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ABSTRACTS
Materials and methods: This study was implemented through a retrospective cross-sectional study, which included analysis of clinical, microbiological and therapeutic data of patients diagnosed with HA-MRSA infections who were hospitalized in ULSNA, during 2013. In addition, data from patients who underwent empirical therapy for the treatment of HAMRSA infections were also studied, to determine the error rate associated with this therapy. The study protocol was approved by ULSNA’s ethics committee. Results: Two samples were considered: one with 150 patients diagnosed with HA-MRSA and another with 105 patients who underwent empirical therapy for the treatment of suspected HA-MRSA infections. In the first sample, HA-MRSA incidence was 1.8% of all hospitalized patients, while the estimated resistance rate of S. aureus was 90.4%. Noteworthy, prior antibiotic consumption was 46.7% and focused on quinolones, third-generation cephalosporins and penicillins. The most commonly prescribed empirical treatment was PIP/TAZ (19.6%), followed by levofloxacin (13.8%) and de-escalation occurred in 71.7% of cases. Following microbiological confirmation of HA-MRSA infection, a directed therapy with vancomycin was applied in 89.8% of patients. Polymicrobial infections were detected in 56% of patients, mainly caused by Klebsiella pneumoniae, Enterococcus sp. and Acinetobacter baumannii. Linezolide use was required in 19.2% of cases that had been previously treated with vancomycin, which suggests a clinical treatment failure with the latter. Concerning the second sample, empiric antibiotic therapy was found unnecessary in 27.6% of the cases after confirming the inexistence of HA-MRSA infection in patients treated with vancomycin or linezolide. Discussion and conclusions: HA-MRSA rates observed in this study are significantly higher than described in the literature, although strict measures of infection control have been implemented in the last few years, with good results. Considering vancomycin use and the suspected treatment failure, an appropriate monitorization of VISA strains is advised. Despite the presence of polymicrobial infections, a possibly unnecessary broad-spectrum therapeutics was maintained and de-escalation was not followed in a wide sample, which stresses the need for a tighter antimicrobial stewardship. Finally, microbiological tests should ideally precede and accompany treatment, as to prevent the emergence of multidrug resistant strains.
CONTACT Telma Sofia Mangerico
[email protected]
References [1] [2]
~es e de Resist^ Direc¸~ao-Geral da Sa ude (DGS). Prevenc¸~ao e Controlo de Infec¸o encia aos Antimicrobianos em N umeros – 2015. Ministerio da Sa ude; 2016. Huang SS, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis: Off Publ Infect Dis Soc Am. 2003;36(3):281–285.
Potentially inappropriate prescribing in domiciliary hospitalization – medication review using GheOP3S tool Ana Mafalda Britoa, Ana Margarida Piresb, Armando Alcobiab and Filipa Alves da Costaa Centro de Investigac¸~ao Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ci^encias da Sa ude Egas Moniz (ISCSEM). Caparica, Portugal; bHospital Garcia de Orta (HGO), EPE, Almada, Portugal
a
Introduction: The Portuguese Health Care System (PHCS), although considered efficient, can improve in hospital care provision [1]. A new model of hospitalization, shifting care to the community, has emerged, named Domiciliary Hospitalization (DH) [2]. This study aimed to determine the prevalence of Potentially Inappropriate Prescribing (PIP) in elders referred to DH. Materials and methods: An exposure cohort was created, including patients hospitalized from August to September 2016 (n ¼ 33). Clinical and therapeutic information was obtained through the hospital database and information on actual drug use was acquired by overt observation at patient’s home. Inclusion criteria were to have been transferred from conventional hospitalization to DH; being 65 years. Patients without ambulatory medication and those where the pharmaceutical visit occurred during the first day of DH were excluded. The PIP was analyzed using the GheOP3S Screening tool [3]. Spearman’s rho was used to test the association between polypharmacy and PIP (SPSS v.24.0). Results: A sample of 17 patients met the inclusion criteria; with a mean age of 77.1 years {65–94; SD ¼ 8.8}, 76.5% being male. Mean number of hospitalization days was 11.3 ± 7.1, during which patients were prescribed approximately 9.9 ± 3.9 drugs. A total of 167 drugs were analysed, 55 of which considered PIP (32.9%). Among these, 40% were inappropriate independent of the diagnosis (PIP-ID), 23.6% were inappropriate dependent on the diagnosis, 25.5% were drug-drug interactions and 10.9% were potential prescribing omissions. The excessive use of benzodiazepines remains alarming, since among 21 PIP-ID, 47.6% were benzodiazepines, mostly intermediate acting (lorazepam and bromazepam). The use of antidepressants for longer periods than 1 year is also worrisome corresponding to 6 PIP-ID (28.6%). 57% of drug–drug interactions were between antidiabetic or insulin and beta-blockers (35.7% cardio selective). The number of PIP was strongly correlated with the number of prescribed drugs (r ¼ 0.648, p ¼ .005).
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Discussion and conclusions: Medication review enabled the detection of various PIPs in patients discharged from the DH. The inclusion of a pharmacist in this unit was determinant to increase patient safety. The impact of this intervention is substantial on patients' health (reduction of adverse effects and increased adherence to therapy) but also on the economy of the PHCS (reduction in drug costs and hospital readmissions) [4].
CONTACT Ana Mafalda Brito
[email protected]
Acknowledgements The authors acknowledge the Domiciliary Hospitalization Unit team for sharing their data.
Funding This project was financed by national funds through FCT- Foundation for Science and Technology, I.P., in the context of project UID/BIM/04585/2016.
References [1] [2] [3]
[4]
European Observatory of Health Systems. Health systems in transition. HIT Portugal. Lisboa; April 2017. Brito AM, Pires AM, Alcobia A, et al. From hospital to domiciliary hospitalization: a pharmacist intervention. Int J Clin Pharm. 2017. DOI:10.1007/s11096-017-0462-2. Tommelein E, Petrovic M, Somers A, et al. Older patients’ prescriptions screening in the community pharmacy: development of the Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP3S) tool. J Public Health (Oxf). 2016;38(2):e158–170. Soares M, Fernandez-Llimos F, Cabrita J, Morais J. Crit erios de avaliac¸~ao de prescric¸~ao de medicamentos potencialmente inapropriado. Acta Medica Portuguesa. 2011;24:775–784.
PRACTISE – PhaRmAcist-led CogniTIve Services in Europe: preliminary results In^ es Branco Soaresa, Tamara Imfeld-Iseneggerb, Urska Nabergoj Makovecc, Nejc Horvatc, Mitja Kosc, Kurt E. Hersbergerb and Filipa A. Costaa; on behalf of PCNE PRACTISE team Centro de Investigac¸~ao Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ci^encias da Sa ude Egas Moniz (ISCSEM), Almada, Portugal; bPharmaceutical Care Research Group, University of Basel, Basel, Switzerland; cUniversity of Ljubljana, Faculty of Pharmacy, Slovenia a
Introduction: The scope of community pharmacy practice varies widely across different countries and health care systems. Cognitive pharmaceutical services are daily provided to the patients in community pharmacies [1]. According to the PGEU, pharmacy services can be divided into: “Core services” (essential services provided by all pharmacies), “Basic services” (may require separate facilities and pharmacy staff training) and “Advanced services” (require accredited pharmacist) [2]. Published literature focuses on pharmacist-led cognitive services available in Europe, but fails to report the implementation level in detail. The main aims of this project are to develop a map of existing pharmacist-led cognitive services in Europe. Materials and methods: A cross-sectional study was conducted where data were collected using an online survey, sent to a sample of 49 countries. The survey comprised three questions for each of the 22 services listed: provision; implementation level and remuneration. The survey was sent to three representatives per country (community pharmacist, researcher and policy maker), to ensure data triangulation, which also considered official documents publicly available. Consensus was sought using the Delphi adapted method. Preliminary results presented here focus on the implementation level, where the PGEU classification of services was used. Data were expressed by numbers of countries where the service is available and proportion of pharmacies providing it [2]. Ethics approval was obtained from “Comiss~ao de Etica Egas Moniz” (Proc. 515). Results: Data were obtained from 75 participants in 35 European countries (response rate ¼ 71%). “Core services” (n ¼ 9): 57% of the countries provide at least six of these services, including “medicines dispensing” (n ¼ 35; 100%), “provision of information on medicines” (n ¼ 34; 97%), “generic substitution” (n ¼ 29; 85%), “provision of emergency oral contraception” (n ¼ 27; 77%), “home delivery of medicines” (n ¼ 21; 60%) and “health screening” (n ¼ 17; 49%). “Basic services” (n ¼ 4): 66% of the countries provide at least 3 of these services including, “assessment of the inhalation technique” (n ¼ 28; 80%), “pharmaceutical care” (n ¼ 23; 66%), “adherence support and monitoring” (n ¼ 22; 63%). “Advanced services” (n ¼ 9): Only 12% of the countries provide at least 6 of these services, including “medication review” (n ¼ 25; 71%), “opioid substitution management”, “new medicines services” (n ¼ 18; 51%), “prescription renewal” (n ¼ 17; 37%), “immunization” (n ¼ 7; 20%) and “prescribing” (n ¼ 6; 17%). The implementation level varied widely for all 3 categories; for example, “health screening” was reported as implemented in 5–100% of pharmacies; “assessment of the inhalation technique” was
