F. Guerrero Sánchez

Evolución de los ingresos y la mortalidad en un Servicio de Medicina Interna de un hospital de tercer nivel (1996-2000). Influencia de las modificaciones en el tratamiento de la infección por el VIH

Objetivo Analizar la repercusion de la terapia antirretroviral de gran actividad (TARGA) sobre los ingresos y mortalidad de los pacientes con infeccion por el virus de la inmunodeficiencia humana (VIH) en particular y sobre un Servicio de Medicina Interna en general. Metodos Estudio retrospectivo que analiza los ingresos y exitus producidos en el Servicio de Medicina Interna de un hospital de especialidades entre enero de 1996 y diciembre de 2000. La TARGA se introdujo a partir de 1997. Se valoraron edad, genero, diagnostico principal al alta, peso del grupo relacionado con el diagnostico (GDR), causa de la muerte y estancia hospitalaria de forma global y distribuidas anualmente. Resultados Durante el periodo se produjeron 7.580 ingresos, de los cuales 939 estuvieron producidos por patologias relacionadas con la infeccion por el VIH. El numero de ingresos por VIH disminuyo en un 32,9% y la tasa de letalidad en un 67,8% entre 1996 y 2000, aumentando el volumen de pacientes con patologia respiratoria no infecciosa e infecciones en general. La estancia media de los pacientes ingresados en el servicio se mantuvo estable, disminuyendo la del grupo con infeccion por el VIH un 31,5% a partir de 1997. La complejidad de los GDR en este grupo disminuyo 0,56 puntos. Conclusiones La introduccion de la TARGA se ha relacionado con una disminucion en el numero de ingresos, complejidad de los diagnosticos y fallecimientos en el grupo de pacientes con infeccion por el VIH. Ese lugar ha sido ocupado por enfermos con patologia respiratoria e infecciosa diferente a la relacionada con el VIH.

Protocolo diagnóstico y tratamiento empírico del paciente con infección por el VIH con sintomatología respiratoria

HIV-associated pulmonary diseases are mainly related with infection. They remain as a major cause of morbidity. Bacterial pneumonia and acute bronchitis are frequent, although Pneumocystis jiroveci pneumonia (PCP) is the most common opportunistic infection in developed countries between patients with poor immune control. The incidence of non-AIDS defining malignancies (lung cancer) has increased. Lung cancer is the leading cause of death among non-AIDS-related neoplasms.

Antiinfecciosos de empleo en infecciones del sistema nervioso central

El sistema nervioso central tiene caracteristicas farmacocineticas que limitan el acceso de los farmacos de la circulacion sistemica. Para que un antibiotico sea eficaz, su concentracion en el LCR debe exceder en 10 o mas veces el valor de la concentracion minima bactericida in vitro, frente al microorganismo responsable de la infeccion. Los farmacos mas empleados habitualmente en este tipo de infecciones son betalactamicos, cefalosporinas y carbapenemas, vancomicina, aciclovir y anfotericina B. La administracion concomitante de corticoides ha demostrado en determinados tipos de meningitis una disminucion de la mortalidad en relacion con un control mas eficaz del proceso inflamatorio.

CP-145 Effect of a training initiative to improve adherence to the recommendations for therapeutic monitoring vancomycin effect of a training initiative to improve adherence to the recommendations for therapeutic monitoring vancomycin

Background Up to 50% of antibiotic treatments prescribed have been estimated to be incorrect. 1 This is probably caused by the high level of knowledge required for the appropriate use. Training may be a way to improve antibiotic use. Purpose To analyse the impact of training on the correct use of trough vancomycin plasma concentrations as a tool for monitoring effectiveness and safety in a teaching hospital. Material and methods The training was conducted by disseminating local antibiotic guidelines including the recommendations contained in the consensus document on therapeutic monitoring of vancomycin. 2 A before-after study was conducted comparing before the training period (January–April 2012) with a later period (September–December 2013). We selected patients treated with vancomycin and we collected data on duration and concomitant treatment, demographic variables, serum creatinine before and during treatment. Creatinine clearance was calculated by MDRD-4, considering impaired renal function ?? Results 85 patients were treated with intermittent infusion of vancomycin, 30 patients before vs. 45 after the training. The median age was 66 vs. 65 years. Mostly men, 70% vs. 55.6%. Median days of treatment were 7 [7 (1–46) vs. 7 (1–24)]. No levels were requested in 90% vs. 73.3% for the two periods, which met one or more criteria; monitoring was 63% vs. 51.1%, no statistically significant difference (p = 0.379). The criterion of more than five days duration was 100%; monitoring was 86.9% in both periods. Conclusion The implementation of an educational activity did not meet expectations in terms of an increase in adherence to recommendations. It is necessary to intensify these training activities and the role of the clinical pharmacist on the usefulness and advantages of monitoring vancomycin, particularly during prolonged treatment. References and/or Acknowledgements Dellit TH. Clin Infect Dis. Rybak M. Am J Health Syst Pharm No conflict of interest.Background Up to 50% of antibiotic treatments prescribed have been estimated to be incorrect.1 This is probably caused by the high level of knowledge required for the appropriate use. Training may be a way to improve antibiotic use. Purpose To analyse the impact of training on the correct use of trough vancomycin plasma concentrations as a tool for monitoring effectiveness and safety in a teaching hospital. Material and methods The training was conducted by disseminating local antibiotic guidelines including the recommendations contained in the consensus document on therapeutic monitoring of vancomycin.2 A before-after study was conducted comparing before the training period (January–April 2012) with a later period (September–December 2013). We selected patients treated with vancomycin and we collected data on duration and concomitant treatment, demographic variables, serum creatinine before and during treatment. Creatinine clearance was calculated by MDRD-4, considering impaired renal function ?? <80 ml??/min. To compare the two periods the McNemar-Bowker test (SPSS v.15) was used. Results 85 patients were treated with intermittent infusion of vancomycin, 30 patients before vs. 45 after the training. The median age was 66 vs. 65 years. Mostly men, 70% vs. 55.6%. Median days of treatment were 7 [7 (1–46) vs. 7 (1–24)]. No levels were requested in 90% vs. 73.3% for the two periods, which met one or more criteria; monitoring was 63% vs. 51.1%, no statistically significant difference (p = 0.379). The criterion of more than five days duration was 100%; monitoring was 86.9% in both periods. Conclusion The implementation of an educational activity did not meet expectations in terms of an increase in adherence to recommendations. It is necessary to intensify these training activities and the role of the clinical pharmacist on the usefulness and advantages of monitoring vancomycin, particularly during prolonged treatment. References and/or Acknowledgements Dellit TH. Clin Infect Dis. Rybak M. Am J Health Syst Pharm No conflict of interest.

Vacunación en el adulto no inmunocomprometido

The introduction a few years ago of population vaccination policies, coupled with migration, has determined the presence of unvaccinated adults cohorts. Moreover, some of the vaccines given during childhood do not maintain immunity in adulthood. For these reasons, it is important for an adequate control of vaccine-preventable infections, to extend vaccination recommendations in the adult population with booster doses of childhood vaccination programs. In the current Spanish healthcare, the immunization schedules are the responsibility of the various regions. This article aims to unify these calendars and to provide the major vaccine indications in the general adult population.

Tratamiento de la infección por el VIH

Antiretroviral therapy has modified the natural history of the HIV infection. The antiretroviral treatment has evolved from an initial phase in which the main and probably sole objective was saving the life to the actual phase in which an additional objective is to avoid the adverse effects. Adherence to therapy is the basis to attain these objectives and prevent viral resistances.

Meningitis (ii). meningitis bacterianas y víricas. manifestaciones clínicas. formas de comienzo. formas truncadas. complicaciones. pronóstico. terapéutica

Las meningitis bacterianas adquiridas en la comunidad son debidas fundamentalmente a Streptococcus pneumoniae, Haemophilus influenzae y Neisseria meningitidis, cuyos cuadros clinicos son clasicos, aunque la introduccion de vacunas efectivas frente a los mismos han modificado su incidencia. Entre las meningitis viricas, amen de las debidas a enterovirus, se ha incrementado nuestro conocimiento sobre aquellas debidas a virus herpes simple y de la inmunodeficiencia humana.