Conclusion and relevance Electronic prescription and pharmacist validation allowed us to detect potential medication errors, promoting patient safety in vaccine administration. This circuit is applicable to all hospitals with an EPP and should allow them to detect and prevent potential medication errors.

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BackgroundThe use of biological drugs such as tocilizumab for rheumatoid arthritis (RA) is very expensive. However, some observational studies and recommendations from guidelines (BBF) suggest the possibility of reducing the dose of biologicals to the minimum effective dose in patients with good control of the disease.PurposeTo assess the financial impact, measured as direct costs, of the use of reduced doses of tocilizumab for the treatment of RA in a tertiary hospital.Material and methodsObservational, descriptive and retrospective study with patients diagnosed with RA. We included patients who received low doses of tocilizumab, because they had achieved remission or low disease activity with standard doses of tocilizumab (8 mg/kg every 28 days).Results7 patients were included, all of them treated with tocilizumab 6 mg/kg every 28 days. The average weight was 75 kg (55–100). The average annual cost per patient with a dose of 6 mg/kg every 28 days was €9,394 (6,647–13,899). The average annual cost for the same patient in the previous year, with doses of 8 mg/kg every 28 days, had been €12,178 (8,863–16,115). The average saving per patient/year was €2,784 (2,215–3,939). The use of reduced doses of tocilizumab for these 7 patients resulted in annual savings for the hospital of €19,490.ConclusionReducing the dose of tocilizumab in patients who have achieved remission or low disease activity having previously been treated with standard doses of tocilizumab provided direct savings for the hospital. Therefore, we are aware of the need to implement optimisation strategies in relation to the treatment of RA with tocilizumab in selected patients. However, more studies should be performed in order to determine the effectiveness of these dose reduction strategies and their financial impact on both direct and indirect costs.References and/or AcknowledgementsNo conflict of interest.

BackgroundInfection by Pseudomonas aeruginosa (PA) is a major cause of morbidity and mortality in hospitals, especially in immunocompromised patients. Mortality from bacteraemia by PA ranges from 25% to 62%, depending on the study consulted. There are multiple factors associated with mortality from bacteraemia by PA.PurposePrimary: to determine mortality at 90 days, from positive blood culture, in patients with PA bacteraemia in our centre. Secondary: to determine risk factors associated with mortality.Material and methodsRetrospective observational study. Includes patients with positive blood culture for PA from 1 January 2011 to 31 December 2014. Patients with polymicrobial infections were excluded. Demographic and clinical variables were collected. The antibiotic treatment administered was recorded. Its relationship with mortality was analysed.Results67 episodes of bacteraemia were identified. Mean age was 64.4 years (DE 13.31). Men: 68.7% (n = 46). The rate of 90 day mortality was 48% (n = 32). 50% (n = 16) of the exitus was directly attributed to an infectious syndrome. Nosocomial bacteraemia: 49%; associated with healthcare: 45%. Average value Charlson Index: 6.75 (DE 3.2). More frequent comorbidity: neoplasia 19.7% (n = 28). McCabe classification: ultimately fatal disease: 48% (n = 32); rapidly fatal disease: 12% (n = 8). Store Pitt medium: 2.7 points. They had sepsis, severe sepsis and septic shock (42%, 10% and 27% of patients, respectively). 55% of patients had some immunodeficiency. Unidentified infection foci: 22% (n = 15). The foci were identified: urinary 23% (n = 12), use of central catheters 23% (n = 12), respiratory 34% (n = 18), abdominal-biliary 17% (n = 9), other 3% (n = 5). Analytical parameters (median and 25–75 percentiles): leukocytes (cells/µL): 11 950 (2150–210 509), neutrophils (cells/ µL): 9870 (852–18 350), platelets (units/µL): 160 500 (83 000–255 250), creatinine (mg/mL): 1.4 (0.9–2), urea (mg/dL): 62 (40–105), PTA (%): 64.6 (49.7–75.5), albumin (g/dL): 1.7 (1.6–2.4), PCR (mg/dL): 233.4 (141–340.8), PCT (ng/ml) 17.1 (1.8–36.8), lactate (mmol/L): 2.4 (1.9–4.5). Received combination therapy, 47.8% (n = 32) of patients. Empiric appropiate treatment: 83% (n = 52), definitive appropiate treatments: 92% (n = 60). Globally, appropriate treatments: 87% (n = 140). Factors independently associated with poor prognosis were neutrophils <500/µL (HR 3.15, 95% CI 1.29–7.65, p = 0.01), Charlson Index (HR 1.23, 1.09–1.39, p = 0.001) and the presence of shock septic (HR 2.4, 1.02–5.65, p = 0.044). No relationship between the inadequate treatment and mortality antipseudomonal (lack of statistical power). In the use of monotherapy versus combination therapy, no difference in terms of mortality.ConclusionThe mortality found in patients with PA bacteraemia in our study confirms the high lethality of this infectious disease. The high comorbidity of the patients included in the study could increase the mortality rate. The Charlson Index, presence of septic shock and a value of neutrophils <500/µL were indep...

BackgroundThe management of infection by Pseudomonas aeruginosa (PA) is complicated. PA is a microorganism with intrinsic resistance to many antibiotics, with increasing resistance to agents that are currently considered therapeutic options.PurposeAnalysing antimicrobial therapy prescribed for the treatment of bacteremia PA at our centre.Material and methodsRetrospective observational study conducted/completed from January 2011 to December 2014. Inclusion criteria: patients with positive blood culture for PA. Treatment related variables were analysed. The adequacy of treatment was evaluated according to the antimicrobial guide from our hospital.Results67 episodes of bacteraemia were identified. The MDR-PA was isolated in 13.5% (n = 9). 161 prescriptions were performed. Antibiotics per patient average: 2.4. Combination therapy: 47.8% (n = 32) versus monotherapy: 52.2% (n = 35). Empirical prescriptions: 48% (n = 77) versus directed prescriptions: 52% (n = 84). Appropriate empirical prescriptions 83% (n = 52). Appropriate directed prescriptions: 92% (n = 60). Overall, appropriate prescriptions were 87% (n = 140). Main reasons for inadequacy: not sensitive germ 70% (n = 14), wrong dose 15% (n = 3). Antibiotics prescribed groups were: 25% quinolones, 24% beta-lactams+beta-lactamase inhibitors, 22% carbapenems, 19% aminoglycosides, 9% cephalosporins, 2% other. The antibiotics used to treat PA bacteraemia were pieracilina-tazobactam 22.9% (n = 37), ciprofloxacin 16.2% (n = 26), imipenem 13.1% (n = 21), amikacin 12.5% (n = 20), meropenem 9.4% (n = 15), levofloxacin 8.7% (n = 14), ceftazidime 6.8% (n = 11), gentamicin 3.8% (n = 6), tobramycin 2.4% (n = 4), cefepime 1.8% (n = 3), colistina 1.2% (n = 2), other 1.2% (n = 2). Only a few patients (5% (n = 3)) were allergic to any anti-pseudomonal antibiotic.ConclusionThe monotherapy and combination therapy was used with similar frequency.The rate of appropriate treatment was high, especially in targeted therapies.The groups of antibiotics used were mainly quinolones, beta-lactams+beta-lactamase inhibitors and carbapenems, with piperacillin-tazobactam, ciprofloxacin and imipenem the most commonly used antibiotics.Due to the low incidence of resistances and patients allergic to anti-pseudomonal antibiotics, it is unlikely that these conditions influence the pattern of prescribing antibiotics.Due to these results, the antibiotic stewardship group will consider training sessions to encourage prescribing anti-pseudomonal cephalosporins.No conflict of interest.