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1.
Michele Bartoletti Sara Tedeschi Renato Pascale Luigi Raumer Alberto Enrico Maraolo Giulia Palmiero Fabio Tumietto Francesco Cristini Simone Ambretti Maddalena Giannella Russell Edward Lewis Pierluigi Viale 《International journal of antimicrobial agents》2018,51(3):516-521
Objectives
We hypothesised that treatment with a tigecycline-based antimicrobial regimen for intra–abdominal infection (IAI) could be associated with lower rates of subsequent carbapenem-resistant Enterobacteriaceae (CRE) colonisation or Clostridium difficile infection (CDI) compared with a meropenem-based regimen.Methods
We performed a retrospective, single-centre, matched (1:1) cohort analysis of all patients who received at least 5 days of empirical or targeted tigecycline (TIG)- or meropenem (MER)-based treatment regimens for IAI over a 50-month period. Patients with previous CRE colonisation and CDI were excluded. Risk factors for CRE and CDI were assessed with a Cox regression model that included treatment duration as a time-dependent variable. Thirty-day mortality was assessed with Kaplan-Meier curves.Results
We identified 168 TIG-treated and 168 MER-treated patients. The cumulative incidence rate ratio of CDI was 10-fold lower in TIG-treated vs. MER-treated patients (incidence rate ratio [IRR] 0.10/1000 patient-days, 95%CI 0.002–0.72, P?=?0.007), but similar incidence rates were found for CRE colonisation (IRR 1.39/1000 patient-days, 95%CI 0.68–2.78, P?=?0.36). In a multivariate Cox regression model, the receipt of a TIG- vs. MER-based regimen was associated with significantly lower rates of CDI (HR 0.07, 95%CI 0.03–0.71, P?=?0.02), but not CRE (HR 1.12, 95% CI 0.45–2.83, P?=?0.80). All-cause 30-day mortality was similar in the two groups (P?=?0.46).Conclusion
TIG-based regimens for IAI were associated with a 10-fold lower incidence of CDI compared with MER-based regimens, but there was no difference in the incidence of CRE colonisation. 相似文献2.
Abdullah T. Khoja Mohammad H. Aljawadi Sulaiman A. Al-Shammari Ashry G. Mohamed Hamad A. Al-Manaa Laura Morlock Saifuddin Ahmed Tawfik A.M. Khoja 《Saudi Pharmaceutical Journal》2018,26(2):292-300
Objectives
To Describe the Saudi older adult (SOA) characteristics and Introduce the Saudi National Survey for Elderly Health (SNSEH).Methods
The SNSEH, a population-based nationally-representative survey, was used. Subjects were included in 2006–2007, using random-cluster sampling utilizing probability proportional to size approach, and followed-up to determine their vital status until June 2015. In the analyses, survey weights were incorporated. Parametric, non-parametric and logistic regression were used. Cox-proportional hazard regression was used to determine gender effects on mortality.Results
We included 2,946 SOA. The mean age was 70.1(SD?=?0.3). Around, 70% were illiterate. Almost 50% had monthly income of 2500 (2007-Saudi-Riyals). The most reported diseases were hypertension, diabetes and joints pain. The most reported medications were over the counter, antidiabetics and antihypertensive. The nine-years age-adjusted death hazard was 42% higher in SOA males.Conclusion
This is an introductory paper for a series of papers that describe SOA health. These efforts will help in guiding the development of a national healthcare model for SOA, evidence-based health policies and public intervention programs that address SOA health-related issues. 相似文献3.
Maddalena Giannella Enrico Maria Trecarichi Daniele Roberto Giacobbe Francesco Giuseppe De Rosa Matteo Bassetti Alessandro Bartoloni Michele Bartoletti Angela Raffaella Losito Valerio del Bono Silvia Corcione Sara Tedeschi Francesca Raffaelli Carolina Saffioti Teresa Spanu Gian Maria Rossolini Anna Marchese Simone Ambretti Roberto Cauda Mario Tumbarello 《International journal of antimicrobial agents》2018,51(2):244-248
Objectives
To evaluate the impact of high-dose (HD) carbapenem-based combination therapy on clinical outcome in patients with monomicrobial carbapenem-resistant Klebsiella pneumoniae (CR-KP) bloodstream-infection (BSI).Methods
Post hoc analysis of all adult patients with CR-KP BSI who were treated with a combination antibiotic regimen, collected over a six-year period in six large Italian teaching hospitals. To control for confounding effects of HD carbapenem combination on 14-day mortality, a multivariate Cox regression analysis was performed. Due to imbalances between patients, a propensity score for receiving HD carbapenem was added to the model.Results
595 patients with CR-KP BSI were analysed, 77% of isolates showed a carbapenem MIC ≥16?mg/L, 428 (71.9%) received HD carbapenem-based combination therapy. Overall, 127 patients (21.3%) died within 14 days after BSI onset. Multivariate analysis showed the Charlson comorbidity index (HR 1.31, 95%CI 1.20–1.43, P?<0.001), septic shock at BSI onset (HR 3.14, 95%CI 2.19–4.50, P?<0.001), and colistin-resistant strain (HR 1.52, 95%CI 1.02–2.24, P?=?0.03) were independently associated with 14-day mortality, whereas admission to surgical ward (HR 0.44, 95%CI 0.25–0.78, P?=?0.005) and HD carbapenem use (HR 0.69, 95%CI 0.47–1.00, P?=?0.05) were protective factors. When adjusted for the propensity score, HD carbapenem use showed a greater protective effect (HR 0.64, 95%CI 0.43–0.95, P?=?0.03). Stratifying the model for carbapenem MIC, the benefit of HD carbapenem was also observed for strains with carbapenem MIC ≥16?mg/L.Conclusions
In patients receiving combination therapy for CR-KP BSI, the use of HD carbapenem seems to be associated with better outcome, even in the presence of high-level carbapenem resistance. 相似文献4.
Konstantinos Z. Vardakas Andreas D. Mavroudis Maria Georgiou Matthew E. Falagas 《International journal of antimicrobial agents》2018,51(4):535-547
Background
To evaluate whether intravenous colistin in combination with other antibiotics (IVCC) is associated with lower mortality compared with intravenous colistin monotherapy (IVCM), and to identify factors influencing study outcomes.Methods
PubMed and Scopus were searched up to November 2016. Studies were included if they evaluated adult patients with multi-drug-resistant (MDR) or extensively-drug-resistant Gram-negative infections, and reported comparative mortality data (adjusted and unadjusted) for patients receiving IVCC vs. IVCM. Random effects meta-analyses were performed.Findings
Thirty-two studies (29 observational, three randomized) were included. The overall quality of data was low to very low, and studies were characterized by the lack of adjusted data. The majority of studies were not designed to evaluate the outcome of the meta-analysis, and focused mainly on infections due to Acinetobacter baumannii and Klebsiella pneumoniae. Colistin was administered at variable doses, with or without a loading dose, and in combination with several antibiotics. Overall, IVCC was not associated with lower mortality than IVCM [32 studies, 2328 patients, risk ratio (RR) 0.91, 95% confidence interval (CI) 0.81–1.02, I2 8%]. A significant difference was observed in favour of IVCC when high-dose (>6 million international units) colistin was used (RR 0.80, 95% CI 0.69–0.93), in studies conducted in Asia (RR 0.82, 95% CI 0.71–0.95), in patients with bacteraemia (RR 0.75, 95% CI 0.57–0.98) and in patients with acinetobacter infections (RR 0.88, 95% CI 0.78–1.00).Interpretation
Overall, low-quality data suggest that IVCC did not lower mortality in patients with MDR Gram-negative infections. However, there is some evidence for a benefit observed with high intravenous doses of colistin. 相似文献5.
Maha Meshal AlRasheed 《Saudi Pharmaceutical Journal》2018,26(8):1199-1203
Background
Coronary heart disease (CAD) is a multiple with several contributory risk traits, including type 2 diabetes and hypertension, which may share common genetic risk variants with the disease. Genome-wide association studies (GWASs) have yielded a wealth of information suggesting that CAD, the extent of contributory variants may differ according to genetic locus. The present study aimed at verifying whether the cyclin-dependent kinase 4 inhibitor B (CDKN2B) genomic region strongly associated with coronary artery disease (CAD)/myocardial infarction (MI) may also constitute risk for its risk factors type 2 diabetes mellitus (T2DM) and hypertension (HTN) in ethnic Saudi Arabs.Methodology
We genotyped eight CDKN2B SNPs for cardiovascular risk in a total of 4650 Saudi Arabs, (3049 male and 1601 female) by Taqman assay. Of these individuals, 3732 had primary hypertension and 2576 had type 2 diabetes mellitus.Results
Out of the eight studied SNPs, two, rs10757274_A [0.915 (0.840–1.00); p?=?0.042], rs1333045_T [0.92(0.84–1.00); p?=?0.048] were initially associated with type 2 diabetes but lost the association after multivariate adjustments for CAD, hypertension and MI, while rs10757274_A showed borderline association with hypertension.Conclusions
Our finding does not support the notion of a critical role for the CDKN2B gene locus as a HTN or T2DM cardiovascular risk in ethnic Arabs. The study also demonstrates the importance of replication studies in ascertaining the role of a genomic sequence in disease. 相似文献6.
7.
Introduction
Adverse drug reactions (ADRs) are a major global clinical problem, causing substantial mortality and morbidity especially in hospitals. Healthcare professionals (HCPs) knowledges’, attitude and practices are crucial points to evaluate the hospital safety environment. Objective of the study was to investigate the knowledge, attitudes, and practices of HCPs regarding the ADRs reporting system.Methods
A cross-sectional survey was conducted between January and February of 2013 in nine tertiary care hospitals (governmental and private) that provide highly specialized medical services in Riyadh, Qassim, and the Eastern region of the Kingdom of Saudi Arabia. A validated questionnaire was used to assess the knowledge, attitudes, and practices of HCPs regarding the ADR reporting system. All statistical analyses were performed using SAS version 9.2.Results
In total, 480 questionnaires were distributed, and the response rate was 70% (n?=?336). Only 33% of the participants were aware of the National Pharmacovigilance Centre (NPC). Of those HCPs who were familiar with the NPC and their responsibility to report ADRs, most (50%) were pharmacists, followed by physicians (24%) and nurses (16%), and these differences were statistically significant (p?<?0.01). Twenty-seven percent of the participants were involved in reporting ADRs; among these HCPs, 62% were pharmacists, 26% were nurses, and 6% were physicians. Most participants (95%) favoured reporting ADRs caused by antibiotics and new/old drugs. The prominent factors discouraging ADR reporting included fear that the report might be incorrect (46%) and lack of time (44%).Conclusions
A significant lack of knowledge, positive attitudes, and practices regarding ADRs and reporting was observed in hospital HCPs. This finding represents an international concern, and urgent action is needed to promote drug safety and pharmacovigilance in this region. 相似文献8.
9.
Ahmad Al-Azayzih Sara Gharaibeh Anan S. Jarab Tareq L. Mukattash 《Saudi Pharmaceutical Journal》2018,26(8):1146-1154
Background
Torsade de Pointes (TdP) is an abnormal cardiac rhythm associated with a prolongation of QT interval. Although in most cases it spontaneously returns to the normal rhythm, TdP can lead to sudden cardiac death. Medications are the main cause of QT-prolongation and subsequent TdP flare, even though the exact mechanism of why some people evoke TdP but others do not is still unknown. It is evident that elderly patients are more susceptible to experience drug's side effects especially with chronically used medications.Objectives
To describe the pattern of prescribing drugs with risk of Torsade’s de Pointes among elderly patients who were visiting different outpatient clinics in North Jordan Hospitals.Methods
All patients who were aged ≥65?years old and were visiting outpatient clinics in King Abdullah University Hospital (KAUH) and Princess Basma Hospital (PBH) through December 2016 were included in the study. A total of 5319 patients’ dispending records were collected and analyzed for the prevalence of drug-induced TdP using both Microsoft Excel and the SPSS statistical software.Results
A total of 5319 patients were included in the study, more than half (58.5%, n?=?3114) of patients were consuming drugs with risk of TdP. Almost half (49.4%, n?=?1539) of these patients were women. The majority of patients (62.3%, n?=?1939) were using only one drug with TdP risk. However, other patients were found to take five or six different TdP-inducing drugs. Excluding age and gender, 94.3% (n?=?2937) of patients who were using TdP-inducing drugs had at least one additional risk factor of inducing TdP.Conclusion
High usage of TdP-inducing drugs among geriatric patients in North Jordan demonstrated the urgent need for increasing awareness of TdP’s risk induced by commonly prescribed medications. 相似文献10.
Ashraf El-Metwally 《Saudi Pharmaceutical Journal》2018,26(5):629-633
Background
Pharmacoepidemiology is the concept used for evaluating the impact of drugs among a large number of people in the post-marketing phase. The use of this concept makes it increasingly necessary to detect the recurrence of drug-related anomalies that mostly occur through health care professionals or patients themselves. Pharmacoepidemiology is important since it helps to provide the right balance of benefits versus risks of the drug products while remaining an excellent tool to prepare the risk/benefit balance profile.Aim
The objective of this study is to review and explore the current status and future prospects of pharmacoepidemiology and post-marketing surveillance in Saudi Arabia.Methods
A literature review has been conducted using keywords such as pharmacoepidemiology’; ‘post-marketing’; ‘surveillance’; ‘Saudi Arabia’; ‘ADRs’; and ‘pharmacovigilance’. The study refines its focus on 13 pharmacoepidemiology and post-marketing surveillance research studies conducted in Saudi Arabia using the databases; Embase, PubMed, EBSCOhost, MEDLINE, and AMED.Results
Pharmacoepidemiology and post-marketing surveillance creates a body of research in Saudi Arabia, but within a restricted scope. The studies that were reviewed assessed the challenge from various perspectives. Lack of knowledge, post-marketing surveillance, ADR reporting, and increased use of generic products were reported.Conclusion
The current level of research may be widened and increased through improving the process of ADRs reporting system. More research needs to be conducted based on nation-wide observational studies. Collaboration among medical professionals, academics and industries should continue to establish a more efficient and consistent post-marketing surveillance system. 相似文献11.
Aisha F. Badr Sawsan Kurdi Samah Alshehri Claire McManus Jeannie Lee 《Saudi Pharmaceutical Journal》2018,26(8):1204-1207
Background
Hospitalization can contribute to insomnia in many patients and is usually treated symptomatically. However, sedative/hypnotic misuse is associated with complications in this population, especially in the elderly. Such complications include dizziness, falls and over-sedation. Due to the implicit dangers, widespread use of these drugs for insomnia, particularly in older patients, has been discouraged by many hospitals. The aim of this study was to review and evaluate prescribing patterns and to optimize the use of the sedative/hypnotic agents through daily pharmacy interventions at a community hospital.Methods
This was a biphasic before and after study. Data on sedative/hypnotic use was collected retrospectively for a 2-month period and a sample of 100 patients was randomly selected for analysis. A 2-month prospective phase followed, in which daily orders were reviewed by one pharmacy resident and recommendations made to discontinue any unnecessary, newly prescribed sedative/hypnotic orders when appropriate. Finally, results of both phases were compared for any differences in patient demographics, being prescribed more than one sedative/hypnotic, and complications documented.Results
During the prospective phase, pharmacist interventions led to the discontinuation of 25% of a total of 97 sedative/hypnotic orders in 97 patients. The number of patients receiving more than one sedative/hypnotic agents in the intervention group was significantly lower than the retrospective control group (15 Vs. 34, P?=?0.0026). The incidence of complications was not significantly different between the control and intervention groups for the following: over-sedation, falls and delirium (p?=?0.835, p?=?0.185, p?=?0.697, respectively).Conclusion
This study suggests that the use of sedative/hypnotics in the inpatient units (excluding the critical care unit), is somewhat prevalent, and many patients may be on more than one sedative/hypnotic, which could potentially cause cumulative harm. During the intervention phase, 25% of the total in-hospital orders for sedative/hypnotics were discontinued following recommendations made by a pharmacist, and significantly lower number of patients receiving duplicate sedative/hypnotics was noted. Further efforts should be implemented to avoid unnecessary sedative/hypnotic initiation in hospitalized patients, and to ensure monitoring by pharmacists is optimized. 相似文献12.
Purpose
Quinolones, and the fluoroquinolones subgroup, are a class of antibiotics commonly used for the treatment of a wide variety of infections. However, their safety profile in pregnant women is controversial. The association between fluoroquinolones and arthropathy was primarily described in immature animals, and only rarely in humans, yet it has led to the restricted use of quinolones during pregnancy. We aimed to assess their safety during pregnancy.Methods
A systematic review and meta-analysis assessing the safety of quinolone exposure during any time of pregnancy, and during first trimester alone, was performed. The systematic review was performed using MEDLINE and EMBASE, and followed the PRISMA guidelines. Pooled effect sizes with corresponding 95% confidence intervals (CI) were calculated using random effects models, comparing fetal outcomes of quinolone exposed and non-exposed pregnancies. Only cohort and case control studies were included in the meta-analysis.Result
Twelve studies met the inclusion criteria. Exposure to quinolones during first trimester was not associated with an increased risk for birth defects (pooled odds ratio (OR)?=?0.89, 95% CI 0.72–1.09, I2 =?0%), stillbirth (OR?=?1.32, 95% CI 0.33–5.34, I2 =?16%), preterm birth (OR?=?1.10, 95% CI 0.83–1.48, I2 =?41%) and low birth weight (OR?=?1.29, 95% CI 0.54–3.12, I2 =?67%).Conclusion
The use of quinolones during the first-trimester of pregnancy was not associated with an increased risk of birth defects, stillbirths, preterm births or low birth weight.Study Registry
PROSPERO CRD42017060573.13.
14.
Naleen Raj Bhandari Niranjan Kathe Corey Hayes Nalin Payakachat 《Research in social & administrative pharmacy》2018,14(11):1080-1084
Background
The SF-12v2 has been validated in general population and other conditions but the evidence is limited in Americans with cancer.Objective
To assess reliability and validity of SF-12v2 among adults with self-reported cancer using the Medical Expenditure Panel Survey (MEPS).Methods
Self-reported cancer participants (SCPs) were identified from 2003 MEPS. SF-12v2 was administered as part of self-administered questionnaires. Physical (PCS12) and mental (MCS12) component scores of SF-12v2 were evaluated for reliability (internal consistency, test-retest) and validity (convergent, discriminant, predictive, concurrent).Results
420 SCPs were identified with average age of 59.3 years (SE?=?0.9). 10.7% had multiple cancers (>1) and 52% had at least one other chronic condition (OCC). Average PCS12 and MCS12 were 45.09 (SE?=?0.5) and 50.75 (SE?=?0.5). PCS12 and MCS12 demonstrated high internal consistency (αPCS12?=?0.89; αMCS12?=?0.88), acceptable test-retest reliability (ICCPCS12?=?0.82; ICCMCS12?=?0.73), strongly correlated with most of the expected EQ-5D domains (r?=?0.51–0.71), and demonstrated strong convergent validity on perceived health (r?=?0.61) and perceived mental health (r?=?0.52). PCS12 and MCS12 were able to discriminate between groups with and without physical/cognitive limitations. Only PCS12 was negatively correlated with number of OCCs.Conclusion
The SF-12v2 is a reliable and valid instrument to quantify health-related quality of life among adults with self-reported cancer. 相似文献15.
16.
Konstantinos Z. Vardakas Georgios L. Voulgaris George Samonis Matthew E. Falagas 《International journal of antimicrobial agents》2018,51(1):1-9
Background
Inhaled colistin is becoming increasingly popular against respiratory tract infections caused by multidrug resistant (MDR) Gram-negative bacteria because it may overcome the problems associated with intravenous (IV) administration.Objective
To investigate the effectiveness and safety of inhaled colistin as monotherapy (without concomitant IV administration of colistin) in the treatment of respiratory tract infections caused by MDR or colistin–only susceptible Gram–negative bacteria.Methods
PubMed and Scopus databases were searched. A systematic review and meta-analysis were conducted.Results
Twelve studies (373 patients receiving inhaled colistin for respiratory tract infection) were included. Ten studies evaluated patients with pneumonia (including 8 studies with ventilator-associated pneumonia) and 2 studies evaluated patients with ventilator-associated tracheobronchitis. Patients with infections due to MDR Acinetobacter baumannii and Pseudomonas aeruginosa were mainly studied. Daily dose of inhaled colistin and treatment duration varied in the individual studies. The pooled all-cause mortality was 33.8% (95% CI 24.6% – 43.6%), clinical success was 70.4% (58.5% – 81.1%) and eradication of Gram-negative bacteria was shown in 71.3% (57.6% – 83.2%) of cases.Conclusions
Inhaled colistin monotherapy may deserve further consideration as a mode for colistin administration for the treatment of respiratory tract infections caused by MDR A. baumannii and P. aeruginosa. 相似文献17.
18.
Abubakr A. Alfadl Alian A. Alrasheedy Musaad S. Alhassun 《Saudi Pharmaceutical Journal》2018,26(2):258-262
Introduction
Pharmacists have a unique opportunity to promote good health through assuring the quality use of medicines. One of the most important tools to achieve this is medication counseling. Counseling plays an important role in enhancing medication adherence and optimizing medication therapy. Therefore, for improving the quality of services delivered by community pharmacists, it is essential to assess the current situation of counseling services delivered to patients.Aims and objectives
To date, there is a paucity of data regarding the quality of counseling services delivered to patients in community pharmacies in Saudi Arabia. This study aims to fill this gap through evaluating the counseling skills and counseling content delivered by pharmacists in a sample of community pharmacies in Qassim region, Saudi Arabia.Methods
The study was conducted at eleven community pharmacies in Qassim region. A convenient sample of community pharmacies was chosen based on their willingness to participate. To gather information, a form was prepared based on the core and complementary drug use indicators for evaluation of drug use in healthcare settings developed by the WHO. The study was conducted through observing the counseling services performed by the community pharmacists who participated in the study.Results
Two hundred and thirty-five forms were completed in eleven community pharmacies. A total of 44.4% of the counseling skills was found to be performed adequately, while only 20.1% of the counseling contents were performed adequately.Conclusions
The overall standard of medication counseling services provided to patients to improve usage of their medications, and consequently, their well-being was poor. 相似文献19.
Eyal Kleinhendler Matan J. Cohen Allon E. Moses Ora Paltiel Jacob Strahilevitz Amos Cahan 《International journal of antimicrobial agents》2018,51(1):71-76