Fuente: Medicine Magazine (Buenos Aires) | MEDICINE – Volume 82 – No. 5, 2022.
Antimicrobial use optimization program during the COVID-19 pandemic | ABSTRACT
Despite the low frequency of bacterial coinfections associated with COVID-19, the rate of empiric antibiotic (ATB) use varies between 70 and 90%. The primary objective of the study was to evaluate the impact of the implementation of an antimicrobial optimization program in patients with COVID-19 (PROA-COVID). A prospective interrupted time series study was conducted. The prevalence, adequacy and consumption of ATB in hospitalized adults with COVID was evaluated prior to the implementation of PROA-COVID (P1, June 2020) and in three subsequent periods (P2 in August 2020, P3 in October 2020 and P4 in June 2021). . 301 patients were included. Moderate-severe clinical forms were more frequent in P2, 3 and 4 (p < 0.001). The implementation of the program showed a significant decrease in the use of ATB (61% vs. 41% vs. 31.1% vs. 8.1%, p < 0.001), in the indication of combined treatment with macrolides (17.3% vs. 19.2% vs. 10.8% vs. 1.4%, p = 0.03) and increased appropriate use (37.5% vs. 46.9% vs. 69.9% vs. 66.6%, p = 0.039). Total ATB consumption in DDT (days of treatment)/1000 patient days was: 347.9 vs. 272.8 vs. 134.3 vs. 43.6 (p < 0.001). There were no significant differences in admission to critical care units or in mortality. The implementation of PROA-COVID was an effective strategy to reduce the use of antibiotics and optimize their indications without impacting morbidity and mortality.
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From publications to daily practice: tocilizumab in patients with severe COVID-19 | ABSTRACT
Introduction: There is evidence on the effectiveness and safety of tocilizumab (TZC) used in combination with systemic corticosteroids for the treatment of severe SARS-CoV-2 pneumonia. The purpose of this study was to describe the epidemiological, clinical and laboratory characteristics, as well as the clinical outcome of patients who received this combination therapy compared to those who received corticosteroids alone. Methods: A retrospective cohort study, including adults with severe SARS-CoV-2 pneumonia, was conducted between March and August 2021. 101 patients were included, 46 on corticosteroids and 55 on corticosteroids plus tocilizumab. Results: the median age was 58 years and 63.9% were women. Arterial hypertension was present in 36.1% and obesity in 54.6%. Survival in the cohort was 81.4%, with a median hospital stay of 19.0 days. Secondary infections were present in 47.4% of the cohort. Patients in the TZC group had lower C-reactive protein (CRP) values at discharge, a lower rate of multi-organ failure, better functional status at discharge, and a shorter hospital stay. In a bivariate analysis, no differences were found in the mortality rate and the occurrence of secondary infections. When evaluating the clinical status according to the WHO Ordinal Scale, there was a significant difference in its variability from worsening to discharge (or 14 days), showing a better functional status in those who received TCZ. Discussion: We were able to demonstrate its efficacy in reducing inflammatory biomarkers and a trend towards fewer days of hospitalization, with no impact on mortality.
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Ceftaroline as salvage treatment for bacteremia complicated by Staphylococcus aureus sensible a la meticilina | ABSTRACT
infections caused by Staphylococcus aureus Methicillin-susceptible (MSSA) are still associated with significant morbidity and mortality. Treatment failures of cefazolin (CFZ) probably related to inoculum effect have been reported. New treatments are needed for these infections and ceftaroline fosamil (CPT) might be an option. Our aim was to describe the clinical characteristics of five patients with SASM bacteremia complicated by CFZ failure who were successfully treated with CPT. We conducted a retrospective review of medical records in a hospital in Buenos Aires, Argentina; over a 12-month period, five patients (24%) of 21 with MSSA bacteremia experienced CFZ failure and were treated with CPT. The median time on CFZ therapy was 10 days before switching to CPT; four patients had evidence of metastatic spread and 2 had endocarditis. All patients experienced microbiological and clinical cure with CPT, which was used as monotherapy in 4 and in combination with daptomycin in another. One patient discontinued CPT due to neutropenia on day 23 of treatment. In patients with severe SASM infections who fail current therapy, CPT might be a good therapeutic option.
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Some Bibliographic News selected with summaries translated by the journal:
CARNITINE AS A POTENTIAL TREATMENT IN CHAGAS DISEASE [ensayos preclínicos] | Updated September 4, 2022.
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THE USE OF STATINS WOULD NOT BE JUSTIFIED FOR HEALTHY PEOPLE WITH HIGH CHOLESTEROL | Updated September 20, 2022.
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