European journal of hospital pharmacy : science and practice最新文献

Objectives: To explore the relationship between vedolizumab trough concentrations and clinical and biochemical remission in patients with Crohn's disease (CD) receiving maintenance therapy, analysing intravenous and subcutaneous administration separately in a real-world clinical setting.

Methods: We conducted a retrospective observational study in 69 patients with CD receiving vedolizumab maintenance therapy. Plasma trough concentrations were measured by ELISA. Clinical remission (Harvey-Bradshaw Index <5) and biochemical remission (faecal calprotectin (FCP) <250 µg/g) were evaluated 6 months after trough level measurement. Patients were stratified according to administration route (intravenous and subcutaneous). Statistical analyses included Mann-Whitney tests, receiver operating characteristic (ROC) curves to determine predictive ability, and multiple linear regression to identify factors associated with vedolizumab exposure.

Results: Median vedolizumab trough concentrations were higher in patients achieving clinical remission compared with those without remission in both intravenous (16.4 vs 10.95 µg/mL, p=0.067) and subcutaneous (37.45 vs 23.05 µg/mL, p=0.134) groups, although differences were not statistically significant. ROC analyses revealed modest predictive capacity for the intravenous group (area under the curve (AUC)=0.676, optimal threshold=11.3 µg/mL, sensitivity=85.7%, specificity=58.3%) and strong predictive ability for the subcutaneous group (AUC=0.813, optimal threshold=25.35 µg/mL, sensitivity=83.3%, specificity=75%). Biochemical remission was not significantly associated with trough concentrations. In multivariable regression analysis, subcutaneous administration, higher albumin and lower FCP were significantly associated with increased vedolizumab concentrations, whereas C-reactive protein (CRP) showed a positive association.

Conclusion: Vedolizumab trough concentrations were numerically higher in patients achieving clinical remission, with stronger predictive ability for remission in the subcutaneous group. While isolated trough levels alone may not predict remission, interpretation alongside biomarkers and clinical context can inform therapeutic decisions. Further prospective studies are warranted to validate optimal therapeutic thresholds.

Semaglutide (Ozempic, Rybelsus, Wegovy) is a GLP-1 receptor agonist used for the treatment of type 2 diabetes and, more recently, weight management. Due to its efficacy in weight loss, semaglutide has gained worldwide popularity, particularly the branded version Ozempic, resulting in off-label use by people seeking rapid weight loss. The resulting high demand has led to an increase in falsified products sold by unregulated online marketplaces. We present a case of a 31-year-old woman who was admitted to the emergency room in a hypoglycaemic coma after self-administrating semaglutide (Ozempic) obtained from a website. Toxicological analysis showed that the vial contained insulin instead of semaglutide, therefore leading to severe hypoglycaemia. This case highlights the growing concern regarding falsified medicines sold in the online drug market and the associated risk of severe adverse events. We reported the case to the Italian Medicines Agency (AIFA) and local authorities. We propose regulatory measures to mitigate similar incidents in the future.

Objectives: The administration of solid drugs via enteral feeding tubes is a common practice in hospitals. However, there is a paucity of literature about the stability of the drug and its interaction with medical devices. This study evaluated the sorption and content of furosemide tablets when administered through an enteral feeding tube, simulating a hospital clinical protocol.

Methods: In the laboratory, a high-performance liquid chromatography method for evaluating furosemide in tablets was validated with the simulation of the hospital protocol involving dispersing furosemide tablets in 10 mL of bottled water using syringes. The content was evaluated before and after passage through enteral feeding tubes made of three different materials (polyvinyl chloride-PVC, polyurethane and silicone). The sorption of furosemide in the tubes was evaluated by infrared spectrophotometry.

Results: The developed analytical method demonstrated selectivity, linearity within the 30-60 µg/mL range, as well as precision and accuracy. The stability of the furosemide in the syringes was also assessed, and no significant decay in content or formation of degradation products was observed during the 180 min exposure before passing through the enteral feeding tube. The simulation demonstrated that the furosemide content remained stable after passing through PVC (100.90%), polyurethane (98.58%) and silicone (99.56%) tubes. Furthermore, no sorption of furosemide was detected in any of the materials.

Conclusion: These results confirm the safety and stability of the hospital's protocol for administering furosemide via enteral feeding tube to the patient.

Background: Tazobactam/piperacillin (TAZ/PIPC), widely used for treating various infections, is often discontinued due to hypokalaemia, although the preventive measures remain unclear. This study aimed to identify the incidence, clinical characteristics and associated risk factors for TAZ/PIPC-induced hypokalaemia.

Methods: Hospitalised patients receiving TAZ/PIPC therapy for >2 days were included. The primary endpoint was the incidence of hypokalaemia (serum potassium level ≤3 mEq/L) and identification of associated risk factors. Survival classification and regression tree (CART) analyses were used to estimate HR (95% CI) and cut-off values for continuous variables.

Results: Of the 224 patients treated with TAZ/PIPC during the study period, 168 were included. The median time (min-max) to the incidence of hypokalaemia was 3 (2-14) days. Hypokalaemia was observed in 30 patients. Survival CART analysis identified baseline serum potassium level (cut-off value of 3.7 mEq/L) and diarrhoea as risk factors.

Conclusions: Monitoring serum potassium levels is recommended after treatment initiation of TAZ/PIPC therapy for patients with baseline serum potassium levels ≤3.7 mEq/L and diarrhoea.

Objectives: Peripherally inserted central catheters (PICCs) are used in clinical settings for mid- to long-term intravenous therapies, including chemotherapy and antibiotics. However, their use involves risks such as infections, thrombosis or occlusions. Pharmacist-led analysis and validation of PICC requests aims to optimise their use and reduce complications. This study evaluates the sustainability of pharmacist-led PICC analysis and validation in a university hospital and investigates the organisation of PICC management in French healthcare institutions.

Methods: A single-centre retrospective observational study was conducted, analysing PICC requests from April 2018 to October 2021. Pharmaceutical interventions (PIs) were categorised based on their targets: applicants, installers or users. A national survey was also conducted to assess PICC practices across French hospitals.

Results: Of the 5503 requests over a 42-month period, 59.9% (3297) required at least one PI, totalling 4406 PIs. Most were directed at installers (69.2%), followed by applicants (18.4%) and users (12.4%). Pharmacists refused 4.1% (223) of requests, mainly due to alternative functional access or contraindications. Despite pharmacist validation, 14.0% (771) of PICC placements were later cancelled by the medical team (ie, transfer of the patient). The national survey revealed limited adoption of pharmaceutical validation, with only two centres (5%) implementing it out of 37 respondents, even though 40 centres (98%) had over 2 years of experience with PICCs.

Conclusions: Pharmacist-led PICCs validation improves patient safety and optimises device use, demonstrating its value and sustainability in clinical practice. The percentage of refusals has remained stable since our pilot study in 2018 in the same centre, probably due to fast staff turnover. Wider implementation of this practice requires addressing resource limitations, raising awareness about the pharmacist's role in managing medical devices, and frequent training.

Objectives: This study uses bibliometric analysis to systematically map research trends, knowledge structure and evolution of information technology (IT) in hospital antimicrobial stewardship (AMS) over the last 20 years.

Methods: A Web of Science Core Collection search (2000-2025) yielded 258 English-language publications on IT applications in hospital AMS. A bibliometric analysis, utilising CiteSpace and Bibliometrix, quantitatively evaluated domain evolution through temporal analysis, network mapping, keyword clustering, burst detection and examination of highly cited publications.

Results: The bibliometric analysis reveals a fluctuating yet overall increasing trend in annual publications, peaking at 49 articles in 2024. The US (131 publications) and European nations demonstrate significant research output (centrality >0.2), with major collaborative networks coalescing around institutions including Harvard University and Imperial College London. Keyword analysis identifies 'AMS' as a core theme, closely associated with technological keywords such as 'machine learning (ML)', 'clinical decision support systems (CDSS)', 'electronic health records (EHR)' and 'artificial intelligence (AI)'. Emerging trends suggest a shift in research focus from foundational strategies to data-driven prediction of antimicrobial resistance (AMR) and precision interventions. Highly cited literature emphasises the integration of EHR and ML technologies for optimising prescriptions and predicting resistance patterns.

Conclusions: IT-driven AMS research has shifted from empirical management to data science. Despite EHR integration, and ML and CDSS support, challenges remain in data standardisation, technical deployment and ethics. Future work must emphasise global collaboration, standardisation, design refinement and ethical guidelines, and provide clear algorithm explanations to enhance AMR mitigation.