1
|
Ahmad T, Khan FU, Ali S, Rahman AU, Ali Khan S. Assessment of without prescription antibiotic dispensing at community pharmacies in Hazara Division, Pakistan: A simulated client's study. PLoS One 2022; 17:e0263756. [PMID: 35176043 PMCID: PMC8853528 DOI: 10.1371/journal.pone.0263756] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/25/2022] [Indexed: 12/30/2022] Open
Abstract
Antibiotics dispensing without a prescription is an irrational practice and can increase the risk of antibiotic resistance, which is a significant public health concern around the globe. This study was aimed to determine the extent to which antibiotics are supplied without prescription in the community pharmacies (CPs) at Hazara Division from November 2020 to February 2021. The simulated client method (SCM) was used, and the data were gathered, recorded, and analyzed through different statistical methods with descriptive and inferential techniques. The antibiotic dispensing was observed in CPs (90.5%), the most dispensed antibiotics were azithromycin (29.4%) and ciprofloxacin (46.5%) respectively. Furthermore, visited medical stores/ drug outlets, 9.5% of the visited stores denied dispensing of antibiotics because they preferred a referral to visit physicians (23. 9%) and (12.8%) did not had the antibiotics at the time of visits. Antibiotics were more obtainable in retail medical stores (AOR = 8.6, 95 percent Cl: 3.0–24.7; p = 0.001) than in pharmacies. In rural areas antibiotics dispensing was more (p = 0.004) as compared to urban areas. Staff members also had asked about patient’s (17.7%) symptoms and drug allergies (12.3% and 3.9%), and (1.5%) they consoled them about their medications. The findings of this study indicate that nonprescription antibiotic sales are very common, despite national rules prohibiting this activity. When the simulated Client requested for any medication to relieve his or her discomfort, many antibiotics were given out without a prescription. Pharmacies/medical stores in Hazara Division selling antibiotics without a prescription are worrying and need immediate action by regulators.
Collapse
Affiliation(s)
- Tawseef Ahmad
- Department of Pharmacy, COMSATS University Islamabad-Abbottabad Campus, Abbottabad, Pakistan
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
| | - Sayyad Ali
- Department of Pharmacy, COMSATS University Islamabad-Abbottabad Campus, Abbottabad, Pakistan
| | - Asad Ur Rahman
- Department of Pharmacy, COMSATS University Islamabad-Abbottabad Campus, Abbottabad, Pakistan
| | - Shujaat Ali Khan
- Department of Pharmacy, COMSATS University Islamabad-Abbottabad Campus, Abbottabad, Pakistan
- * E-mail: ,
| |
Collapse
|
2
|
Clar J, Oltra MR, Benavent R, Pinto C, Ruiz A, Sanchez MT, Noceda J, Redon J, Forner MJ. Prognostic value of diagnostic scales in community-acquired sepsis mortality at an emergency service. Prognosis in community-adquired sepsis. BMC Emerg Med 2021; 21:161. [PMID: 34922448 PMCID: PMC8684687 DOI: 10.1186/s12873-021-00532-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 09/30/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives To asses the prognostic value of diagnostic scales in mortality of community-adquired sepsis and added value of additional parameters. Methods Prospective observational study of patients with community-adquired sepsis in the Emergency Room of University Hospital. The study population were patients presented in the Emergency Room with confirmed infection and practicians sepsis diagnosis. Demographics, triage vital signs, inhaled oxygen fraction, inflammatory markers, biochemistry, all-cause mortality during hospitalization and three months after were recorded. Prognostic value of qSOFA, NEWS, SOFA, SIRS, and amplified scales were calculated by using logistic regression and ROC curves. Results 201 patients, 54% male, average age 77±11,2 years were included. Sixty-three (31.5%) died during hospitalization and 24 (12%) three months after discharge. At the time of admission vital signs related with in-hospital mortality were Glasgow Coma Scale <13, respiratory rate ≥22 bpm, temperature, oxygen desaturation, high flow oxygen therapy and heart rate. Patients dead in-hospital had lower PaCO2, higher lactate, glucose and creatinine. Greater predictive capacity of the scales, from higher to lower, was: qSOFA, NEWS2, SOFA and SIRS. Amplified scales with lactate >2mg/dl, glucose, blood level >190mg/dl and PaCO2 <35mmHg improved predictive value. Conclusion Amplified-qSOFA and amplified-NEWS2 scales at Emergency Department may offer a better prognostic of septic patients mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00532-1.
Collapse
Affiliation(s)
- Jorge Clar
- Clinic Hospital. University of Valencia, 46010, València, Spain
| | | | - Raquel Benavent
- Clinic Hospital. University of Valencia, 46010, València, Spain
| | - Carolina Pinto
- Clinic Hospital. University of Valencia, 46010, València, Spain
| | - Adrian Ruiz
- Clinic Hospital. University of Valencia, 46010, València, Spain
| | | | - Jose Noceda
- Clinic Hospital. University of Valencia, 46010, València, Spain
| | - Josep Redon
- Clinic Hospital. University of Valencia, 46010, València, Spain. .,INCLIVA Research Institute, 46010, Valencia, Spain. .,CIBERObn, Institute of Health Carlos III, Madrid, Spain.
| | | |
Collapse
|
3
|
Zhou W, Zhou W, Bai J, Ma S, Liu Q, Ma X. TEG in the monitoring of coagulation changes in patients with sepsis and the clinical significance. Exp Ther Med 2019; 17:3373-3382. [PMID: 30988714 PMCID: PMC6447775 DOI: 10.3892/etm.2019.7342] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022] Open
Abstract
Application values of thromboelastography (TEG) in dynamic monitoring of coagulation parameters of sepsis patients were investigated. Eighty-one patients with sepsis who were admitted to the ICU department of the General Hospital of Ningxia Medical University from April 1, 2015 to December 31, 2015 were collected. Clinical data of the patients were collected. Data were compared using 5 grouping methods: i) the 81 patients were divided into the sepsis group (n=45) and sepsis shock group (n=36); ii) patients were divided into two groups: group A (APACHE II score ≤13, n=51); group B (APACHE II score >13, n=30); iii) according to Disseminated Intravascular Coagulation Diagnosis Integral System (CDSS), patients were divided into non-disseminated intravascular coagulation (DIC) group (CDSS <7 points) and DIC group (CDSS ≥7 points); TEG indexes were compared between the two groups; iv) correlation between TEG indexes and Sequential Organ Failure Assessment (SOFA) scores was analyzed; v) patients were divided into survival group and non-survival group and correlations between TEG indicators and prognosis were analyzed. At 6 h after ICU entry, compared with sepsis group, R value and K time were significantly increased, LY30 was also increased, while MA value, coagulation index (CI), and α angle were significantly decreased in the septic shock group (P<0.05). At 6 h after ICU entry, compared with sepsis group, R value and K time were significantly increased, while MA value, CI, and α angle were significantly decreased in the septic shock group (P<0.05). Compared with the non-DIC group, the DIC group had prolonged K time, decreased α angle, increased R value, and decreased CI and MA value (P<0.05). With increase of SOFA scores, R value and K value increased significantly, and α angle, MA value, and CI decreased significantly (P<0.05). According to TEG, platelet function and fibrinogen function of DIC patients were significantly reduced, and the body showed hypocoagulability.
Collapse
Affiliation(s)
- Wenyan Zhou
- Department of Intensive Care Unit, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Wenjie Zhou
- Department of Intensive Care Unit, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Jijia Bai
- Department of Intensive Care Unit, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Shenmao Ma
- Resident Standardized Training Base, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Qinfu Liu
- Department of Intensive Care Unit, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Xigang Ma
- Department of Intensive Care Unit, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| |
Collapse
|
4
|
Larkin CM, Hante NK, Breen EP, Tomaszewski KA, Eisele S, Radomski MW, Ryan TA, Santos-Martinez MJ. Role of matrix metalloproteinases 2 and 9, toll-like receptor 4 and platelet-leukocyte aggregate formation in sepsis-associated thrombocytopenia. PLoS One 2018; 13:e0196478. [PMID: 29734352 PMCID: PMC5937753 DOI: 10.1371/journal.pone.0196478] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background The development of thrombocytopenia in sepsis is a poor prognostic indicator associated with a significantly increased mortality risk. Mechanisms underlying this phenomenon remain to be clearly elucidated. Matrix metalloproteinases (MMPs) are enzymes that regulate the turnover of the extra-cellular matrix. MMP-2 is recognised as a platelet agonist with MMP-9 proposed as an inhibitor of platelet activation. The existence of MMP-9 in platelets is a subject of debate. There is limited evidence thus far to suggest that toll-like receptor 4 (TLR-4) and platelet-leukocyte aggregate (PLA) formation may be implicated in the development of sepsis-associated thrombocytopenia. Objectives To investigate whether MMP -2/-9, toll-like receptor 4 (TLR-4) or platelet-leukocyte aggregate (PLA) formation are implicated in a decline in platelet numbers during septic shock. Methods This was an observational study which recruited healthy controls, non-thrombocytopenic septic donors and thrombocytopenic septic donors. MMP-2, MMP-9 and TLR-4 platelet surface expression as well as PLA formation was examined using flow cytometry. In addition MMP-2 and MMP-9 were examined by gelatin zymography and enzyme-linked immunosorbent assay (ELISA) using a 3 compartment model (plasma, intraplatelet and platelet membrane). Results There was no difference found in MMP-2, MMP-9 or TLR-4 levels between non-thrombocytopenic and thrombocytopenic septic donors. PLA formation was increased in thrombocytopenic patients. MMP-9 was detected in platelets using flow cytometry, gelatin zymography and ELISA techniques. Conclusions Platelet consumption into PLAs may account for the development of thrombocytopenia in septic shock. MMP-9 is found in platelets and it is upregulated during septic shock.
Collapse
Affiliation(s)
- Caroline M. Larkin
- Department of Anaesthesia and Intensive Care Medicine, St James’s Hospital, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Nadhim Kamil Hante
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- College of Pharmacy, University of Kufa, Najaf, Iraq
| | - Eamon P. Breen
- Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Krzysztof A. Tomaszewski
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Simon Eisele
- Department of Pharmacy, Ludwig Maximilian University, Munich, Germany
| | - Marek W. Radomski
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- School of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Thomas A. Ryan
- Department of Anaesthesia and Intensive Care Medicine, St James’s Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Maria-Jose Santos-Martinez
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
5
|
Herrán-Monge R, Muriel-Bombín A, García-García MM, Merino-García PA, Martínez-Barrios M, Andaluz D, Ballesteros JC, Domínguez-Berrot AM, Moradillo-Gonzalez S, Macías S, Álvarez-Martínez B, Fernández-Calavia MJ, Tarancón C, Villar J, Blanco J. Epidemiology and Changes in Mortality of Sepsis After the Implementation of Surviving Sepsis Campaign Guidelines. J Intensive Care Med 2017. [PMID: 28651474 DOI: 10.1177/0885066617711882] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine the epidemiology and outcome of severe sepsis and septic shock after 9 years of the implementation of the Surviving Sepsis Campaign (SSC) and to build a mortality prediction model. METHODS This is a prospective, multicenter, observational study performed during a 5-month period in 2011 in a network of 11 intensive care units (ICUs). We compared our findings with those obtained in the same ICUs in a study conducted in 2002. RESULTS The current cohort included 262 episodes of severe sepsis and/or septic shock, and the 2002 cohort included 324. The prevalence was 14% (95% confidence interval: 12.5-15.7) with no differences to 2002. The population-based incidence was 31 cases/100 000 inhabitants/year. Patients in 2011 had a significantly lower Acute Physiology and Chronic Health Evaluation II (APACHE II; 21.9 ± 6.6 vs 25.5 ± 7.07), Logistic Organ Dysfunction Score (5.6 ± 3.2 vs 6.3 ± 3.6), and Sequential Organ Failure Assessment (SOFA) scores on day 1 (8 ± 3.5 vs 9.6 ± 3.7; P < .01). The main source of infection was intraabdominal (32.5%) although microbiologic isolation was possible in 56.7% of cases. The 2011 cohort had a marked reduction in 48-hour (7% vs 14.8%), ICU (27.2% vs 48.2%), and in-hospital (36.7% vs 54.3%) mortalities. Most relevant factors associated with death were APACHE II score, age, previous immunosuppression and liver insufficiency, alcoholism, nosocomial infection, and Delta SOFA score. CONCLUSION Although the incidence of sepsis/septic shock remained unchanged during a 10-year period, the implementation of the SSC guidelines resulted in a marked decrease in the overall mortality. The lower severity of patients on ICU admission and the reduced early mortality suggest an improvement in early diagnosis, better initial management, and earlier antibiotic treatment.
Collapse
Affiliation(s)
- Rubén Herrán-Monge
- 1 Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | | | | | - David Andaluz
- 3 Intensive Care Unit, Hospital Clínico Universitario, Valladolid, Spain
| | | | | | | | - Santiago Macías
- 7 Intensive Care Unit, Hospital General de Segovia, Segovia, Spain
| | | | | | | | - Jesús Villar
- 11 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,12 Multidisciplinary Organ Dysfunction Evaluation Research Network (MODERN), Hospital Universitario Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - Jesús Blanco
- 1 Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain.,11 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
6
|
Ruiz-Ramos J, Frasquet J, Romá E, Poveda-Andres JL, Salavert-Leti M, Castellanos A, Ramirez P. Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units. J Med Econ 2017; 20:652-659. [PMID: 28345481 DOI: 10.1080/13696998.2017.1311903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. MATERIALS AND METHODS A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. RESULTS In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG. LIMITATIONS Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided. CONCLUSIONS Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.
Collapse
Affiliation(s)
- Jesus Ruiz-Ramos
- a Intensive Care Unit , Hospital Universitario y Politecnico La Fe , Valencia , Spain
| | - Juan Frasquet
- b Microbiology Department , Hospital Universitario y Politecnico La Fe , Valencia , Spain
| | - Eva Romá
- c Pharmacy Department , Hospital Universitario y Politecnico La Fe , Valencia , Spain
| | | | - Miguel Salavert-Leti
- d Infectious Disease Unit , Hospital Universitario y Politecnico La Fe , Valencia , Spain
| | - Alvaro Castellanos
- a Intensive Care Unit , Hospital Universitario y Politecnico La Fe , Valencia , Spain
| | - Paula Ramirez
- a Intensive Care Unit , Hospital Universitario y Politecnico La Fe , Valencia , Spain
| |
Collapse
|
7
|
Trends in hospitalizations of patients with sepsis and factors associated with inpatient mortality in the Region of Madrid, 2003–2011. Eur J Clin Microbiol Infect Dis 2013; 33:411-21. [DOI: 10.1007/s10096-013-1971-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/28/2013] [Indexed: 11/25/2022]
|
8
|
Hernández-Palazón J, Fuentes-García D, Burguillos-López S, Domenech-Asensi P, Sansano-Sánchez TV, Acosta-Villegas F. [Analysis of organ failure and mortality in sepsis due to secondary peritonitis]. Med Intensiva 2012; 37:461-7. [PMID: 23044280 DOI: 10.1016/j.medin.2012.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/17/2012] [Accepted: 07/27/2012] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To identify the organs most susceptible to develop multiorgan dysfunction syndrome (MODS) in patients with sepsis due to secondary peritonitis, and to determine the outcome and mortality predicting utility of the SOFA (Sequential Organ Failure Assessment) system. DESIGN A prospective, observational cohort study was made. SETTING The resuscitation unit of a third-level university hospital. PATIENTS A prospective, observational cohort study was made of 102 patients with sepsis of abdominal origin and failure of at least one organ related to the infection. The demographic characteristics were documented, along with the abdominal origin of sepsis, mortality after 28 days, and the daily SOFA score. RESULTS The mortality rate after 28 days was 55%. A total of 53% of the patients presented failure of two or more organs on the first day of admission. The mean daily SOFA score was significantly higher among the patients that died after day 4 of admission. The variables showing a statistically significant correlation to increased mortality were: MODS (P=.000), central nervous system failure (P=.000) and SOFA score on day 4 of admission (P=.012). The area under the ROC curve showed the mortality predicting capacity of the SOFA score on day 4 of admission to be 0.703 (95%CI 0.538-0.853; P=.026). The maximum discriminating capacity was recorded for MODS, with an area under the ROC curve of 0.776 (95%CI 0.678-0.874; P=.000). CONCLUSIONS Organ failure outcome as predicted by the SOFA score showed high precision - the mean SOFA score on day 4 of admission being a good mortality predictor. MODS was the main cause of death, while central nervous system, renal and respiratory failure were identified as the mortality risk factors.
Collapse
Affiliation(s)
- J Hernández-Palazón
- Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
| | | | | | | | | | | |
Collapse
|
9
|
Sepsis grave y shock séptico: Todo hecho, todo por hacer. Med Intensiva 2012; 36:245-6. [DOI: 10.1016/j.medin.2012.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/16/2012] [Indexed: 11/24/2022]
|