FARMACIA HOSPITALARIA最新文献_第6页

Persistence of optimal and suboptimal response in chronic immune-mediated inflammatory diseases. 慢性免疫介导的炎症性疾病的最佳和次最佳反应的持久性。

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

FARMACIA HOSPITALARIA

Pub Date : 2025-11-03 DOI: 10.1016/j.farma.2025.10.014

Joaquín Borrás-Blasco, Vicente Merino-Bohorquez, Esther Ramírez-Herráiz, Andrés Navarro-Ruiz

引用次数: 0

[Translated article] Network meta-analysis of perioperative immunotherapies in non-small-cell lung cancer according to tumor programmed death ligand 1 expression. 基于肿瘤程序性死亡配体1表达的非小细胞肺癌围手术期免疫治疗网络meta分析

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

FARMACIA HOSPITALARIA

Pub Date : 2025-11-03 DOI: 10.1016/j.farma.2025.10.006

Manuel David Gil-Sierra, María Del Pilar Briceño-Casado, Cristina Moreno-Ramos

Objective: Immunotherapy has emerged as a therapeutic alternative to chemotherapy (CT) for perioperative treatment of resectable non-small cell lung cancer (NSCLC). The objective is to perform a network meta-analysis comparing the perioperative efficacy of immunotherapies in resectable NSCLC taking into account tumor expression of programmed death ligand 1 (PD-L1).

Method: A review was performed in Pubmed® and EMBASE® until September 17, 2024. Phase III clinical trials on perioperative immunotherapies (P-) for resectable NSCLC with ≥50 patients were included. The selected endpoint was progression-free survival (PFS) according to different levels of PD-L1 expression. The statistical analysis used Bayesian methods. Fixed- or random-effects models were assessed using deviance information criteria (DIC). A sensitivity analysis was developed to evaluate the influence of heterogeneous studies.

Results: Four trials were included. Immunotherapeutic schemes with P-toripalimab, P-nivolumab, P-pembrolizumab and P-durvalumab were selected. Only P-toripalimab included a cycle of adjuvant toripalimab + CT. The remaining perioperative combinations contained the neoadjuvant immunotherapeutic agent + CT (4 cycles) regimen followed by adjuvant immunotherapy. The common comparator was neoadjuvant placebo + CT with adjuvant placebo (P-placebo). P-toripalimab was evaluated in a population with heterogeneous characteristics. Fixed effects model was selected for DIC values with irrelevant differences. P-toripalimab obtained greater magnitude of effect in PFS for populations with PD-L1 < 1% and 1-49% (reference treatment). No benefit of any immunotherapeutic combination over P-placebo was observed in resectable NSCLC with PD-L1 expression <1%. P-toripalimab was statistically superior to the other regimens [except P-pembrolizumab, HR = 1.6 (95%CrI: 0.84-3.2)] for PD-L1 expression 1-49%. Immunotherapeutic schemes were superior to p-placebo for PD-L1 expression ≥50%. Sensitivity analysis showed results compatible with the primary analysis.

Conclusions: Our network meta-analysis provides reliable evidence on the efficacy of perioperative immunotherapy in resectable NSCLC according to PD-L1 expression levels, and may favor competition between therapeutic alternatives. A sensitivity analysis supported these results.

目的：免疫治疗已成为可切除非小细胞肺癌（NSCLC）围手术期化疗（CT）的替代治疗方法。目的是进行一项网络荟萃分析，比较可切除的非小细胞肺癌中免疫疗法的围手术期疗效，考虑肿瘤表达程序性死亡配体1 （PD-L1）。方法：在Pubmed®和EMBASE®中进行综述，直至2024年9月17日。可切除的非小细胞肺癌围手术期免疫疗法（P-）的III期临床试验纳入≥50例患者。根据不同的PD-L1表达水平，选择的终点是无进展生存期（PFS）。统计分析采用贝叶斯方法。使用偏差信息标准（DIC）评估固定或随机效应模型。采用敏感性分析来评价异质性研究的影响。结果：纳入4项试验。选择p -托利帕单抗、p -纳武单抗、p -派姆单抗和p -杜伐单抗的免疫治疗方案。只有p -托帕利单抗包括一个辅助托帕利单抗 + CT周期。其余围手术期联合采用新辅助免疫治疗剂 + CT（4 周期）方案，再辅以辅助免疫治疗。常见的比较物是新辅助安慰剂 + CT与辅助安慰剂（P-placebo）。在具有异质特征的人群中评估p -托利单抗。差异不相关的DIC值选择固定效应模型。结论：我们的网络荟萃分析为可切除的非小细胞肺癌围手术期免疫治疗根据PD-L1表达水平的疗效提供了可靠的证据，并可能有利于治疗方案之间的竞争。敏感性分析支持这些结果。

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引用次数: 0

[Translated article] Influence of SARS-CoV-2 infection on the use of ceftazidime-avibactam in the critical patient [翻译]SARS-CoV-2感染对危重患者头孢他啶-阿维巴坦使用的影响。

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

FARMACIA HOSPITALARIA

Pub Date : 2025-11-01 DOI: 10.1016/j.farma.2025.03.016

Fátima Mayo Olveira, José Manuel Caro Teller, María Dolores Canales Siguero, Sara Ortiz Pérez, María del Carmen Jiménez León, José Miguel Ferrari Piquero

Objective

The objective of the study was to analyse possible changes in antibiotic policy with ceftazidime-avibactam during the SARS-CoV-2 pandemic in an Intensive Care Unit (ICU) to determine patient mortality 28 days after initiation of antimicrobial therapy and to describe the microorganisms that most frequently colonise critically ill patients.

Material and method

Observational, single-centre, cohort study that included patients on treatment with ceftazidime-avibactam in ICU between March 2020 and September 2021. Demographic (age, sex), microbiological (colonisation, microorganisms isolated in blood cultures), pharmacotherapeutic (duration of treatment with ceftazidime-avibactam, antimicrobials used in synergy with ceftazidime-avibactam) and clinical (mortality, length of hospital stay and comorbidities) variables were collected. As associated comorbidities, we identified how many of the patients included in the study had diabetes mellitus (DM), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD) or obesity.

Results

Eighty-nine patients were included, 85.39% of whom were male. Forty-nine patients were infected with Sars-CoV-2. Median ICU stay was 46 days (RIQ = 58–27) in SARS-CoV-2 infected and 34 days (RIQ = 51–24) in non-infected patients. Patients were on ceftazidime-avibactam treatment for a median of 8 days (RIQ = 13–4), being 7 days (RIQ = 11–2) in COVID-19 positive patients and 11 days (RIQ = 14–6) in COVID-19 negative patients (p > 0.05). Empirical treatment with ceftazidime-avibactam was started empirically in 41.57% (n = 37) of the patients. The percentage of empiric initiations in SARS-CoV-2 infected patients was 43% and in non-infected patients 40%, with no statistically significant difference between empiric initiation according to SARS-CoV-2 diagnostic status (p > 0.05). A total of 43.8% (n = 39) of the patients were colonised by a multidrug-resistant (MDR) bacterium. Regarding on the microorganisms that colonised patients had, the most frequent was Klebsiella pneumoniae, present in 66.6% of patients (n = 26 patients). Overall mortality was 41.6%, with no statistically significant differences between SARS-CoV-2 infected and non-infected patients (42.9% and 40%, respectively; p > 0.05).

Conclusion

The SARS-CoV-2 pandemic did not lead to a change in the criteria for the use of ceftazidime-avibactam in the critically ill patient.

目的：本研究的目的是分析重症监护病房（ICU）在SARS-CoV-2大流行期间头孢他啶-阿维巴坦的抗生素政策可能发生的变化，以确定开始抗菌治疗后28 天的患者死亡率，并描述最常定菌于危重患者的微生物。材料和方法：观察性、单中心、队列研究，纳入2020年3月至2021年9月在ICU接受头孢他啶-阿维巴坦治疗的患者。收集了人口统计学（年龄、性别）、微生物学（定殖、血液培养中分离的微生物）、药物治疗（使用头孢他啶-阿维巴坦治疗的持续时间、与头孢他啶-阿维巴坦协同使用的抗菌剂）和临床（死亡率、住院时间和合并症）变量。作为相关的合并症，我们确定了研究中有多少患者患有糖尿病（DM）、慢性肾脏疾病（CKD）、慢性阻塞性肺疾病（COPD）或肥胖。结果：共纳入89例患者，男性占85.39%。49例患者感染Sars-CoV-2。SARS-CoV-2感染患者中位住院时间为46 d (RIQ = 58 ~ 27)，未感染患者中位住院时间为34 d （RIQ = 51 ~ 24）。患者ceftazidime-avibactam治疗平均8 天(RIQ =常规 ),被7 天(RIQ =本季 )COVID-19积极患者和11 天(RIQ = 14:6)COVID-19 -患者(p > 0.05)。41.57% （n = 37）的患者开始经验性治疗头孢他啶-阿维巴坦。SARS-CoV-2感染患者的经验起始率为43%，未感染患者为40%，根据SARS-CoV-2诊断状态的经验起始率差异无统计学意义（p > 0.05）。共有43.8% （n = 39）的患者被多药耐药（MDR）细菌定植。在定植患者的微生物方面，最常见的是肺炎克雷伯菌，占患者的66.6% （n = 26例）。总死亡率为41.6%，SARS-CoV-2感染患者与非感染患者的死亡率差异无统计学意义（分别为42.9%和40%；p > 0.05）。结论：SARS-CoV-2大流行未导致危重患者头孢他啶-阿维巴坦使用标准的改变。

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引用次数: 0

[Artículo traducido] Conocimiento, percepción y disposición para implementar la metodología CMO (Capacidad-Motivación-Oportunidad) entre médicos especialistas que atienden a pacientes con VIH en España 西班牙照顾HIV患者的专科医生对实施CMO（能力-动机-机会）方法的知识、认知和意愿。

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

FARMACIA HOSPITALARIA

Pub Date : 2025-11-01 DOI: 10.1016/j.farma.2025.08.009

Enrique Contreras Macías , Pilar Taberner Bonastre , Anaïs Corma Gómez , José Ramón Blanco Ramos , Ramón Morillo Verdugo

Introduction

The CMO (Capability-Motivation-Opportunity) methodology is an innovative pharmaceutical care model designed to improve the quality of care for people living with HIV/AIDS (PLWHA). This approach evaluates the knowledge, perception, and willingness to implement the methodology among specialist physicians in Spain.

Methods

This observational and descriptive study utilized a validated questionnaire distributed among clinicians involved in the care of PLWHA. The survey assessed their knowledge and perception of the methodology. Associations between variables were analyzed using bivariate tests.

Results

Thirty physicians participated. Sixty percent reported moderate-to-high knowledge of the methodology, correlating with a positive perception of its clinical relevance (p = 0.02). Motivational interviewing and remote follow-up were identified as key tools.

Conclusion

Knowledge of the CMO methodology is limited but positively valued. Its association with improved quality of health care underscores the importance of strategies to enhance its dissemination and adoption in clinical practice.

CMO（能力-动机-机会）方法是一种创新的药物护理模式，旨在提高艾滋病毒/艾滋病患者（PLWHA）的护理质量。该方法评估了西班牙专科医生实施该方法的知识、认知和意愿。方法：这项观察性和描述性研究使用了一份有效的问卷，在参与艾滋病护理的临床医生中分发。调查评估了他们的知识和对方法的认知。使用双变量检验分析变量之间的关联。结果：30名医生参与。60%的人报告对该方法有中等到较高的了解，与对其临床相关性的积极看法相关（p = 0.02）。动机性访谈和远程随访被确定为主要工具。结论：CMO方法学知识有限，但受到积极评价。它与提高保健质量的关系强调了在临床实践中加强其传播和采用的战略的重要性。

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引用次数: 0

Knowledge, perception, and willingness to implement the CMO (Capability-Motivation-Opportunity) methodology among specialist physicians caring for patients with HIV in Spain 知识，感知，并愿意实施CMO方法的专科医生照顾患者的艾滋病毒在西班牙。

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

FARMACIA HOSPITALARIA

Pub Date : 2025-11-01 DOI: 10.1016/j.farma.2025.05.007

Enrique Contreras Macías , Pilar Taberner Bonastre , Anaïs Corma Gómez , José Ramón Blanco Ramos , Ramón Morillo Verdugo

Introduction

The CMO (Capability-Motivation-Opportunity) methodology is an innovative pharmaceutical care model designed to improve the quality of care for people living with HIV (PLWH). This approach evaluates the knowledge, perception, and willingness to implement the methodology among specialist physicians in Spain.

Methods

This observational and descriptive study utilized a validated questionnaire distributed among clinicians involved in the care of PLWH. The survey assessed their knowledge and perception of the methodology. Associations between variables were analyzed using bivariate tests.

Results

Thirty physicians participated. Sixty percent reported moderate-to-high knowledge of the methodology, correlating with a positive perception of its clinical relevance (p = 0.02). Motivational interviewing and remote follow-up were identified as key tools.

Conclusion

Knowledge of the CMO methodology is limited but positively valued. Its association with improved quality of health care underscores the importance of strategies to enhance its dissemination and adoption in clinical practice.

CMO（能力-动机-机会）方法是一种创新的药物护理模式，旨在提高艾滋病毒感染者（PLWH）的护理质量。该方法评估了西班牙专科医生实施该方法的知识、认知和意愿。方法：这项观察性和描述性研究使用了一份有效的问卷，在参与PLWH护理的临床医生中分发。调查评估了他们的知识和对方法的认知。使用双变量检验分析变量之间的关联。结果：30名医生参与。60%的人报告对该方法有中等到较高的了解，与对其临床相关性的积极看法相关（p = 0.02）。动机性访谈和远程随访被确定为主要工具。结论：CMO方法学知识有限，但受到积极评价。它与提高保健质量的关系强调了在临床实践中加强其传播和采用的战略的重要性。

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引用次数: 0

Medication Safety Officers: A pillar of patient safety in hospital pharmacy 用药安全人员：医院药房病人安全的支柱。

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

FARMACIA HOSPITALARIA

Pub Date : 2025-11-01 DOI: 10.1016/j.farma.2025.05.017

Elizabeth Hess Ford , Christina Michalek

The role of a Medication Safety Officer has emerged as a critical element in hospital pharmacy, addressing the persistent issue of medication errors. These errors, which can cause significant patient harm, have been documented for decades, prompting the establishment of formal roles dedicated to medication safety. Organizations such as the Institute for Safe Medication Practices (ISMP), the American Society of Health System Pharmacists (ASHP) as well as the United Kingdom's Medicines and Healthcare products Regulatory Agency (MHRA) and National Health Service (NHS) have been instrumental in supporting the Medication Safety Officer role.

Medication errors can result in severe consequences, including patient harm and death. Landmark publications like the Institute of Medicine's “To Err is Human” and “Crossing the Quality Chasm” have highlighted the prevalence and impact of these errors, advocating for system improvements and the necessity of dedicated safety roles.

Medication Safety Officers lead strategies and processes related to medication safety, develop strategic plans, and implement error prevention strategies. They analyze medication error reports, collaborate with healthcare staff, and optimize medication safety technologies. Medication Safety Officers play a key role in fostering a culture of safety within organizations, influencing practices to minimize harm and support second victim programs.

Studies have shown that employing a Medication Safety Officer can significantly improve hospital safety scores, demonstrating the effectiveness of this role in enhancing patient safety. The daily responsibilities of a Medication Safety Officer include reviewing medication errors, assessing harm, attending meetings, and collaborating with healthcare practitioners.

Overall, the role of a Medication Safety Officer is essential in identifying and mitigating medication risks, making hospitals safer, and ensuring the delivery of high-quality patient care.

药物安全干事的作用已成为医院药房的一个关键因素，解决持续存在的药物错误问题。这些可能对患者造成重大伤害的错误已经记录了几十年，促使建立了专门负责药物安全的正式角色。诸如安全用药实践研究所（ISMP）、美国卫生系统药剂师协会（ASHP）以及英国药品和保健产品监管机构（MHRA）和国家卫生服务（NHS）等组织在支持药物安全官员的角色方面发挥了重要作用。用药错误可能导致严重后果，包括患者伤害和死亡。医学研究所的《人孰无过》和《跨越质量鸿沟》等具有里程碑意义的出版物强调了这些错误的普遍性和影响，倡导系统改进和专门的安全角色的必要性。药物安全官员领导与药物安全相关的策略和流程，制定策略计划，并实施预防错误的策略。他们分析用药错误报告，与医护人员协作，并优化用药安全技术。药物安全官员在组织内部培养安全文化、影响实践以尽量减少伤害和支持第二受害者项目方面发挥着关键作用。研究表明，聘用用药安全官可以显著提高医院的安全评分，证明了这一角色在提高患者安全方面的有效性。药物安全官员的日常职责包括审查药物错误、评估危害、参加会议以及与医疗保健从业人员合作。总体而言，在识别和减轻用药风险、使医院更安全以及确保提供高质量的患者护理方面，用药安全干事的作用至关重要。

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引用次数: 0

Desarrollo de la aplicación móvil Guía de conciliación de la medicación en el paciente crítico 开发移动应用指南的药物和解在危重病人。

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

FARMACIA HOSPITALARIA

Pub Date : 2025-11-01 DOI: 10.1016/j.farma.2025.03.021

María Martín Cerezuela , Fernando Becerril Moreno , Jesús Ruiz Ramos , Ana de Lorenzo Pinto , Esther Domingo Chiva , Marta Valera Rubio , Irene Aquerreta González , Carla Bastida Fernández , Laura Doménech Moral , Amaia Egüés Lugea , Miguel Ángel Amor García , Tatiana Betancor García , Sara Cobo Sacristán , Marta Albanell Fernández , Sara Ortiz Pérez , Luis Pérez de Amezaga Tomás

Objective

Medication reconciliation is an essential process in the care of critically ill patients, ensuring that patients' chronic medication is adapted to the patient's clinical situation and administered safely during hospitalisation. Given the profile of the patient admitted to a critical care unit (ICU), this becomes even more relevant. Reconciliation minimises possible medication errors and adverse effects, improving safety in the critically ill patient.

Methods

The project, carried out between 2021 and 2024, was led by the FarMIC (Pharmacists in Intensive Care Medicine and Critical Care) and RedFaster (Pharmaceutical Care in Emergencies) groups of the Spanish Society of Hospital Pharmacy (SEFH), and included: selection of the drugs, review of the available literature and previous conciliation guidelines in similar areas of application, preparation of the drug information with the recommendations issued by the working group, the review of the same and the development of the mobile application.

Results

In October 2024, the app ‘Conciliation Guide for Critically Ill Patients®’ was published, available free of charge for iOS and Android. It provides a drug index with detailed information on medication reintroduction schedules, routes of administration, monitoring, and drug-specific considerations. In addition, the tool includes information on withdrawal syndromes, drug-drug interactions with the usual ICU drugs and hazardous drugs information according to the NIOSH list.

Conclusions

This app facilitates pharmacotherapeutic reconciliation process in the ICU, supporting healthcare professionals in making personalised decisions. Its use can optimise patient safety, reduce adverse events and improve critical patient care. Finally, this tool reinforces the role of the clinical pharmacist in the ICU, who must lead this process in all care transitions and adapt it to the clinical situation of the patient.

目的：药物调节是危重患者护理的一个重要过程，确保患者的慢性药物适应患者的临床情况，并在住院期间安全用药。考虑到入住重症监护病房（ICU）的患者的概况，这变得更加相关。和解最大限度地减少了可能的用药错误和不良反应，提高了危重病人的安全性。方法：该项目由西班牙医院药学学会（SEFH）的FarMIC（重症监护医学和重症监护药剂师）和RedFaster（紧急情况下的药学护理）小组牵头，于2021年至2024年开展，包括：药物的选择，审查类似应用领域的现有文献和以前的调解指南，根据工作组发布的建议准备药物信息，审查相同的信息和开发移动应用程序。结果：2024年10月，“危重患者调解指南®”app发布，iOS和Android平台免费。它提供了一个药物索引，其中包含药物重新引入时间表、给药途径、监测和药物特异性注意事项的详细信息。此外，该工具还包括有关戒断综合征的信息，与ICU常用药物的药物相互作用以及根据NIOSH清单的危险药物信息。结论：该应用程序促进了ICU的药物治疗和解过程，支持医疗保健专业人员做出个性化决策。它的使用可以优化患者安全，减少不良事件并改善危重患者护理。最后，该工具加强了ICU临床药师的作用，他们必须在所有护理过渡中领导这一过程，并使其适应患者的临床情况。

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引用次数: 0

Nuevos tratamientos para la enfermedad de Alzheimer: esperanza o desilusión 阿尔茨海默病的新疗法：希望还是失望？

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

FARMACIA HOSPITALARIA

Pub Date : 2025-11-01 DOI: 10.1016/j.farma.2025.06.004

Daniel Sevilla-Sánchez , Alejandro J. Garza-Martínez

引用次数: 0

Standarization and characterization of intravenous drug dilutions in critically ill pediatric patients 危重儿科患者静脉药物稀释度的标准化和特征。

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

FARMACIA HOSPITALARIA

Pub Date : 2025-11-01 DOI: 10.1016/j.farma.2025.08.005

Laura Torralba-Fernández , Marta García-Palomo , Miguel López de Abechuco-Ruiz , Natalia Ramos-Sánchez , Clara Jiménez-Méndez , Rocío Prieto-Galindo , María Carmen Lorenzo-Lozano , Pablo Aguado-Barroso

Objective

To standardize the drug dilutions administered intravenously in a Pediatric Intensive Care Unit and to characterize these dilutions based on their pH, osmolarity, and vesicant nature. This aims to guide the selection of the most appropriate vascular access device, minimizing associated complications, and preserving the patient's venous capital.

Methods

Through a consensus between Pharmacy and Pediatric Services, the most frequently administered intravenous drugs in the Pediatric Intensive Care Unit were selected. Two different dilutions were established for each drug, followed by the determination of their respective osmolarity and pH values. The vesicant nature of each drug was assessed according to the classification proposed by Clark et al. Additionally, vascular access device selection was guided by the algorithm proposed by Manrique et al., which considers the drug’s properties, the duration of intravenous therapy, and the patient's venous capital status.

Results

A total of 60 dilutions corresponding to 30 drugs from the following therapeutic groups were analyzed: antimicrobials (56%), antiepileptics (13%), sedatives (7%), diuretics (7%), anti-inflammatory and analgesics (7%), and others (10%). Twenty-five percent of the dilutions exhibited at least one high-risk factor for phlebitis (osmolarity > 600 mOsm/L or pH < 4 or > 9), while 35% were classified as intermediate risk (osmolarity 450–600 mOsm/L or pH 4–5 or > 7.5–9). Only 10% of the analyzed drugs were classified as vesicants (acyclovir, phenytoin, and vancomycin). Seventeen dilutions of nine different drugs were identified that should not be administered through a peripheral venous catheter, even in short-term treatments. Of these, 15 had a high risk of causing phlebitis, while 2 had an intermediate risk.

Conclusions

The physicochemical properties (osmolarity and pH) and vesicant nature of drugs are key factors contributing to the development of phlebitis in critically ill pediatric patients. Standardizing and characterizing drug dilutions will facilitate the selection of the most appropriate vascular access device, improving the safety and effectiveness of intravenous therapy.

目的：规范儿科重症监护室静脉给药的药物稀释度，并根据其pH值、渗透压和发泡剂性质对这些稀释度进行表征。目的是指导选择最合适的血管通路装置，尽量减少相关并发症，并保留患者的静脉资本。方法：通过药房和儿科部门之间的共识，选择儿科重症监护病房最常用的静脉注射药物。为每种药物建立两种不同的稀释度，然后测定其各自的渗透压和pH值。根据Clark等人提出的分类对每种药物的泡腾性进行评估。此外，血管通路装置的选择由Manrique等人提出的算法指导，该算法考虑了药物的性质、静脉治疗的持续时间和患者的静脉资本状态。结果：共分析了抗菌药（56%）、抗癫痫药（13%）、镇静剂（7%）、利尿剂（7%）、抗炎镇痛药（7%）和其他（10%）30种药物对应的60种稀释度。25%的稀释液至少表现出一种静脉炎的高风险因素（渗透压bbb600 mOsm/L或pH  9），而35%被归类为中等风险（渗透压450-600 mOsm/L或pH 4-5或 > 7.5-9）。只有10%的分析药物被归类为泡腾剂（阿昔洛韦、苯妥英和万古霉素）。9种不同药物的17种稀释度被确定为不应通过外周静脉导管施用，即使是在短期治疗中。其中，15人有引起静脉炎的高风险，2人有中等风险。结论：药物的理化性质（渗透压、pH）和泡沫性是导致小儿危重症患者静脉炎发生的关键因素。药物稀释度的标准化和特征化将有助于选择最合适的血管通路装置，提高静脉治疗的安全性和有效性。

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引用次数: 0

Influencia de la infección por SARS-CoV-2 en el uso de ceftazidima-avibactam en el paciente crítico SARS-CoV-2感染对危重患者头孢他啶-阿维巴坦使用的影响。

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

FARMACIA HOSPITALARIA

Pub Date : 2025-11-01 DOI: 10.1016/j.farma.2024.10.018

Fátima Mayo Olveira, José Manuel Caro Teller, María Dolores Canales Siguero, Sara Ortiz Pérez, María del Carmen Jiménez León, José Miguel Ferrari Piquero

Objective

The objective of the study was to analyse possible changes in antibiotic policy with ceftazidime-avibactam during the SARS-CoV-2 pandemic in an Intensive Care Unit (ICU) to determine patient mortality 28 days after initiation of antimicrobial therapy and to describe the microorganisms that most frequently colonise critically ill patients.

Material and method

Observational, single-centre, cohort study that included patients on treatment with ceftazidime-avibactam in ICU between March 2020 and September 2021. Demographic (age, sex), microbiological (colonisation, microorganisms isolated in blood cultures), pharmacotherapeutic (duration of treatment with ceftazidime-avibactam, antimicrobials used in synergy with ceftazidime-avibactam) and clinical (mortality, length of hospital stay and comorbidities) variables were collected. As associated comorbidities, we identified how many of the patients included in the study had diabetes mellitus (DM), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD) or obesity.

Results

Eighty-nine patients were included, 85.39% of whom were male. Forty-nine patients were infected with Sars-CoV-2. Median ICU stay was 46 days (RIQ = 58–27) in SARS-CoV-2 infected and 34 days (RIQ = 51–24) in non-infected patients. Patients were on ceftazidime-avibactam treatment for a median of 8 days (RIQ = 13–4), being 7 days (RIQ = 11–2) in COVID-19 positive patients and 11 days (RIQ = 14–6) in COVID-19 negative patients (p > 0.05). Empirical treatment with ceftazidime-avibactam was started empirically in 41.57% (n = 37) of the patients. The percentage of empiric initiations in SARS-CoV-2 infected patients was 43% and in non-infected patients 40%, with no statistically significant difference between empiric initiation according to SARS-CoV-2 diagnostic status (p > 0.05). A total of 43.8% (n = 39) of the patients were colonised by a multidrug-resistant (MDR) bacterium. Regarding on the microorganisms that colonised patients had, the most frequent was Klebsiella pneumoniae, present in 66.6% of patients (n = 26 patients). Overall mortality was 41.6%, with no statistically significant differences between SARS-CoV-2 infected and non-infected patients (42.9% and 40%, respectively; p > 0.05).

Conclusion

The SARS-CoV-2 pandemic did not lead to a change in the criteria for the use of ceftazidime-avibactam in the critically ill patient.

研究目的本研究旨在分析重症监护病房（ICU）在SARS-CoV-2大流行期间头孢他啶-阿维巴坦抗生素政策可能发生的变化，确定开始抗菌治疗28天后的患者死亡率，并描述重症患者最常定植的微生物：观察性、单中心、队列研究，包括2020年3月至2021年9月期间在重症监护室接受头孢他啶-阿维巴坦治疗的患者。研究收集了人口统计学变量（年龄、性别）、微生物学变量（定植、血液培养分离出的微生物）、药物治疗变量（头孢他啶-阿维巴坦的治疗时间、与头孢他啶-阿维巴坦协同使用的抗菌药物）和临床变量（死亡率、住院时间和合并症）。作为相关合并症，我们确定了有多少患者患有糖尿病（DM）、慢性肾病（CKD）、慢性阻塞性肺病（COPD）或肥胖症：共纳入 89 名患者，其中 85.39% 为男性。49名患者感染了Sars-CoV-2。SARS-CoV-2 感染者在重症监护室的中位住院时间为 46 天（RIQ = 58-27），非感染者为 34 天（RIQ = 51-24）。患者接受头孢他啶-阿维巴坦治疗的中位数为 8 天（RIQ = 13-4），COVID-19 阳性患者为 7 天（RIQ = 11-2），COVID-19 阴性患者为 11 天（RIQ = 14-6）（P > 0.05）。41.57%的患者（n = 37）开始使用头孢他啶-阿维巴坦进行经验性治疗。SARS-CoV-2感染者的经验性治疗启动率为43%，非感染者为40%，根据SARS-CoV-2诊断情况启动经验性治疗的差异无统计学意义（P > 0.05）。共有 43.8%（39 人）的患者定植了耐多药（MDR）细菌。关于定植患者所感染的微生物，最常见的是肺炎克雷伯菌，在 66.6% 的患者（n = 26 例）中存在。总死亡率为 41.6%，感染 SARS-CoV-2 和未感染 SARS-CoV-2 的患者之间没有明显的统计学差异（分别为 42.9% 和 40%；P > 0.05）：结论：SARS-CoV-2大流行并未改变重症患者使用头孢他啶-阿维菌素的标准。

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