Modifications in the digestive tract secondary to gastrointestinal surgery may compromise the bioavailability of drugs. Decreased absorption surface, gastric emptying speed, and gastric pH alteration are factors to be taken into account in the management of pharmacological treatment after surgery. Evidence supported by data in clinical practice is scarce, but after studying the pharmacokinetic profile of some molecules, it is possible to offer recommendations for its adaptation to the patient's clinical situation.

IntroductionOne of the most common complications of parenteral nutrition (PN) is liver dysfunction (LD). Therapeutic approaches for LD include, among others, administering cyclic parenteral nutrition (cPN), allowing some hours for metabolic rest. The purpose of this study was to evaluate the effectiveness of cPN in treating PN-associated LD.Materials and methodsA retrospective observational study was carried out at the Costa del Sol Hospital in Spain between 2013 and 2014. The study involved inpatients ≥18 years old prescribed with cPN due to the development of PN-associated LD. The hepatic biochemical parameters measured at baseline and after completion of cPN included aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and total bilirubin (TB). Quantitative values (age, biochemical parameters) were compared using matched Student’s t-test; the mean change in qualitative variables (sex, indication of PN, hepatic comorbidities, presence of insulin in cPN, infection during cPN, management of LD prior to cPN administrarion) was estimated using Mann-Whitney U test, and bivariate correlation between quantitative variables was determined by Spearman’s coefficient of correlation.ResultsThirty-seven patients met inclusion criteria. All hepatic function parameters except ALP improved after the administration of cPN, with statistically significant differences (p < 0.05) in AST GGT and TB.ConclusioncPN improves PN-associated LD by restoring abnormal AST, GGT, and BT levels to normal, and reducing ALT levels close to normal. The results obtained suggest that the administration of cPN is effective in reverting PN-associated LD.

The aims of this study were to assess the impact of a follow-up nutrition consultation for ostomy patients on the rate of high output stoma (HOS)-related readmissions, as well as on the detection of poor nutritional status and their management, and to determine the associated economic impact. A single-centre ambispective cohort study was conducted in which all adult patients undergoing intestinal resection and stoma creation were recruited. Two nutrition consultations were established for early follow-up after hospital discharge and patients were prospectively included. Additionally, a retrospective search was carried out to include a control group. In both groups, a 12-month follow-up was conducted to record readmissions associated with high output stoma. A multivariate logistic regression was performed. Statistical significance level was established at p < 0.05. 170 patients were recruited, 85 patients in each cohort. Demographic data and clinical characteristics were recorded. A significant difference was observed in HOS-related readmissions, with readmission rates of 28.6% vs 10.3% in the retrospective and prospective cohort, respectively. At the first follow-up consultation, 50.5% of patients presented some degree of protein-calorie malnutrition. A statistically significant improvement in nutritional status was observed in the second evaluation. The intervention carried out resulted in a total saving of €24,175. Early follow-up of patients after discharge resulted in a significant reduction in the rate of HOS-related readmissions and allowed to identify a high percentage of patients with malnutrition. The cost analysis showed the process to be a cost-effective improvement.

BackgroundThe recommended starting dose of vancomycin is 25–30 mg/kg followed by 15–20 mg/kg/12–8 h (adjusted if there is renal impairment). Early plasma concentrations (PC), after 3 doses, should be obtained as soon as possible to determine if therapeutic levels (TL) have been reached (10–20 µg/ml).PurposeTo describe patients and indications, and to analyse treatments and a pharmacokinetic monitoring plan. To assess efficacy and its relation with PC and AUC/MIC, and nephrotoxicity (0.5 mg/dL or 50% creatinine increase).Material and methodsRetrospective study of vancomycin treatment guided by pharmacokinetic monitoring (Bayesian method) over 5 months. ICU, haemodyalisis, paediatrics, duration <5 days and de-escalations were excluded. Descriptive analysis through median and interquartile range (IR); frequency distribution for categories; quantitative variables comparison with clinical cure using the Mann-Whitney test (p < 0.05 for significance).Results87.9% of treatments were monitored (n = 22). Patients were 64 years (IR=22), CrCl=96 mL/min (IR=71.5) and 77.3% showed some nephrotoxicity risk factor.22.7% were skin/soft tissue (40% E faecium, 20% MRSA, 20% CNS), intra-abdominal 18.2% (66.7% E faecium, 33.3% CNS), bacteraemia 13.6% (100% CNS), catheter 13.6% (100% CNS), pneumonia 9.1% (100% MRSA), urinary tract 9.1% (100% Enterococcus), 9.1% without a clear focus and 4.5% non-pneumonia respiratory infections (100% MRSA). 100% E faecium showed MIC ≤4, 100% MRSA MIC ≥1.5, 50% CNS MIC ≥2.No loading dose was administered. Initial dosage was appropriate in 31.8%; 68.2% was under dosed.The first PC was obtained after 3 days (IR=2.25); 50% were delayed beyond the third dose and 42% were subtherapeutic. TL were obtained after 5 days (IR=4). Pharmacokinetically guided dosing showed 72.7% of patients achieved TL (18.2% above; 9% under range).Clinical cure rate was 77.3%. By indication: 100% bacteraemia, urinary and non-pneumonia respiratory infections were cured; 80% skin/soft tissues; 75% intra-abdominal; 66.6% catheter; 50% pneumonia; and 50% without focus. By microorganism: 87.5% CNS; 66.7% E faecium; and 66.7% MRSA. There was no statistically significant difference in clinical cure related to PC or AUC/MIC although there was a tendency to higher PC in the cure group (16.7 µg/mL vs 12.13 µg/mL). 9.1% of patients developed nephrotoxicity.ConclusionAlthough most treatments were pharmacokinetically monitored, the first level was delayed in half of the patients; 68.2% of treatments were initially under dosed. This led to delay in achieving TL. A relationship was not found between clinical cure and PC or AUC/MIC, probably due to the small sample size.No conflict of interest.

BackgroundThe main objective of antiretroviral therapy (ART) is to maintain undetectable viral load (VL) and preserve immune function. But nowadays reduction in morbidity and improvements in patient quality of life appear to be as important therapy goals, encouraging clinicians to change ART although VL and immune function are controlled.PurposeThe aim of our study was to assess the reasons for ART switches in patients with effective previous treatment (undetectable VL) and to analyse if these switches had been done according to the GESIDA (Grupo de Estudio del SIDA, AIDS Study Group) 2015 guidelines.Material and methodsAn observational retrospective study was carried out from June 2014 to January 2015. All patients with ART during this period were included, and patients who underwent treatment switching were analysed. Previous and actual treatments, pre-switch VL, and reasons for the switch were recorder in a database. Pregnant patients and those with detectable VL were excluded from the final analysis in relation to its adaptation to the GESIDA 2015 guideline recommendations.Results781 patients were included. 120 treatments were switched (15.4): 103 patients had undetectable VL, 13 patients had detectable VL and 4 patients were pregnant. The reasons for switching in patients with undetectable VL are shown in table 1.Abstract CP-150 Table 1Reasons for switching in patients with undetectable VL (n = 103)Side effects (56%):· Gastrointestinal disorders 26% · Impaired renal function 24%· Metabolic disorders 21% · Neurologic disorders 21% · Skin reactions 5%· Osteopenia 3%Simplification (23%):· Minor number of tablets 56%· Improve adherence 44%Relevant interactions 8%New comorbidities appearance 3%Changes in patients’ lifestyle 2%Improve immune response 2%Unknown reason 6%Analysing our clinicians reasons for switching according to the GESIDA recommendations (excluding unknown reasons), we found that 32% of switches had no defined level of evidence; 17% had a level of evidence BII; 2% BI; 10% AIII; 20% AII; and 19% AI.ConclusionThe main reason for ART switching in patients with undetectable VL was side effects. Nearly one-third of all switches did not correspond to any level of evidence, according to the GESIDA 2015 guidelines. Among the switches that followed the recommendation, 71% had a level of evidence of A.No conflict of interest.