The Canadian journal of hospital pharmacy最新文献

Background: Opioids are known to induce delirium, and the incidence of delirium induced by individual opioids has been investigated. However, only a limited number of studies have examined the incidence of delirium induced by oral hydromorphone.

Objective: To investigate whether differences exist in the incidence of delirium associated with oral morphine and oral hydromorphone during the initiation phase of treatment.

Methods: The participants were opioid-naive inpatients with cancer who started oral morphine or oral hydromorphone at Shizuoka Cancer Center (in Shizuoka, Japan) between June 2017 and November 2020. The incidence of delirium in the first week of opioid use was compared between the 2 groups.

Results: A total of 90 patients met the inclusion criteria, 27 who received oral hydromorphone and 63 who received oral morphine. The incidence rate of delirium in the oral hydromorphone group tended to be higher (19%, 5/27) than in the oral morphine group (8%, 5/63), although the difference was not statistically significant (odds ratio 0.4, 95% confidence interval, 0.1-1.4, p = 0.16 by the Fisher exact test). Propensity score matching was used to control for differences in patient background as confounders in the development of delirium, following which the incidence rate of delirium remained higher, but not significantly so, in the oral hydromorphone group (11%, 2/19) than in the oral morphine group (5%, 1/19) (odds ratio 0.5, 95% confidence interval 0.04-5.7, p > 0.99 by the Fisher exact test).

Conclusions: There was no statistically significant difference in the incidence of delirium between those who received morphine and those who received hydromorphone, which suggests that for opioid-naive inpatients with cancer, oral hydromorphone can be used in a manner similar to that for oral morphine.

Background: Pregnant people, especially those with diabetes mellitus or hypertension, are particularly vulnerable to adverse drug reactions (ADRs).

Objective: To determine the incidence of and factors associated with ADRs in hospitalized pregnant people with diabetes and/or hypertension.

Methods: This prospective cohort study involved pregnant people with diabetes and/or hypertension admitted to a maternity hospital in Natal, Brazil, between August 2019 and July 2022. Data for various patient characteristics and the occurrence of ADRs were collected by means of interviewing patients and searching their medical charts. Multivariate logistic regression was used to identify and analyze the association of ADRs with various patient characteristics and other factors.

Results: A total of 571 pregnant people met the inclusion criteria. Over the study period, the incidence rate of ADRs was 634.4 (95% confidence interval [CI] 522.7-787.1) per 1000 patient-days, with 123 (21.5%) of the patients experiencing at least 1 incident. ADRs occurred predominately in the first 24 hours, with a marked decrease in frequency to the seventh day of admission. Methyldopa was identified as the cause in 42.1% (8/19) of cases of headache and 39.5% (17/43) of cases of sedation. Systemic corticosteroids were responsible for almost all cases of hyperglycemia (97.0% [32/33]). Blurred vision (82.4% [14/17]) and sedation (14.0% [6/43]) were related to the administration of antiemetics and antinauseants, especially scopolamine. Longer hospitalization time (OR 1.052, 95% CI 1.010-1.097, p = 0.016) and greater number of prescribed medications (OR 1.200, 95% CI 1.099-1.310, p < 0.001) were related to the occurrence of ADRs.

Conclusions: In this study, 1 of every 5 hospitalized pregnant people had at least 1 ADR, most often in the first 24 hours, with a decrease in incidence in the following days. Pregnant people with longer hospital stays and a greater number of medications had a higher risk of ADRs.

Background: Antimicrobial use data from inpatients in northern Canada suitable to inform stewardship programs are limited.

Objective: As a special project of the Canadian Nosocomial Infection Surveillance Program, to describe antimicrobial use for inpatients in northern Canadian acute care hospitals.

Methods: Participating acute care hospitals serving adult or mixed adult and pediatric populations in northern Canada submitted annual data on the use of all systemic antimicrobials from 2019 to 2021. Patient-day denominators were also submitted. Northern Canada was defined as the territories and Statistics Canada's provincial north. Data were analyzed in terms of defined daily doses per 1000 patient days (DDD/1000pd), as per the Anatomical Therapeutic Chemical classification system. Antimicrobials were categorized using the World Health Organization's AWaRe (Access/ Watch/Reserve) classification system.

Results: Each year, 42-47 hospitals participated. More than 90% of participating hospitals were in Alberta or British Columbia. There was large variation in overall antimicrobial use between hospitals (e.g., interquartile range 429 to 779 DDD/1000pd in 2021). From 2019 to 2021, there was a 49% relative increase in antimicrobial use, from 401 to 596 DDD/1000pd (p = 0.11). Over the same period, the use of third- and first-generation cephalosporins increased by 80% and 64%, respectively; antimicrobials in the "Reserve" category increased from 0.4% to 2% of overall use.

Conclusions: This study represents the largest collection of antimicrobial use data for inpatients in northern Canada to date. From 2019 to 2021, there was an increase in antimicrobial use of 195 DDD/1000pd, largely driven by increases in the use of third- and first-generation cephalosporins. The findings should be interpreted with caution, as results may not be generalizable to all northern hospitals.