1
|
Orsatti VN, Ribeiro VST, de Oliveira Montenegro C, Costa CJ, Raboni EA, Sampaio ER, Michielin F, Gasparetto J, Telles JP, Tuon FF. Sepsis death risk factor score based on systemic inflammatory response syndrome, quick sequential organ failure assessment, and comorbidities. Med Intensiva 2024; 48:263-271. [PMID: 38575400 DOI: 10.1016/j.medine.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE In this study, we aimed to evaluate the death risk factors of patients included in the sepsis protocol bundle, using clinical data from qSOFA, SIRS, and comorbidities, as well as development of a mortality risk score. DESIGN This retrospective cohort study was conducted between 2016 and 2021. SETTING Two university hospitals in Brazil. PARTICIPANTS Patients with sepsis. INTERVENTIONS Several clinical and laboratory data were collected focused on SIRS, qSOFA, and comorbidities. MAIN VARIABLE OF INTEREST In-hospital mortality was the primary outcome variable. A mortality risk score was developed after logistic regression analysis. RESULTS A total of 1,808 patients were included with a death rate of 36%. Ten variables remained independent factors related to death in multivariate analysis: temperature ≥38 °C (odds ratio [OR] = 0.65), previous sepsis (OR = 1.42), qSOFA ≥ 2 (OR = 1.43), leukocytes >12,000 or <4,000 cells/mm3 (OR = 1.61), encephalic vascular accident (OR = 1.88), age >60 years (OR = 1.93), cancer (OR = 2.2), length of hospital stay before sepsis >7 days (OR = 2.22,), dialysis (OR = 2.51), and cirrhosis (OR = 3.97). Considering the equation of the binary regression logistic analysis, the score presented an area under curve of 0.668, is not a potential model for death prediction. CONCLUSIONS Several risk factors are independently associated with mortality, allowing the development of a prediction score based on qSOFA, SIRS, and comorbidities data, however, the performance of this score is low.
Collapse
Affiliation(s)
- Vinicius Nakad Orsatti
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Victoria Stadler Tasca Ribeiro
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Carolina de Oliveira Montenegro
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Clarice Juski Costa
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Eduardo Albanske Raboni
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Eduardo Ramos Sampaio
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Fernando Michielin
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Juliano Gasparetto
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - João Paulo Telles
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil.
| |
Collapse
|
2
|
Rocha JLL, Riediger I, Gasparetto J, Tuon FF. COVID-19 in real world: Survival and medical costs of hospitalized patients in Brazil´s first wave. Braz J Infect Dis 2023; 27:102778. [PMID: 37209711 PMCID: PMC10183623 DOI: 10.1016/j.bjid.2023.102778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/01/2023] [Accepted: 05/04/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVE To evaluate survival and direct medical costs of patients admitted in private hospitals with COVID-19 during the first wave. METHODS A retrospective, observational study analyzing survival and the economic data retrieved on hospitalized patients with COVID-19. Data from March 2020 to December 2020. The direct cost of hospitalization was estimated using the microcosting method with each individual hospitalization. RESULTS 342 cases were evaluated. Median age of 61.0 (95% CI 57.0‒65.0). 194 (56.7%) were men. The mortality rate was higher in the female sex (p = 0.0037), ICU (p < 0.001), mechanical ventilation (p<0.001) and elderly groups. 143 (41.8%) patients were admitted to the ICU (95% CI 36.6%-47.1%), of which 60 (41.9%) required MV (95% CI 34.0%-50.0%). Global LOS presented median of 6.7 days (95% CI 6.0-7.2). Mean costs were US$ 7,060,00 (95% CI 5,300.94-8,819,00) for each patient. Mean cost for patients discharged alive and patients deceased was US$ 5,475.53 (95% CI 3,692.91-7,258.14) and US$ 12,955.19 (95% CI 8,106.61-17,803.76), respectively (p < 0.001). CONCLUSIONS Patients admitted with COVID-19 in these private hospitals point to great economic impact, mainly in the elderly and high-risk patients. It is key to better understand such costs in order to be prepared to make wise decisions during the current and future global health emergencies.
Collapse
Affiliation(s)
- Jaime Luís Lopes Rocha
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil
| | - Irina Riediger
- Laboratório Central do Estado do Paraná, São José dos Pinhais, PR, Brazil
| | - Juliano Gasparetto
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil
| | - Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil.
| |
Collapse
|
3
|
Lenci Marques G, De Franca AC, Saito AC, Hornung FL, Motter AC, Falzoni Pontello AC, Fontana H, Gasparetto J, Zequinão T. Clinical Outcomes and Costs of Rivaroxaban for Thromboprophylaxis in Acutely Ill Medical Inpatients: A Cross-Sectional Study. Cureus 2021; 13:e15497. [PMID: 34268028 PMCID: PMC8262521 DOI: 10.7759/cureus.15497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Venous thromboembolism (VTE) is the primary cause of preventable death in hospitalized patients in the United States. This is a cross-sectional study with a brief cost analysis of thromboprophylaxis with rivaroxaban and enoxaparin in acutely ill medical inpatients. Methods: The study included a total of 122 patients admitted to a public teaching hospital from December 2019 to January 2021. The sample was equally divided into two groups according to the thromboprophylactic agent prescribed: rivaroxaban or enoxaparin. The primary outcomes included bleeding and symptomatic, ultrasonography-confirmed arterial or venous thrombotic events during or within 90 days after hospitalization. Our secondary outcome was the direct costs of each anticoagulant in US dollars over the 14 months. Results: During hospitalization, two events were detected in the enoxaparin group: minor bleeding with minimum intervention required (1.6%) and a deep vein thrombosis (DVT) case (1.6%) confirmed by ultrasonography. Within 90 days after discharge, two patients, one of each sample (1.6% vs. 1.6%), were readmitted due to confirmed acute arterial occlusion. Concerning financial assessment, the mean unit cost of enoxaparin during the 14 months assessed was 102.14% more expensive than rivaroxaban. Conclusions: Both rivaroxaban and enoxaparin showed equivalence in effectiveness and safety in thromboprophylaxis in medical inpatients, aside from possible financial benefit with the first-mentioned drug.
Collapse
Affiliation(s)
| | | | - Ana Carolina Saito
- Internal Medicine, Pontifical Catholic University of Parana, Curitiba, BRA
| | - Fabiana L Hornung
- Internal Medicine, Pontifical Catholic University of Parana, Curitiba, BRA
| | | | | | - Helena Fontana
- Internal Medicine, Pontifical Catholic University of Parana, Curitiba, BRA
| | - Juliano Gasparetto
- Internal Medicine, Pontifical Catholic University of Parana, Curitiba, BRA
| | - Tiago Zequinão
- Internal Medicine, Pontifical Catholic University of Parana, Curitiba, BRA
| |
Collapse
|
4
|
Zequinão T, Telles JP, Gasparetto J, Tuon FF. Carbapenem stewardship with ertapenem and antimicrobial resistance-a scoping review. Rev Soc Bras Med Trop 2020; 53:e20200413. [PMID: 33174959 PMCID: PMC7670755 DOI: 10.1590/0037-8682-0413-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/24/2020] [Indexed: 11/25/2022] Open
Abstract
Consumption of carbapenem has increased due to extended-spectrum
beta-lactamase-producing bacteria spreading. Ertapenem has been suggested as a
not carbapenem-resistance inducer. We performed a scoping review of
carbapenem-sparing stewardship with ertapenem and its impact on the antibiotic
resistance of Gram-negative bacilli. We searched PubMed for studies that used
ertapenem as a strategy to reduce resistance to carbapenems and included
epidemiologic studies with this strategy to evaluate susceptibility patterns to
cephalosporins, quinolones, and carbapenems in Gram-negative-bacilli. The search
period included only studies in English, up to February 2018. From 1294
articles, 12 studies were included, mostly from the Americas.
Enterobacteriaceae resistance to quinolones and
cephalosporins was evaluated in 6 studies and carbapenem resistance in 4
studies. Group 2 carbapenem (imipenem/meropenem/doripenem) resistance on
A. baumannii was evaluated in 6
studies. All studies evaluated P.
aeruginosa resistance to Group 2 carbapenem. Resistance profiles of
Enterobacteriaceae and P. aeruginosa to
Group 2 carbapenems were not associated with ertapenem consumption. The
resistance rate of A. baumannii to Group 2 carbapenems after
ertapenem introduction was not clear due to a lack of studies without bias. In
summary, ertapenem as a strategy to spare use of Group 2 carbapenems may be an
option to stewardship programs without increasing resistance of
Enterobacteriaceae and P. aeruginosa. More
studies are needed to evaluate the influence of ertapenem on A.
baumannii.
Collapse
Affiliation(s)
- Tiago Zequinão
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brasil
| | - João Paulo Telles
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brasil.,A.C.Camargo Cancer Center, São Paulo, SP, Brasil
| | - Juliano Gasparetto
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brasil
| | - Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brasil
| |
Collapse
|
5
|
Yamada CH, Telles JP, Oliveira DDS, Cieslinski J, Ribeiro VST, Gasparetto J, Tuon FF. Comparison of intermittent versus continuous-infusion vancomycin for treating severe patients in intensive care units. Braz J Infect Dis 2020; 24:356-359. [PMID: 32763234 PMCID: PMC9392078 DOI: 10.1016/j.bjid.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/21/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose The aim of this study was to compare pharmacokinetic characteristics between intermittent infusion and continuous infusion of vancomycin for critically ill patients admitted to intensive care units. Methods Intermittent therapy was administered for 60 minutes and prescribed as a loading dose of 30 mg/kg and continued with 15 mg/kg q12 h. Continuous infusion was prescribed as a loading dose of 30 mg/kg followed by 30 mg/kg on constant infusion pump. Blood samples from vancomycin intermittent infusion group were collected 1 h before third dose, 1 h, 8 h and 24 h after third dose infusion. Blood samples from vancomycin continuous infusion group were collected 1 h after loading dose, 12 h, 24 h, 36 h, and 48 h after continuous infusion initiation. Results Median serum concentration of continuous infusion group at 24-hour was 23.59 μg/mL [14.52–28.97], while of intermittent infusion group at 23-hour was 12.30 μg/mL [7.27–18.12] and on 25-hour was 17.58 μg/mL [12.5–22.5]. Medians AUC24–48h were 357.2 mg.h/L and 530.2 mg.h/L for intermittent infusion and continuous infusion groups, respectively (p = 0.559). Conclusion Vancomycin CI reached steady state earlier, which guaranteed therapeutic levels from the first day and made it possible to manage therapeutic drug monitoring faster.
Collapse
Affiliation(s)
- Carolina Hikari Yamada
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, Paraná, PR, Brazil
| | - João Paulo Telles
- AC Camargo Cancer Center, São Paulo, SP, Brazil; Hospital Universitário Cajuru, Curitiba, Paraná, PR, Brazil; Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infeccionas Emergentes, Curitiba, PR, Brazil
| | | | - Juliette Cieslinski
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, Paraná, PR, Brazil; Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infeccionas Emergentes, Curitiba, PR, Brazil
| | - Victoria Stadler Tasca Ribeiro
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, Paraná, PR, Brazil; Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infeccionas Emergentes, Curitiba, PR, Brazil
| | - Juliano Gasparetto
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, Paraná, PR, Brazil; Hospital Universitário Cajuru, Curitiba, Paraná, PR, Brazil
| | - Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, Paraná, PR, Brazil; Hospital Universitário Cajuru, Curitiba, Paraná, PR, Brazil; Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Laboratório de Doenças Infeccionas Emergentes, Curitiba, PR, Brazil.
| |
Collapse
|
6
|
Zequinao T, Gasparetto J, Oliveira DDS, Silva GT, Telles JP, Tuon FF. A broad-spectrum beta-lactam-sparing stewardship program in a middle-income country public hospital: antibiotic use and expenditure outcomes and antimicrobial susceptibility profiles. Braz J Infect Dis 2020; 24:221-230. [PMID: 32504551 PMCID: PMC9392143 DOI: 10.1016/j.bjid.2020.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background Antimicrobial stewardship programs are an efficient way to reduce inappropriate use of antimicrobials and costs; however, supporting data are scarce in middle-income countries. The aim of this study was to evaluate antibiotic use, bacterial susceptibility profiles, and the economic impact following implementation of a broad-spectrum beta-lactam-sparing antimicrobial stewardship program. Methods An interrupted time-series analysis was performed to evaluate antibiotic use and expenditure over a 24-month period (12 months before the antimicrobial stewardship program and in the 12 months after implementation of the antimicrobial stewardship program). Antibiotics were classified into one of two groups: beta-lactam antibiotics and beta-lactam-sparing antibiotics. We also compared the antimicrobial susceptibility profiles of key pathogens in each period. Results Beta-lactam antibiotics use decreased by 43.04 days of therapy/1000 patient-days (p = 0.04) immediately following antimicrobial stewardship program implementation, whereas beta-lacta-sparing antibiotics use increased during the intervention period (slope change 6.17 days of therapy/1000 patient-days, p < 0.001). Expenditure decreased by $2089.99 (p < 0.001) immediately after intervention and was maintained at this level over the intervention period ($−38.45; p = 0.24). We also observed that a greater proportion of pathogens were susceptible to cephalosporins and aminoglycosides after the antimicrobial stewardship program. Conclusions The antimicrobial stewardship program significantly reduced the use of broad-spectrum beta-lactam-antibiotics associated with a decrease in expenditure and maintenance of the susceptibility profile in Gram-negative bacteria.
Collapse
Affiliation(s)
- Tiago Zequinao
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Juliano Gasparetto
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | | | - João Paulo Telles
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil; AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
| |
Collapse
|
7
|
Granzotto EM, Gouveia AM, Gasparetto J, Dantas LR, Tuon FF. Depression and anxiety in hospitalized patients on contact precautions for multidrug-resistant microorganisms. Infect Dis Health 2020; 25:133-139. [PMID: 32005585 DOI: 10.1016/j.idh.2020.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/19/2019] [Accepted: 01/05/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Contact precautions for patients with multidrug-resistant organisms (MDROs) have been associated with adverse effects. The aim of this study was, therefore, to evaluate the level of anxiety and depression through different standardized scales in patients isolated by MDROs. METHODS This is a case-control study with hospitalized patients on contact precautions for MDROs. A questionnaire survey was conducted to analyse the presence and level of depression and anxiety. A multivariable analysis was performed to define independent questions for anxiety/depression scores to create a short questionnaire facilitating a practical approach to the care of hospitalized patients with MDROs. A receiver operating characteristic (ROC) curve was plotted to determine the diagnostic ability of the simplified score. RESULTS A total of 141 patients were included in the study, among whom 68 were isolated because of MDRO colonization while 73 were not isolated (control-group). Forty-five (31.9%) patients had some degree of anxiety. Patients in MDRO contact isolation had a higher level of anxiety than those who were not isolated (55.9% vs. 9.6%, p < 0.001). The equation obtained by multivariated analysis allowed for the construction of a score with ROC area of 0.949 and a sensitivity of 91.1%. CONCLUSION Contact isolation for MDROs is associated with increased depression and anxiety. A simple anxiety score was developed and should be validated for screening.
Collapse
Affiliation(s)
| | - Aline Maciel Gouveia
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil
| | - Juliano Gasparetto
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil
| | - Letícia Ramos Dantas
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil
| | - Felipe Francisco Tuon
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil; Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil.
| |
Collapse
|
8
|
Pitta RD, Gasparetto J, De Moraes TP, Telles JP, Tuon FF. Antimicrobial therapy with aminoglycoside or meropenem in the intensive care unit for hospital associated infections and risk factors for acute kidney injury. Eur J Clin Microbiol Infect Dis 2019; 39:723-728. [PMID: 31832808 DOI: 10.1007/s10096-019-03779-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Abstract
There have historically been concerns of acute kidney injury (AKI) with the use of aminoglycosides. The present study aimed to compare the AKI incidence and mortality rate between critically ill patients treated with aminoglycoside or meropenem in the intensive care unit setting using a propensity score matching approach. This cross-sectional study was conducted at two university hospitals from January 2011 to October 2017. Clinical and laboratorial data were evaluated to exclude potential confounders and to calculate the Charlson index. AKI was classified according to the Acute Kidney Injury Network criteria. All tests were two-tailed, and a p value ≤ 0.05 was considered significant in the univariate and multivariate analyses. We included 494 patients, 95 and 399 of whom used meropenem and aminoglycoside, respectively. Patients in the subgroup that used meropenem were matched with controls (aminoglycoside). Among the 494 patients, 120 developed any grade of AKI (24.2%). After propensity score matching, there were no significant differences in AKI incidence and mortality rate between the aminoglycoside and meropenem groups (p = 0.324 and 0.464, respectively). Patients on the aminoglycoside regimen neither presented a higher AKI incidence nor mortality rate when compared with those on the meropenem regimen. Aminoglycosides may be a safe option for the treatment of critically ill patients on carbapenem sparing antimicrobial stewardship programs.
Collapse
Affiliation(s)
- Raphael Donadio Pitta
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Juliano Gasparetto
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Thyago Proença De Moraes
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - João Paulo Telles
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Felipe Francisco Tuon
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.
| |
Collapse
|
9
|
Gasparetto J, Tuon FF, Dos Santos Oliveira D, Zequinao T, Pipolo GR, Ribeiro GV, Benincá PD, Cruz JAW, Moraes TP. Intravenous-to-oral antibiotic switch therapy: a cross-sectional study in critical care units. BMC Infect Dis 2019; 19:650. [PMID: 31331272 PMCID: PMC6647098 DOI: 10.1186/s12879-019-4280-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/11/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the oral switch (OS) stewardship intervention in the intensive care unit (ICU). METHODS This was a retrospective study with a convenience sample in two Brazilian ICUs from different hospitals in patients with sepsis receiving antibiotic therapy. The stewardship intervention included OS in patients diagnosed with sepsis when clinical stability was achieved. The primary outcome was overall mortality. Other variables evaluated were as follows: cost of antimicrobial treatment, daily costs of intensive care, acute kidney injury, and length of stay. RESULTS There was no difference in mortality between the OS and non-OS groups (p = 0.06). Length of stay in the ICU (p = 0.029) was shorter and acute kidney injury incidence (p = 0.032) and costs of antimicrobial therapy (p < 0.001) were lower in the OS group. CONCLUSION OS stewardship programs in the ICU may be considered a safe strategy. Switch therapy reduced the cost and shortened the length of stay in ICUs.
Collapse
Affiliation(s)
- Juliano Gasparetto
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.
| | - Dayana Dos Santos Oliveira
- Laboratory of Emerging Infectious Diseases, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Tiago Zequinao
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | | | - Paola Delai Benincá
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | - Thyago Proenca Moraes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| |
Collapse
|
10
|
Telles JP, Cieslinski J, Gasparetto J, Tuon FF. Efficacy of Ceftriaxone 1 g daily Versus 2 g daily for The Treatment of Community-Acquired Pneumonia: A Systematic Review with Meta-Analysis. Expert Rev Anti Infect Ther 2019; 17:501-510. [PMID: 31179786 DOI: 10.1080/14787210.2019.1627872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Ceftriaxone has been recommended as a first-line treatment for various infections; however, the doses for pneumonia have not been a consensus in randomized clinical trials. To compare ceftriaxone 1 g daily efficacy to other ceftriaxone dosing regimens in community-acquired pneumonia. Area covered: We performed a systematic review and meta-analysis on PubMed, Web of Science, Scopus, and LILACS. Randomized controlled trials of ceftriaxone in community-acquired pneumonia were included. Outcomes included clinical cure in modified intention-to-treatment, clinically and microbiologically evaluable patients. Expert opinion: Ceftriaxone dosages of 1 g daily are as safe and effective as other antibiotic regimens for community-acquired pneumonia. Twenty-four articles fulfilled the inclusion criteria. Twelve studies evaluated ceftriaxone regimens at a dosage of 2 g daily and 12 studies evaluated ceftriaxone at a dosage of 1 g daily. The odds-ratio of clinical cure in the modified intention-to-treatment patients administered either ceftriaxone (4666 patients) or a comparator (4411 patients) was 0.98 (95% CI [0.82-1.17]). Comparator regimens showed similar efficacy to ceftriaxone regimens of 1 g daily, with an odds ratio of 1.03 (95% CI [0.88-1.20]). Dosages higher than ceftriaxone 1 g daily did not result in improved clinical outcomes for community-acquired pneumonia patients (OR 1.02, 95% CI [0.91-1.14]).
Collapse
Affiliation(s)
- João Paulo Telles
- a Department of Infectious Diseases , AC Camargo Cancer Center , São Paulo , Brazil
| | - Juliette Cieslinski
- b Division of Infectious Diseases, School of Medicine , Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Juliano Gasparetto
- b Division of Infectious Diseases, School of Medicine , Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Felipe Francisco Tuon
- b Division of Infectious Diseases, School of Medicine , Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| |
Collapse
|
11
|
Bacal F, Marcondes-Braga FG, Rohde LEP, Xavier Júnior JL, Brito FDS, Moura LAZ, Colafranceschi AS, Lavagnoli CFR, Gelape CL, Almeida DR, Gaiotto FA, Atik FA, Figueira FAMS, Souza GEC, Rodrigues H, Campos IW, Souza Neto JDD, Rossi Neto JM, Gasparetto J, Goldraich LA, Benvenuti LA, Seguro LFBC, Ulhôa Júnior MB, Moreira MDCV, Ávila MS, Carneiro R, Mangini S, Ferreira SMA, Strabelli TM. 3ª Diretriz Brasileira de Transplante Cardíaco. Arq Bras Cardiol 2019; 111:230-289. [PMID: 30335870 DOI: 10.5935/abc.20180153] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fernando Bacal
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | - Cláudio Leo Gelape
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | - Fábio Antônio Gaiotto
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | - Hélcio Rodrigues
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | - Iáscara Wozniak Campos
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luiz Alberto Benvenuti
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | - Mônica Samuel Ávila
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | - Rodrigo Carneiro
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE - Brasil
| | - Sandrigo Mangini
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Tânia Mara Strabelli
- Instituto do Coração Hospital das Clínicas FMUSP (InCor-HCFMUSP), São Paulo, SP - Brasil
| |
Collapse
|
12
|
Abstract
BACKGROUND Polymyxin B and colistin are nephrotoxic drugs used in the treatment of carbapenem-resistant Enterobacteriaceae. The aim of this study is to evaluate the burden of costs due to polymyxin associated AKI and propose a simulated break-even price for new therapies. METHODS The pharmacoeconomic model is based on two large cross-sectional studies of polymyxin nephrotoxicity. Total direct costs in patients with and without renal failure were compared. The direct cost of each hemodialysis section (USD82.94) and daily hospital charges (USD934.85) were based on the values used in a major public hospital in the city where the clinical study was performed. The break-even price of new drugs was simulated considering eventual new drugs as effective as polymyxins, but less nephrotoxic in different percentages. Outcomes of patients after hospital discharge were not evaluated. RESULTS Total direct cost of the group of patients who survived without AKI was significantly lower than total direct cost of the groups either with AKI or the group who died without AKI. There was a tendency of even higher costs in those who died with AKI and dialysis. Direct cost of hemodialysis was not as important as the longer hospitalization after sepsis. Considering daily cost of polymyxin is USD60, drugs with 50% less AKI could be considered cost-beneficial if the daily cost is lower than USD160. CONCLUSIONS AKI in patients with carbapenem-resistant Enterobacteriaceae treated with polymyxin increases both length of stay in hospital and total costs.
Collapse
Affiliation(s)
- Felipe F Tuon
- a School of Medicine , Pontificia Universidade Catolica do Paraná , Curitica , PR , Brazil
- b Division of infectious Diseases , Hospital de Clínicas da UFPR , Curitiba , PR , Brazil
| | - Jaime L Rocha
- a School of Medicine , Pontificia Universidade Catolica do Paraná , Curitica , PR , Brazil
- c Unimed Curitiba , PR , Brazil
| | - Juliano Gasparetto
- a School of Medicine , Pontificia Universidade Catolica do Paraná , Curitica , PR , Brazil
| |
Collapse
|
13
|
Affiliation(s)
- Felipe Francisco Tuon
- Laboratory of Microbiology and Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil,
| | - Rudson Romero
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Juliano Gasparetto
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Juliette Cieslinski
- Laboratory of Microbiology and Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil,
| |
Collapse
|
14
|
Peixoto BC, Contrera GG, Cieslinski J, Gasparetto J, Tuon FF. Acute kidney injury in patients using low dose (3 mg/kg/day) of gentamicin under therapeutic dose monitoring. J Infect 2018; 76:496-498. [DOI: 10.1016/j.jinf.2018.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 11/25/2022]
|
15
|
Tuon FF, Gasparetto J, Wollmann LC, Moraes TPD. Mobile health application to assist doctors in antibiotic prescription – an approach for antibiotic stewardship. Braz J Infect Dis 2017; 21:660-664. [PMID: 28941393 PMCID: PMC9425452 DOI: 10.1016/j.bjid.2017.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 11/19/2022] Open
Abstract
Background Technologies applied to mobile devices can be an important strategy in antibiotic stewardship programs. Objective The aim of this study was to determine the impact of a decision-making application on antibiotic prescription. Methods This was an observational, analytical and longitudinal study on the implementation of an antimicrobial guide for mobile application. This study analyzed the period of 12 months before and 12 months after the app implementation at a university hospital based on local epidemiology, avoiding high cost drugs and reducing the potential for drug resistance including carbapenem. Antimicrobials consumption was evaluated in Daily Defined Dose/1000 patients-day and direct expenses converted into USD. Results The monthly average consumption of aminoglycosides and cefepime had a statistically significant increase (p < 0.05), while the consumption of piperacillin/tazobactam and meropenem was significantly decreased (p < 0.05). The sensitivity to meropenem as well as to polymyxin increased after the app implementation. A decrease in sensitivity to cefepime was observed after introduction of this antibiotic as a substitute of piperacillin/tazobactam for treating intra-hospital infections. There was a net saving of USD 296,485.90 (p < 0.05). Conclusion An antibiotic protocol in the app can help antibiotic stewardship reducing cost, changing the microbiological profile and antimicrobial consumption.
Collapse
Affiliation(s)
- Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Escola de Saúde e Biociências, Departamento de Medicina, Curitiba, PR, Brazil.
| | - Juliano Gasparetto
- Pontifícia Universidade Católica do Paraná, Escola de Saúde e Biociências, Departamento de Medicina, Curitiba, PR, Brazil
| | - Luciana Cristina Wollmann
- Pontifícia Universidade Católica do Paraná, Escola de Saúde e Biociências, Departamento de Medicina, Curitiba, PR, Brazil
| | - Thyago Proença de Moraes
- Pontifícia Universidade Católica do Paraná, Escola de Saúde e Biociências, Departamento de Medicina, Curitiba, PR, Brazil
| |
Collapse
|
16
|
Tuon FF, Aragao BZD, Santos TA, Gasparetto J, Cordova K, Abujamra M. Acute kidney injury in patients using amikacin in an era of carbapenem-resistant bacteria. Infect Dis (Lond) 2016; 48:869-71. [PMID: 27389520 DOI: 10.1080/23744235.2016.1205215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Felipe Francisco Tuon
- a Department of Medicine , School of Health and Biosciences, Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Bruna Zanette de Aragao
- a Department of Medicine , School of Health and Biosciences, Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Thiago Almeida Santos
- a Department of Medicine , School of Health and Biosciences, Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Juliano Gasparetto
- a Department of Medicine , School of Health and Biosciences, Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Kassia Cordova
- b Department of Medicine , Faculdade Evangélica do Paraná , Curitiba , Brazil
| | - Marcela Abujamra
- b Department of Medicine , Faculdade Evangélica do Paraná , Curitiba , Brazil
| |
Collapse
|