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Legros S, Vanoverschelde A, van Krieken J, Debaveye Y, Versporten A, Huis In 't Veld D, Westelinck V, Briquet C, Vercheval C, Spriet I, Denis O, Magerman K, De Schepper M, Buyle F. Development of quality indicators for antimicrobial stewardship in Belgian hospitals: a RAND - modified Delphi procedure. Acta Clin Belg 2024; 79:77-86. [PMID: 38146874 DOI: 10.1080/17843286.2023.2297123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Inappropriate antibiotic use is a major cause of antibiotic resistance. Therefore, optimizing antibiotic usage is essential. In Belgium, optimization of antimicrobials for the fight against multidrug resistant organisms (MDROs) is followed up by national surveillance by public health authorities. To improve appropriate antimicrobial use in hospitals, an effective national Antimicrobial Stewardship (AMS) program should include indicators for measuring both the quantity and quality of antibiotic use. OBJECTIVES The aim of this study was to develop a set of process quality indicators (QIs) to evaluate and improve AMS in hospitals. METHODS A RAND-modified Delphi procedure was used. The procedure consisted of a structured narrative literature review to select the QIs, followed by two online questionnaires and an intermediate multidisciplinary panel discussion with experts in infectious diseases from general and teaching hospitals in Belgium. RESULTS A total of 38 QIs were selected after the RAND-modified Delphi procedure, from which 11 QIs were selected unanimously. These QIs address compliancy of antibiotic therapy and prophylaxis with local guidelines, documentation of the rationale for antibiotic treatment in the medical record, the availability of AMS Programs and Outpatient Parenteral Antibiotic Therapy, resistance patterns and antimicrobial prescribing during focused ward rounds. CONCLUSION Our study selected 38 relevant process QIs, from which 11 were unanimously selected. The QIs can contribute to the improvement of quality of antibiotic use by stimulating hospitals to present better outcomes and by providing a focus on how to intervene and to improve prescribing of antimicrobials.
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Affiliation(s)
- Sylvie Legros
- Pharmacy Department, Europe Hospitals, Brussels, Belgium
- Department of Antimicrobial Stewardship, Antimicrobial Stewardship, Europe Hospitals, Brussels, Belgium
| | - Anna Vanoverschelde
- Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium
| | | | - Yves Debaveye
- Department of Intensive Care Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Ann Versporten
- Belgian Antibiotic Policy Coordination Commission (BAPCOC), Quality and Patient Safety, Direction General Healthcare, Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Diana Huis In 't Veld
- Department of Internal Medicine and Infectious Diseases, University Hospital Ghent, Ghent, Belgium
| | - Veerle Westelinck
- Department of Pharmacy, AZ Sint-Maarten, Mechelen, Belgium
- Antimicrobial Stewardship, AZ Sint-Maarten, Mechelen, Belgium
| | - Caroline Briquet
- Antimicrobial Stewardship, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
- Pharmacy Department, Cliniques Universitaires, Saint-Luc, UCLouvain, Brussels, Belgium
| | - Christelle Vercheval
- Department of Antimicrobial Stewardship, Hospital Outbreak Support Team (HOST), H.uni network, Brussels, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Olivier Denis
- Laboratory of microbiology, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Koen Magerman
- Department of Laboratory Medicine, Jessa Ziekenhuis vwz, Hasselt, Belgium
| | | | - Franky Buyle
- Pharmacy Department, Ghent University Hospital, Ghent, Belgium
- Antimicrobial Stewardship, Ghent University Hospital, Ghent, Belgium
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Thirot H, Fage D, Leonhardt A, Clevenbergh P, Besse-Hammer T, Yombi JC, Cornu O, Briquet C, Hites M, Jacobs F, Wijnant GJ, Wicha SG, Cotton F, Tulkens PM, Spinewine A, Van Bambeke F. Towards a better detection of patients at-risk of linezolid toxicity in clinical practice: a prospective study in three Belgian hospital centers. Front Pharmacol 2024; 15:1310309. [PMID: 38313312 PMCID: PMC10834751 DOI: 10.3389/fphar.2024.1310309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction: Linezolid is a last-resort antibiotic for infections caused by multidrug-resistant microorganisms. It is widely used for off-label indications and for longer than recommended treatment durations, exposing patients at higher risk of adverse drug reactions (ADRs), notably thrombocytopenia. This study aimed to investigate ADR incidence and risk factors, identify thrombocytopenia-related trough levels based on treatment duration, and evaluate the performance of predictive scores for ADR development. Methods: Adult in- and outpatients undergoing linezolid therapy were enrolled in three hospitals and ADRs and linezolid trough levels prospectively monitored over time. A population pharmacokinetic (pop-PK model) was used to estimate trough levels for blood samples collected at varying times. Results: A multivariate analysis based on 63 treatments identified treatment duration ≥10 days and trough levels >8 mg/L as independent risk factors of developing thrombocytopenia, with high trough values correlated with impaired renal function. Five patients treated for >28 days did not develop thrombocytopenia but maintained trough values in the target range (<8 mg/L). The Buzelé predictive score, which combines an age-adjusted Charlson comorbidity index with treatment duration, demonstrated 77% specificity and 67% sensitivity to predict the risk of ADR. Conclusion: Our work supports the necessity of establishing guidelines for dose adjustment in patients with renal insufficiency and the systematic use of TDM in patients at-risk in order to keep trough values ≤8 mg/L. The Buzelé predictive score (if ≥7) may help to detect these at-risk patients, and pop-PK models can estimate trough levels based on plasma samples collected at varying times, reducing the logistical burden of TDM in clinical practice.
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Affiliation(s)
- Hélène Thirot
- Pharmacologie cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Clinical Pharmacy, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - David Fage
- Department of Clinical Chemistry, Laboratoire hospitalier universitaire de Bruxelles (LHUB-ULB), Brussels, Belgium
| | - Antonia Leonhardt
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hambourg, Germany
| | | | | | - Jean Cyr Yombi
- Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Olivier Cornu
- Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Caroline Briquet
- Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Maya Hites
- Hôpitaux universitaires de Bruxelles-Erasme (HUB), Université libre de Bruxelles, Brussels, Belgium
| | - Frédérique Jacobs
- Hôpitaux universitaires de Bruxelles-Erasme (HUB), Université libre de Bruxelles, Brussels, Belgium
| | - Gert-Jan Wijnant
- Pharmacologie cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Sebastian G Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hambourg, Germany
| | - Frédéric Cotton
- Department of Clinical Chemistry, Laboratoire hospitalier universitaire de Bruxelles (LHUB-ULB), Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Anne Spinewine
- Clinical Pharmacy, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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Tossens B, Barthelme P, Briquet C, Belkhir L, Ngyuvula E, Soumillion K, Verroken A, Rodriguez-Villalobos H, Delmée M, Anantharajah A. Impact of the COVID-19 pandemic on Clostridioides difficile infection in a tertiary healthcare institution in Belgium. Acta Clin Belg 2023; 78:459-466. [PMID: 37608759 DOI: 10.1080/17843286.2023.2250624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Clostridioides difficile infection (CDI) causes the greatest number of healthcare-associated infectious diarrhoea. CDIs are transmitted by direct and indirect patient-to-patient contact and risk increases with the use of antibiotics. Since early 2020, the COVID-19 pandemic has affected healthcare systems in many ways including substantial changes in hygiene behaviour. The aim of this study was to assess whether CDI incidence differed during the COVID-19 pandemic compared to a year before. METHODS All tests for suspected CDI cases were recorded for a hospital in Brussels, Belgium. The percentage of CDI-positive results and incidences (total and healthcare-associated (HA)-CDI)) for years 2019, 2020, 2021, and 2022 were calculated. Antibiotic consumption was analysed for years 2019 and 2020. RESULTS Since the COVID-19 pandemic struck, a significant reduction of up to 39% was observed in the number of Clostridioides difficile stool tests in our hospital. A significant decrease in the percentage of positive tests and a 50% decrease in the incidence of CDI (total and HA-CDI) was found for 2020 compared with 2019 and confirmed for years 2021 and 2022. The decrease in CDI incidence was mostly marked in haematology, nephrology, and gastroenterology units. No significant change in the use of antibiotics was found. CONCLUSION The global decrease in CDI incidence observed in our hospital was not associated with a change in the use of antibiotics. The control measures implemented to prevent COVID-19 transmission may explain a reduction in CDI incidence. An underdiagnosis of CDI cannot be excluded.
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Affiliation(s)
- Bastien Tossens
- Department of Clinical Microbiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Philippe Barthelme
- Department of Pharmacy, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Caroline Briquet
- Department of Pharmacy, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Leila Belkhir
- Department of Internal Medicine and Infectious Diseases, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Eléonore Ngyuvula
- National Reference Center Clostridioides difficile, Microbiology Unit, Université Catholique de Louvain, Brussels, Belgium
| | - Kate Soumillion
- National Reference Center Clostridioides difficile, Microbiology Unit, Université Catholique de Louvain, Brussels, Belgium
| | - Alexia Verroken
- Department of Clinical Microbiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Michel Delmée
- National Reference Center Clostridioides difficile, Microbiology Unit, Université Catholique de Louvain, Brussels, Belgium
| | - Ahalieyah Anantharajah
- Department of Clinical Microbiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- National Reference Center Clostridioides difficile, Microbiology Unit, Université Catholique de Louvain, Brussels, Belgium
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Dufour I, Devresse A, Scohy A, Briquet C, Georgery H, Delaey P, Greef JD, Goffin E, Labriola L. Safety and efficiency of molnupiravir for COVID-19 patients with advanced chronic kidney disease. Kidney Res Clin Pract 2023; 42:275-278. [PMID: 37037486 PMCID: PMC10085722 DOI: 10.23876/j.krcp.22.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/27/2022] [Indexed: 04/03/2023] Open
Affiliation(s)
- Inès Dufour
- Department of Nephrology, Saint-Luc University Clinics, Brussels, Belgium
| | - Arnaud Devresse
- Department of Nephrology, Saint-Luc University Clinics, Brussels, Belgium
| | - Anais Scohy
- Department of Microbiology, Saint-Luc University Clinics, Brussels, Belgium
| | - Caroline Briquet
- Department of Pharmacy, Saint-Luc University Clinics, Brussels, Belgium
| | - Hélène Georgery
- Department of Nephrology, Saint-Luc University Clinics, Brussels, Belgium
| | - Philippe Delaey
- Department of Nephrology, Saint-Luc University Clinics, Brussels, Belgium
| | - Julien De Greef
- Department of Internal Medicine and Infectious Disease, Saint-Luc University Clinics, Brussels, Belgium
| | - Eric Goffin
- Department of Nephrology, Saint-Luc University Clinics, Brussels, Belgium
| | - Laura Labriola
- Department of Nephrology, Saint-Luc University Clinics, Brussels, Belgium
- Correspondence: Laura Labriola Department of Nephrology, Cliniques Universitaires Saint-Luc, Av. Hippocrate 10, Brussels 1200, Belgium. E-mail:
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Briquet C, Khaouch Y, Yombi JC. Perceptions, attitudes, and practices of a Belgian teaching hospital's physicians, pharmacists, and nurses regarding antibiotic use and resistance: survey towards targeted actions for Antimicrobial Stewardship. Antimicrob Resist Infect Control 2023; 12:19. [PMID: 36934291 PMCID: PMC10024823 DOI: 10.1186/s13756-023-01228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 03/10/2023] [Indexed: 03/20/2023] Open
Abstract
OBJECTIVES This study aimed to identify barriers to the proper use of antibiotics by healthcare professionals and to help the hospital Antimicrobial Stewardship develop suitable actions for the staff. METHODS In a Belgian teaching hospital, a survey was conducted among physicians, pharmacists, and nurses involved in antibiotherapy. Questions from the 2019 European Center for Disease Prevention and Control (ECDC) survey were analyzed based on components of the COM-B model (capabilities, opportunities, and motivations). First, collected data were reviewed with the Ethnos software to analyze the different COM-B model components. For statistical analyses, responses were grouped into three clear-cut answers in a Fisher's exact test. RESULTS Overall, 400 staff members were included. We found that our professions, combined, have a good perception of antibiotic resistance (97.8%). For capabilities, however, only 77.2% state that they have sufficient knowledge, with 91.3%, 71.5%, and 63.0% for physicians, nurses, and pharmacists, respectively. For opportunities (access to resources, information, and training), it is observed that 72.2% report having easy access to the guidelines they need to manage infections. In comparison, for 64.2% of the respondents, this information changed their opinion on the useless or inappropriate prescription, administration, and delivery of antibiotics. For 55.0%, this information has enabled them to change their practices. Finally, for motivations, 92.8% of respondents state that they know about the link between their practices and the emergence and spread of antibiotic resistance. However, only 65.0% of participants say they have a role in managing antibiotic resistance. We found that 5 out of 8 questions are significantly dependent on the profession: 2 inquiries related to capability, 1 to opportunity, and 2 to motivation. CONCLUSION We found that responses to the ECDC questionnaire are related to the profession. While some topics are universal/cross-functional, others must be explicitly tailored to each professional category. Information is useless if not accessible. Communication and provision of documents are thus paramount.
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Affiliation(s)
- Caroline Briquet
- Antimicrobial Stewardship, Cliniques Universitaires Saint-Luc, UCLouvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium.
- Department of Pharmacy, Cliniques Universitaires Saint-Luc, UCLouvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium.
| | - Youssra Khaouch
- Department of Clinical Biology, Cliniques Universitaires Saint-Luc, UCLouvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium
| | - Jean Cyr Yombi
- Antimicrobial Stewardship, Cliniques Universitaires Saint-Luc, UCLouvain, 10 Avenue Hippocrate, 1200, Brussels, Belgium
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, UCLouvain, 10 Avenue Hippocrates, 1200, Brussels, Belgium
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Banse X, Kaminski L, Irda N, Briquet C, Cornu O, Yombi JC. PMMA-cement anterior column reconstruction in surgical treatment of spondylodiscitis. Brain and Spine 2022; 2:101186. [PMID: 36248128 PMCID: PMC9560712 DOI: 10.1016/j.bas.2022.101186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 11/20/2022]
Abstract
Introduction: and research question This paper explains how antibiotic loaded cement can be used in surgical treatment of spondylodiscitis to reconstruct the anterior column of the spine. Material and methods 35 consecutive surgical procedures performed for spondylodiscitis were collected over a 11-year period and charts were reviewed. Most infections were caused mainly by staphylococcus spp (n = 16), streptococcus spp (n = 8) and pseudomonas spp (n = 4). Most patients had long standing but unsuccessful antibiotic therapy (median 42 days). Other indications included instability, neurologic deficit, abscess, and patients were generally in very poor medical condition. Results Anterior debridement was followed by a partial cavity filling with surgical high viscosity PMMA cement in all cases. Cement was a high viscosity gentamycin loaded cement, that was placed in the cavity created by debridement under the direct eye control. In 25 cases, a part of the cavity was filled with freeze dried cancellous bone allograft rehydrated in rifampicin. Spine was further stabilized with an anterior plate in 15 cases, with short (+1/+1) posterior instrumentation in 5 cases, and a long (≥ +2/+2) posterior instrumentation in 11 cases. In four patients, spine was left un-instrumented. Immediate, unrestricted mobilization was always authorized after surgery. None of the patients were reoperated neither for mechanical failure nor for infection relapse. Conclusion This report supports the idea that surgical bone cement is an efficient gap filler when used through anterior approach. For small as well as for large defects, it can help to reconstruct the anterior column and locally control the infection in combination with additional stabilization and optimal intravenous and oral antibiotic treatment. Surgery is indicated in the treatment of some spondylodiscitis. PMMA cement has been tested to immediately fill the cavity left by debridement through anterior approach. Additional mechanical stability of the anterior column is valuable, in addition to classic instrumentation. As cement is loaded with gentamycin, it may participate to the local control of the infection and was surprisingly well tolerated on long term follow up.
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Affiliation(s)
- X. Banse
- Department of Orthopaedic and Trauma Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Corresponding author. Service de chirurgie orthopédique et de traumatologie de l'appareil locomoteur, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Bruxelles, Belgium.
| | - L. Kaminski
- Department of Orthopaedic and Trauma Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - N. Irda
- Department of Orthopaedic and Trauma Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - C. Briquet
- Pharmacy Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - O. Cornu
- Department of Orthopaedic and Trauma Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - J.-C. Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
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Briquet C, Cornu O, Servais V, Blasson C, Vandeleene B, Yildiz H, Stainier A, Yombi JC. Clinical characteristics and outcomes of patients receiving outpatient parenteral antibiotic therapy in a Belgian setting: a single-center pilot study. Acta Clin Belg 2020; 75:275-283. [PMID: 31023169 DOI: 10.1080/17843286.2019.1608396] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Outpatient parenteral antibiotic therapy (OPAT) was not used in Belgium before 2013, except for patients with cystic fibrosis. Thus, we have performed a pilot study to evaluate clinical characteristics and outcomes of patient receiving OPAT in a Belgian setting. METHODS The study was a prospective observational single-center study of patients receiving OPAT between 1 September 2013 and 31 December, 2017. RESULTS We included 218 OPATs. The median age was 58 years and 71% were men. At the end of the treatment, 92% of the patients on OPAT were cured. Risk factors for treatment failure were obesity, diabetes and diabetic foot infections, longer duration of hospitalization before OPAT, and duration of OPAT >16 days. An average of 24 days of hospitalization per patient discharge was saved, which amounted to 5205 days saved during the project. During the OPAT and 30 days thereafter, 71 (32.6%) of patients were readmitted, but only 26 (12%) readmissions were directly related to OPAT. Risk factors for readmissions were diabetes and diabetic foot infections, endovascular infections, longer duration of hospitalization before OPAT, duration of OPAT >30 days, and history of hospitalizations in the year before OPAT. There were 2.3 intravenous catheter-related events per 1000 days of catheter use. Patients' level of satisfaction was high (99.5%). CONCLUSIONS In this pilot study, OPAT is found to be efficacious in saving hospitalization's days, with a low rate of readmissions and complications and a high patients' level of satisfaction. We therefore conclude that OPAT is feasible and safe. BACKGROUND Outpatient parenteral antibiotic therapy (OPAT) was not used in Belgium before 2013, except for patients with cystic fibrosis. Thus, we have performed a pilot study to evaluate clinical characteristics and outcomes of patient receiving OPAT in a Belgian setting. METHODS The study was a prospective observational single-center study of patients receiving OPAT between 1 September 2013 and 31 December, 2017. RESULTS We included 218 OPATs. The median age was 58 years and 71% were men. At the end of the treatment, 92% of the patients on OPAT were cured. Risk factors for treatment failure were obesity, diabetes and diabetic foot infections, longer duration of hospitalization before OPAT, and duration of OPAT >16 days. An average of 24 days of hospitalization per patient discharge was saved, which amounted to 5205 days saved during the project. During the OPAT and 30 days thereafter, 71 (32.6%) of patients were readmitted, but only 26 (12%) readmissions were directly related to OPAT. Risk factors for readmissions were diabetes and diabetic foot infections, endovascular infections, longer duration of hospitalization before OPAT, duration of OPAT >30 days, and history of hospitalizations in the year before OPAT. There were 2.3 intravenous catheter-related events per 1000 days of catheter use. Patients' level of satisfaction was high (99.5%). CONCLUSIONS In our study, OPAT is found to be efficacious in saving hospitalization's days, with a low rate of readmissions and complications and a high patients' level of satisfaction. We therefore conclude that OPAT is feasible and safe.
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Affiliation(s)
- Caroline Briquet
- Department of Pharmacy and Groupe de Gestion de l’antibiothérapie Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Olivier Cornu
- Department of Orthopaedic surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Valerie Servais
- Service social, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Chloe Blasson
- Service social, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Bernard Vandeleene
- Department of endocrinology and Diabetes, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Halil Yildiz
- Department of Internal medicine and infectious diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Annabelle Stainier
- Depertment of Urology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jean Cyr Yombi
- Department of Internal medicine and infectious diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Thirot H, Briquet C, Frippiat F, Jacobs F, Holemans X, Tulkens P, Spinewine A, Bambeke FV. 2434. Review of Linezolid (LZD) Use and Onset of Toxicity in 4 Belgian Hospital Centers: A Retrospective Study. Open Forum Infect Dis 2018. [PMCID: PMC6254233 DOI: 10.1093/ofid/ofy210.2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background LZD is approved (FDA label and Belgian Summary of Product Characteristics [SmPC]) for the treatment of SSSTI and pneumonia caused by Gram-positive organisms (mainly MRSA and VRE) only. Yet IDSA recommendations for MRSA infections also position LZD for osteomyelitis and as an alternative for CNS infections and bacteremia (CID 2011;52:e18–55). LZD use is limited by adverse events, the incidence of which may vary according to the length and conditions of therapy. The aim of this study was to document LZD actual use and onset of adverse events in real life clinical practice. Methods Observational, retrospective study in 4 Belgian hospital centers (about 4,000 beds) over 1 year (2016). Analysis of medical files (222 treatments) to collect information on (i) patient’s characteristics and treatment modalities and indications, (ii) occurrence, causality and severity of adverse drug reactions (ADR), and (iii) concomitant medications (increasing the risk of developing a serotonin syndrome [SS]). Results Key data are shown in the figure. 18% of prescriptions matched the indications approved in the United States and in Belgium and 47% those mentioned in the IDSA recommendations. 54% of the patients were infected by bacteria resistant to first choice drugs. Decreases in platelet counts (DPC) were observed in 30% of patients (compared with <1% thrombocytopenia in the Belgian SmPC or 25% DPC in 3% of patients in FDA label) and was observed in 15/39 cases (patients with in-Belgian label indications), 35/105 cases (patients with IDSA indications), 30/117 (other indications). Treatment duration > 10 days was the only significant risk factor for DPC (Kaplan Meyer; P < 0.005 [Mann–Whitney]). 7 cases of CNS ADR were reported. Although 41% of patients were prescribed at least 1 drug increasing SS risk, SS was actually observed in only 1 patient. Conclusion LZD is mainly used in off-Belgian label indications, some of which, however, are in the IDSA recommendations. The high incidence of ADR (40%) as well as the frequent use of co-medications putting patients at risk of SS highlight the importance of follow-up for LZD-treated patients. A prospective study is now needed to better assess the severity of these ADR and identify more associated risk factors. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Caroline Briquet
- Department of Pharmacy, Université Catholique de Louvain, Clinique Universitaires Saint Luc, Brussels, Belgium
| | - Frédéric Frippiat
- Infectious Diseases and Internal Medicine, Centre Hospitalier Universitaire De Liège, Liège, Belgium
| | | | | | - Paul Tulkens
- Université Catholique de Louvain, Bruxelles, Belgium
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Martinez-Mugica C, Yombi CJ, Vandercam B, Briquet C. Use of Antifungals in Daily Practice in a Belgian Hospital. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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