p<0.001) and chemotherapy (12.6% vs 1.9%, p<0.001). Admission to the intensive care unit (ICU) was significantly more frequent in surgical patients (35.4% vs 10.9%, p<0.001) as well as use of second and third generation cephalosporins (30.0% vs 17.6%, p=0.001; 64.6% vs 53.1%, p=0.007, respectively). Conclusion and relevance Age !65 years, use of PPIs, chemotherapy and fluoroquinolones were positively associated with the medical group and were significant predictors of CDI, whereas admission to the ICU and the use of second and third generation cephalosporins were positively associated with being in the surgical group and were significant predictors of CDI. We conclude that medical patients were more endangered with HA CDI than surgical patients.

psoriasis. Median age was 50.7 years (range 5.9-91.7) and 221 (61.9%) patients were men. 282 patients (79%) were treated with only one biological drug: 75 patients with anti-TNF-a, 132 with anti-IL-17 and 75 with anti-IL-23. 65 patients (18.2%) were treated with two biological drugs in sequence (table 1). Conclusion and relevance More than 97% of patients were treated with only one (79%) or two (18.2%) biological drugs for moderate-to-severe plaque psoriasis, with a prevalence of anti-IL-17. Further investigation of the causes for the change from one to another biological drug is needed. These could include adverse events, ineffectiveness or other reasons.

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BackgroundDarunavir/cobicistat (DRV/COB) is the first fixed combination inhibitor of protease. Both are metabolised by the cytochrome CYP3A4, the reason why they are susceptible to present a multitude of drug interactions (DI).PurposeTo describe the DI of DRV/COB in HIV patients to avoid and to optimise therapy.Material and methodsRetrospective observational study performed in a county hospital. We reviewed the digital clinical history to collect the following data: patients treated with DRV/COB from 1 January 2016 to 1 November 2016, demographics, duration of treatment, concomitant medications, drugs involved, and DI. We review HIV-drug interactions using the database of the University of Liverpool to classify DI according to the mechanism of action (MA) and their potential severity. The pharmaceutical intervention (PI) was to notify to the prescribing physician, by report attached in the patient’s medical record, the contraindicated interactions (CI).ResultsThirty-five patients, 51% males (n=18). Race: 54% non-Caucasian (n=19). Median age 37 years (IQR 64–20). Median days of treatment 195 (IQR 465–22), total of concomitant medications 199, median 5 (IQR 1–19), DI 31% (n=62) median 1 (IQR 0–8), 40 drugs involved in DI. Type of DI according to their MA: CYP3A inhibition 62% (n=25), inhibition CYP2D6 10% (n=4), inhibition CYP3A and CYP2D6 7% (n=3) and inducer CYP3A 5% MA 15% (n=6). DI type according to its potential severity: high (CI) 15% (n=6) (midazolam, budesonide, phenobarbital, ivabradine, simvastatin and domperidone); and potential: 89% (n=35). PI: accepted 3 (50%): one change from simvastatin to rosuvastatin, one change from phenobarbital to levetiracetam and a change from midazolam to lormetazepam.ConclusionA high rate of DI is observed in patients receiving treatment with DRV/COB. The most relevant interactions are observed at the level of the CYP3A family. Acceptance of PI was low in the case of CI detected, probably because the prescribing physician was unaware of it. To have a higher success rate we could have made a phone call to him to put him on notice. The pharmacist is important in optimising drug therapy.References and/or AcknowledgementsThanks to all my colleagues in the Hospital de Poniente for their selfless helpNo conflict of interest

BackgroundCutaneous diphtheria is a skin infection caused by toxigenic and non-toxigenic strains of Corynebacterium diphtheriae. It is characterised by chronic nonhealing ulcers. Diagnosis may be delayed because it is a rare infection in developed countries. Usual treatment is erythromycin or penicillin, although erythromycin is more effective than penicillin.PurposeTo describe a case of cutaneous diphtheria caused by non-toxigenic C. diphtheriae in a Visiting Friends and Relatives (VFR) patient.Material and methodsData were obtained by a review of the electronic medical records, Pubmed and Uptodate.ResultsA 25-years-old female. No known drug allergy. No usual treatment. She is from Guinea Bissau but she has lived in Spain since she was 7-years-old. She has been on holiday in Guinea Bissau from April to May 2017. Two weeks before her return she had a papular lesion in her left leg and subsequently it was ulcerated. Two days after she returned, she went to the hospital. Progressively similar lesions appeared in both legs, right shoulder and back. Exudate samples from ulcers were taken for microbiological culture and biopsy. In addition, we performed a protocol to care for immigrants: serology for strongyloides, treponema pallidum, plasmodium falciparum/vivas/malariae/ovale and HIV-1/2 were negative as well as PCR for Loa-loa and filarias. Skin histology showed eosinophil infiltrates with a central ulceration. PAS/Ziehl–Neelsen stains remained negative. Microbiological culture of ulcer swabs revealed C. diphtheria with Streptococcus pyogenes group A and methicillin-sensitive Staphylococcus aureus superinfection. PCR analysis for C. diphtheria toxin was negative. Pharyngeal swab cultures remained negative for C. diphtheriae. The patient was treated with erythromycin 500 mg/6 hours for 14 days. Topical treatment included daily fusidic acid. Lesions improved progressively with the treatment. Within 2 weeks all skin lesions had completely resolved.ConclusionCutaneous diphtheria was caused by non-toxigenic C. diphtheria. It is a highly contagious infection. Due to high vaccination rates it is a quite a rare infection in developed countries, but due to the increase in migration and refugees into Europe, more cases are being seen. Cutaneous diphtheria should be included in the differential diagnosis of patients with skin ulcerations, especially in immigrants.No conflict of interest