The objective of this study was to identify risk factors for bacteremia by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Retrospective casecontrol study performed in a 450-bed acute care academic tertiary hospital in Barcelona, Spain. Cases included 53 patients with ESBL-producing E. coli or K. pneumoniae bacteremia, and 159 controls with non-ESBL-producing E. coli or K. pneumoniae bacteremia. Controls were matched in a 3:1 ratio to case patients according to species of infecting organism, age, and severity of illness in the 24-48h before blood sample collection for culture calculated by the Simplified Acute Physiology Score (SAPS II) system. Previous antimicrobials were more frequently administered to cases than to controls (56.5% vs 17%, p < 0.001). Binary logistic regression showed that the number (> 2) of different families of antimicrobials received within 90 days before bloodstream infection was the only predictor of ESBL-producing E. coli or K. pneumoniae in blood culture (OR = 2.29, 95% CI 1.35-3.88, p = 0.002). Conclusion: Previous use of different families of antimicrobials (more than two) in patients with bloodstream infection caused by E. coli or K. pneumoniae increased the risk for ESBL-producing strains.

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Background Patients with chronic heart failure (CHF) have complex medicines regimens which can frequently be difficult to remember/understand, especially for elderly patients. This fact can be responsible for non-adherence and drug related problems (DRPs) in this population. In our hospital, a post-discharge pharmacist educational interventions system (PEI) has been implemented as a part of a multidisciplinary CHF disease management system with two different modalities of care: telemonitoring or usual care. Purpose To describe patients’ knowledge of the pharmacological treatment for CHF when included in this PEI by using a quantitative scale and to seek a relationship between the degree of knowledge and the CHF patient’s characteristics and the modality of care. Materials and methods Retrospective observational study including all CHF patients attending our PEI from May 2010–2013. Data collected: demographics; New York Heart Association (NYHA) class, modality of care that had been received: telemonitoring (TM) vs. usual care (UC); total no. of drugs (TD); degree of knowledge, no. of comorbidities (NC); self-administration of medicines (SA); self-reported adherence to diet (AD); self-reported adherence to medicines (AM); contraindicated drugs (CID) and DRP. The quantitative knowledge scale calculated the% of their CHF medicines of which the patients knew the dose, frequency and indication (DFI). A good knowledge was considered when a patient knew ≥50% DFI of all their CHF drugs. Statistical test: Chi-Square and Fischer exact test for dichotomous variables and t-test and U-Mann Whitney test for continuous responses. Results Patients: 185 Patient profile: 108 (58.4%) male; mean age: 73.08 (SD 0.839) years; patients/NYHA class 145 (79.2%)/class 1–2, 38 (20.7%)/class 3–4; usual care 139 (75.1%), telemonitoring 46 (24.9%); TD: 8.53 (SD 0.244); NC 3.53 (SD 0.135). Adherence and knowledge. SA: 113 (61.1%); AD: 153 (82.7%); AM: 179 (96.8); knowledge of CFH medicines, mean% drugs with knowledge of DFI: 39.08 (SD 2.694). DRPs: 40 patients (21.6%). Comparison between patients with a good and a poor knowledge: age 71.16 years vs. age 74.6 (p = 0.05); NC: 3.26 vs. 3.74 (p = 0.075); telemonitoring care 27/70 (38.6%) vs. 11/88 (12.5%) (p < 0.001); SA 56/70 (80%) vs. 49/88 (55.7%) (p = 0.001). No other significant differences were observed between the two groups. Conclusions The post-discharge PEI system allowed us to check the degree of knowledge in our CHF patients and also DRPs in almost 25% of them. Older age and a tendency to a more treatment complexity observed in a higher number of comorbidities were the only factors related to a poorer knowledge of the medicines. Telemonitoring as a modality of care increased the knowledge of medicines in these patients and their self-care allowing them to take the medicines by themselves. The use of telemonitoring in our PEI would probably increase patients’ knowledge of their medicines and reduce DRPs. No conflict of interest.