Efecto de la inadecuación de la antibioterapia en Urgencias sobre la eficiencia en la hospitalización

Castillo, Juan González-Del; Domínguez-Bernal, Clara; Gutiérrez-Martín, María Cristina; Núñez-Orantos, María José; Candel, Francisco Javier; Martín‐Sánchez, Francisco Javier

doi:10.1016/j.eimc.2015.10.005

Cited by 17 publications

(5 citation statements)

References 15 publications

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“…This disparity in criteria between primary and emergency care may weaken the doctor-patient relationship still further. To prevent this, antibiotic optimisation programmes should be extended to the emergency services, using the same criteria as in primary care [39][40][41]. (2) Another alternative is to resort to the use of the home medicine cabinet or their trusted pharmacy to obtain antibiotics without prescription.…”

Section: Plos Onementioning

confidence: 99%

Factors determining antibiotic use in the general population: A qualitative study in Spain

et al. 2021

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Background Antibiotic resistance is an important Public Health problem and many studies link it to antibiotic misuse. The population plays a key role in such misuse. Objective The aim of this study was thus to explore the factors that might influence antibiotic use and resistance in the general population. Methods Qualitative research using the focus group (FG) method. Groups were formed by reference to the following criteria: age (over and under 65 years); place of origin; and educational/professional qualifications. FG sessions were recorded, transcribed and then separately analysed by two researchers working independently. Written informed consent was obtained from all participants. Results Eleven FGs were formed with a total of 75 participants. The principal factors identified as possible determinants of antibiotic misuse were: (i) lack of knowledge about antibiotics; (ii) doctor-patient relationship problems; (iii) problems of adherence; and, (iv) use without medical prescription. Antibiotic resistance is a phenomenon unknown to the population and is perceived as an individual problem, with the term “resistance” being confused with “tolerance”. None of the groups reported that information about resistance had been disseminated by the health care sector. Conclusions The public is unaware of the important role it plays in the advance of antimicrobial resistance. There is evidence of diverse factors, many of them modifiable, which might account for antibiotic misuse. Better understanding these factors could be useful in drawing up specific strategies aimed at improving antibiotic use.

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Section: Plos Onementioning

confidence: 99%

Factors determining antibiotic use in the general population: A qualitative study in Spain

et al. 2021

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“…En referencia a la microbiología, el microorganismo causal se buscó en 1 de cada 4 pacientes lográndose identificar en el 23% de los casos; lo que supone una rentabilidad inferior a la reportada por Sainz-Rodríguez et al (46,5%) [15]. Por otro lado, es de destacar que nuestra tasa de antibioticoterapia inapropiada se aproximó al 20%, inferior al 80% reportado por Fernández-Urrusuno et al [16] y superior al 11,2% reportado por González-del Castillo et al [17]. La diferencia entre los 3 estudios realizados en nuestro medio podría radicar en la metodología aplicada; específicamente, Fernández-Urrusuno et al [16] consideraron en su análisis 668 pacientes con entidades que no requieren antibióticos o no había registro de la infección por lo cual se podría haber magnificado la proporción.…”

Section: Discussionunclassified

“…La diferencia entre los 3 estudios realizados en nuestro medio podría radicar en la metodología aplicada; específicamente, Fernández-Urrusuno et al [16] consideraron en su análisis 668 pacientes con entidades que no requieren antibióticos o no había registro de la infección por lo cual se podría haber magnificado la proporción. Contrariamente, González del Castillo et al [17] asumieron que la antibioterapia fue apropiada en los 217 pacientes que tuvieron cultivos negativos (comunicación personal del autor) lo que podría haber infravalorado la proporción. Nuestra proporción también podría estar infravalorada dado que no consideramos la dosis, ni la duración del tratamiento, ni la sensibilidad in vitro del microorganismo.…”

Section: Discussionunclassified

Development of a predictive model for hospital mortality and re-admission in a cohort of infected patients that require hospitalization

Villanueva¹,

Montes-Andujar²,

Baez-Pravia³

et al. 2020

Rev Esp Quimioter

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Introduction. The aims of the study were: to develop a predictive model for hospital mortality and another for hospital re-admission, to identify the impact of antibiotic delay in the mortality rate and, to report the rate of inappropriate antibiotic therapy. Material and methods. A cohort and retrospective study was conducted at the HM Sanchinarro University Hospital during the period September 1st, 2012 to March 31th, 2013. The inclusion criteria were: age> 18 years, hospital admission from the ED with a diagnosis of bacterial infection. The exclusion criteria were: suspected viral infection, negative bacteriological cultures, life expectancy less than 6 months, lack of clinical information, assistance exclusively by the trauma emergency department. Two logistic models were made (hospital mortality and hospital re-admission). Results. A total of 517 patients were included. The final mortality model (30 deaths) include the following variables: respiratory rate (OR 1.12; IC95% 1.02; 1.22), oxygen saturation (OR 0.92; IC95% 0.87; 0.98), creatinine (OR 2.33; IC95% 1.62; 3.36), COPD (OR 3.02; IC95% 1.06; 8.21), cancer (OR 3.34; IC95% 1.07; 9.98) and chemotherapy in the last 3 months (OR 4.83; IC95% 1.54; 16.41). The final model for hospital re-admission (28 re-admissions) include the following variables: hepatopathy (OR 5.51; IC95% 1.57; 16.88), GPT (OR 1.005; IC95% 1.003; 1.008), history of stroke (OR 5.06; IC95% 1.04; 18.80) and arterial hypertension (OR 3.15; IC95% 1.38; 7.56). The antibiotic therapy delays not influenced the mortality or re-admission rate. In 24.3% the causative microorganism was identified and antibiotic treatment was inappropriate 19.6%. Conclusion. Hospital mortality rate was 5.8% and readmission rate was 5.7%. Variables associated with mortality differ from those associated with re-admission. The delay in the antibiotic initiation was not associated with a deleterious effect. Antibiotic therapy was inadequate in almost 20% of patients.

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“…Existen estudios que han comprobado que el uso de antimicrobianos es inadecuado hasta en el 50% de los casos 3 . Este aspecto es relevante ya que dicha inadecuación se ha correlacionado con un peor pronóstico en el paciente infectado, una mayor estancia hospitalaria, un mayor coste económico, un incremento de ingresos en unidades de cuidados intensivos (UCI) y una mayor selección de microorganismos resistentes 2,4 . El pronósti-co del paciente séptico está marcado por el tiempo hasta la instauración de la antibioterapia 5 y por la prescripción adecuada desde el primer momento de atención 6 .…”

Section: Introductionunclassified

“…En pacientes con disfunción orgánica y shock séptico el retraso en el inicio del tratamiento antimicrobiano se correlaciona con una mayor mortalidad 5 . En pacientes sin sepsis un tratamiento inapropiado conlleva un aumento de la estancia media, lo cual incrementará el gasto sanitario 4 . A pesar de los grandes avances en lo referente a los procesos diagnósticos, la monitorización y la antibioterapia 7,8 , existen situaciones en las que el tratamiento antibiótico puede fracasar.…”

Section: Introductionunclassified

Factors predicting failure in empirical antibiotic treatment

García-Lamberechts

Castillo

Hormigo-Sánchez

et al. 2017

An Sist Sanit Navar

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resuMenLas infecciones constituyen uno de las principales causas de morbimortalidad en la población. La elección del tratamiento empírico es una de las decisiones más habituales para cualquier médico responsable de su atención. Además, esta primera decisión puede tener consecuencias en cuanto al pronóstico del paciente o provocar un incremento de los costes asociados al proceso. Esta revisión intenta resumir cuáles son los aspectos que pueden provocar el fracaso al tratamiento antibiótico considerando aspectos microbiológicos, farmacológicos, del perfil del paciente y del control del foco infeccioso. Además, se establecen una serie de recomendaciones para minimizar este riesgo, desde el punto de vista de la precisión diagnóstica del foco y de la etiología, la estratificación adecuada de la gravedad del paciente, el conocimiento de los aspectos farmacocinéticos y farmacodinámicos de los antibióticos y el control, quirúrgico o mediante radiología intervencionista, del foco infeccioso.Palabras clave: Antibiótico. Adecuación. Tratamiento inapropiado. Infección. Urgencias. AbstrACtInfections are one of the main causes of morbidity and mortality in the population. The choice of empirical treatment is one of the most common decisions facing the physician. This first decision has consequences in the prognosis of the patient and the costs associated with the process. This review attempts to summarize the aspects that can lead to failure of antibiotic treatment by considering microbiological and pharmacological aspects, patient profile and infectious focus control. In addition, a series of recommendations are established to minimize this risk, from the point of view of diagnostic accuracy, adequate severity stratification of the patient, knowledge of the pharmacokinetic and pharmacodynamic aspects of antibiotics and control of the infectious focus.

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Efecto de la inadecuación de la antibioterapia en Urgencias sobre la eficiencia en la hospitalización

Cited by 17 publications

References 15 publications

Factors determining antibiotic use in the general population: A qualitative study in Spain

Factors determining antibiotic use in the general population: A qualitative study in Spain

Development of a predictive model for hospital mortality and re-admission in a cohort of infected patients that require hospitalization

Factors predicting failure in empirical antibiotic treatment

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