Paulo Andrade

Reasons for treatment discontinuation in the first year after beginning antiretroviral therapy in a cohort of Portuguese HIV-infected patients

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Implementation and impact of an audit and feedback antimicrobial stewardship intervention in the orthopaedics department of a tertiary-care hospital: a controlled interrupted time series study

A prospective audit and feedback antimicrobial stewardship intervention conducted in the Orthopaedics Department of a university hospital in Portugal was evaluated by comparing an interrupted time series in the intervention group with a non-intervention (control) group. Monthly antibiotic use (except cefazolin) was measured as the World Health Organizations Anatomical Therapeutic Chemical defined daily doses (ATC-DDD) from January 2012 to September 2016, excluding the 6-month phase of intervention implementation starting on 1 January 2015. Compared with the control group, the intervention group had a monthly decrease in the use of fluoroquinolones by 2.3 DDD/1000 patient-days [95% confidence interval (CI) -3.97 to -0.63]. An increase in the use of penicillins by 103.3 DDD/1000 patient-days (95% CI 47.42 to 159.10) was associated with intervention implementation, followed by a decrease during the intervention period (slope = -5.2, 95% CI -8.56 to -1.82). In the challenging scenario of treatment of osteoarticular and prosthetic joint infections, an audit and feedback intervention reduced antibiotic exposure and spectrum.

Chronic Q fever: A missed prosthetic valve endocarditis possibly for years

Chronic Coxiella burnetii endocarditis usually develops in people with underlying heart disease and accounts for 60–70% of chronic Q fever. Onset is generally insidious and manifestations are atypical. The authors report a case of Coxiella burnetii prosthetic valve endocarditis in a 53 years- old patient with recurrent mechanical valve dehiscence on mitral position. He lived in a rural area with sheep and goats on the surroundings. During a 9 year- period, he was submitted to three cardiac mitral valve surgeries two of which with no Q fever diagnosis suspicion. Diagnosis was based on a positive serology test (Indirect imunofluorescence). Treatment consisted in a combination of prolonged course of hydroxychloroquine plus doxycycline and surgical replacement of the mitral valve, with a favorable outcome. With this case report, the authors pretend to highlight the not always expected diagnosis of Q fever endocarditis. If not considered, Coxiella burnetii endocarditis may lead to multiple cardiac surgeries, greater morbidity and potentially death.

Tiapride Associated Toxic Epidermal Necrolysis in an HIV-Infected Patient

Toxic epidermal necrolysis is a rare but severe and often fatal adverse cutaneous drug reaction. Early diagnosis and prompt discontinuation of the culprit drug is of the utmost importance, making drug causality assessment the mainstay when managing this condition. We present the first reported case of toxic epidermal necrolysis induced by tiapride, in a 43 year-old male Caucasian with a history of liver cirrhosis and HIV infection. This case report should raise awareness on the medical community to a potentially fatal reaction to a frequently prescribed drug in alcoholic patients. It also underlines the importance of further research regarding HIV infection, immune deregulation and adverse cutaneous drug reactions.