dosificación , Desoxicitidina/efectos adversos , Desoxicitidina/uso terapéutico , Combinación de Medicamentos , Combinación Efavirenz, Emtricitabina y Fumarato de Tenofovir Disoproxil , Femenino , Infecciones por VIH/economía , Humanos , Masculino , Persona de Mediana Edad , Organofosfonatos/administración & dosificación , Organofosfonatos/efectos adversos , Oxazinas/administración & dosificación , Oxazinas/efectos adversos , EspañaRESUMEN
The physiological parameters of heterothermy (e.g. minimum body temperature and oxygen consumption, percentage metabolic reduction, and bout length) were measured in two species of Elephantulus elephant shrews (Elephantulus myurus and Elephantulus rozeti; Macroscelidea) as a function of ambient temperature. Both species displayed deep torpor whereby the body temperatures of ca. 5 degrees C and oxygen consumption as low as 2% of basal metabolic rate were attained. Torpor bout length (n = 57 bouts) never exceeded 24 h. These data are characteristic of both hibernation (minimum body temperature and metabolism) and daily torpor (bout length), and argue that these two physiological responses may not necessarily have separate evolutionary origins.
Asunto(s)
Temperatura Corporal/fisiología , Hibernación/fisiología , Musarañas/fisiología , Animales , Metabolismo Basal , Ritmo Circadiano , Metabolismo Energético , Consumo de Oxígeno , Especificidad de la Especie , Factores de TiempoRESUMEN
Patterns of daily torpor were measured in response to photoperiod and food restriction at a constant temperature (18 degrees C) in two species of elephant shrew (Macroscelidea), Elephantulus rozeti (from Morocco) and Elephantulus myurus (from southern Africa). Body temperature was monitored continuously for ca. 3 months using temperature-sensitive telemeters. Under short photoperiods (8:16 L:D), both species entered spontaneous torpor on an ad libitum diet, but showed a higher frequency of induced torpor when food was restricted. Under long photoperiods (16:8 L:D), E. myurus could be induced to enter daily 'summer' torpor. A total of 378 torpor bouts were measured, none of which were longer in duration than 18 h. Under short photoperiods, arousal from torpor was associated with the onset of the photoperiod, whereas the time of entry was variable throughout the scotophase. However, E. myurus tended to phase shift torpor from the photophase to the scotophase under long photoperiods, despite displaying weak circadian amplitudes of body temperature indicative of a photophase rest phase. Both species lacked well-defined circadian amplitudes of body temperature, a pattern thought to be associated with polyphasic activity cycles characteristic of several Elephantuluis species. It was concluded that these and other patterns of torpor shown by Elephantulus show similarities with other small Afrotropical insectivores inhabiting semi-arid habitats or unpredictable environments.
Asunto(s)
Temperatura Corporal/fisiología , Musarañas/fisiología , Animales , Ritmo Circadiano , Privación de Alimentos/fisiología , Fotoperiodo , Especificidad de la Especie , Factores de TiempoRESUMEN
This study examines the hypothesis that Mystromys albicaudatus, a cricetine relic in southern Africa, has thermal characteristics typical of a rodent adapted to a cold temperature regime. Metabolic rate (oxygen consumption) of M. albicaudatus was measured using open-flow respirometry at ambient temperatures ranging from 5 degrees C to 35 degrees C. Lowest specific oxygen consumption was 1.352 +/- 0.089 ml O2 g-1hr-1 (n = 8; body mass = 93.78 +/- 6.27 g) at 25 degrees C, equivalent to 121.8% of the predicted value of Kleiber (1975), 128.8% of the value predicted for eutherians and 113.7% of the value predicted for cricetidae (Hayssen and Lacy, 1985).
Asunto(s)
Regulación de la Temperatura Corporal , Ratas/fisiología , África , Animales , Consumo de Oxígeno , Ratas/metabolismo , Temperatura , Pérdida Insensible de AguaRESUMEN
The microflora in the gastrointestinal tracts of wild vervet and samango monkeys (Cercopithecus aethiops and C. mitis, respectively) were studied, using fermentation acid analysis, electron microscopy, and culturing methods. The diets of the two species of monkey differ considerably, with that of the samango including a greater proportion of cellulose-rich leaf material, and this is reflected in the microflora. Volatile fatty acid measurements along the gut of both species showed that these end products of bacterial metabolism were concentrated in the cecum and colon. Electron microscopy indicated that morphologically similar bacteria were present in the cecum and colon of both species, but the samango possessed a distinct stomach microflora. Bacteria in the lumina of the four main regions of the gut of the monkeys (stomach, small intestine, cecum, and colon) were plated on a number of anaerobic media (Mann, Rogosa, and Sharp; clostridial basal; and complex media). The cecum and colon were found to contain higher numbers of microbes per gram (wet weight) of gut content than the stomach and small intestine. Microbial isolates were able to catabolize carboxymethyl cellulose and other polymers. This may aid the monkeys, particularly samangos, in the digestion of fibrous dietary components such as leaves.
Asunto(s)
Cercopithecus/microbiología , Chlorocebus aethiops/microbiología , Sistema Digestivo/microbiología , Animales , Bacterias/aislamiento & purificación , Bacterias/ultraestructura , Dieta , Sistema Digestivo/ultraestructura , Concentración de Iones de Hidrógeno , Microscopía Electrónica de Rastreo , Especificidad de la EspecieRESUMEN
1. Laboratory and field studies of energy and water metabolism employing isotopic dilution methods examined the ability of Namib Desert moles to survive on an insect diet without drinking water. 2. Water independence is achieved through efficient renal function while low rates of energy usage and torpor are further effective in reducing overall water requirements.
Asunto(s)
Agua Corporal/metabolismo , Clima Desértico , Eulipotyphla/metabolismo , Topos/metabolismo , África , Animales , Composición Corporal/fisiología , Metabolismo Energético/fisiología , Riñón/anatomía & histología , Riñón/metabolismo , Riñón/fisiología , Reproducibilidad de los Resultados , Tenebrio , TritioRESUMEN
The samango monkey occurs at the southern limit of the range of Cercopithecus mitis. Greater climatic seasonality at this latitude results in more predictable fruiting patterns. In addition, there are no diurnal sympatric primate frugivores. Under these conditions, the diet and feeding strategies of samango monkeys would be expected to differ notably from those of central or east African C. mitis subspecies. Contrary to these expectations, the preliminary observations reported here indicate that diets of samango and blue monkeys differ only superficially in the proportions of items eaten. Similarities in feeding behaviour are especially marked during the dry season period when fruit is not abundant. Both samango and blue monkeys tend to be less selective in their choice of food species and to eat available food species regardless of their energy content; a shift toward less nutritious items such as leaves is also noted. Feeding behaviour during the summer wet season is characterized by the selection of fruits with high-energy values. A high proportion of visits by the monkeys to areas of greater food availability suggests a concentration of feeding effort in food patches and the selection of higher energy food species within patches.