Risk classification and door-to-antibiotic time in patients with suspected sepsis

OBJECTIVE

to evaluate the association between risk classification and door-to-antibiotic time in patients with suspected sepsis.

METHOD

retrospective cohort study, with a sample of 232 patients with suspected sepsis treated at the emergency department. They were divided into 2 groups: with and without risk classification. Once the door-to-antibiotic time was identified, one-way analysis of variance was performed with Bonferroni post hoc test or independent Student's t-test for continuous quantitative variables; Pearson correlation tests, point-biserial correlation or biserial correlation for association analyses; and bootstrap procedure when there was no normal distribution of variables. For data analysis, the Statistical Package for the Social Sciences software was used.

RESULTS

the door-to-antibiotic time did not differ between the group that received risk classification compared to the one that was not classified. Door-to-antibiotic time was significantly shorter in the group that received a high priority risk classification.

CONCLUSION

there was no association between door-to-antibiotic time and whether or not the risk classification was performed, nor with hospitalization in infirmaries and intensive care units, or with the length of hospital stay. It was observed that the higher the priority, the shorter the door-to-antibiotic time.

[Data processing of the Brazilian National System of Controlled Product Management for drug utilization research with antimicrobials]

The Brazilian National System of Controlled Product Management (SNGPC) stores data on the dispensing of manufactured and compounded drugs and pharmaceutical inputs, whether controlled and antimicrobial, based on the records of private pharmacies and drugstores. This study assessed the quality of SNGPC data from the dispensing records of manufactured antibiotics, aiming to propose their use in drug utilization researchs (DURs), with a descriptive and retrospective design, analyzing the raw dataset of the SNGPC from January 2014 to December 2020. A total of 475,805,207 drug-dispensing records were collected. On average, antibiotics corresponded to 54.5% of the total records. The quality dimension "unreported" was systematically identified in the variables "active ingredient", "sex", "age" and "ICD-10". The amount of vials/bottles and packages ranged from one to 536 units and the amount of pharmaceutical inputs dispensed, from one to 7,500 units. Results show that 25% of the records exceed an individual therapy and the SNGPC has no critical mechanism to avoid dispensations outside the therapeutic standard for the class. Despite vulnerabilities due to data quality, which can be overcome, the SNGPC allows for the construction of different analytical plans, involving time and other aggregations, in the analysis of community use of antimicrobials and controlled drugs, which makes it a powerful source of data for DUR.

Brainstem abscess of undetermined origin: microsurgical drainage and brief antibiotic therapy

CONTEXT

Solitary brainstem abscesses are rare and they are usually associated with other infections. They are severe conditions with high morbidity and mortality. The surgical options are stereotactic aspiration and microsurgical drainage. Systemic antibiotic therapy is used for more than six weeks.

CASE REPORT

We present the case of a young man with a solitary abscess at the pons, without other systemic infections. The patient was treated by means of microsurgical drainage and antibiotic therapy for three weeks. His postoperative recovery was good.

CONCLUSIONS

A microsurgical approach may be considered to be an important option for large abscesses that are multiloculated, close to the surface or contain thick fluid. Complete emptying of the purulent accumulation may diminish the required duration of antibiotic therapy.

Evidence on acne therapy

Among the current treatments available for acne vulgaris, many widely practiced options lack support from studies at the best level of scientific evidence. The aim of this narrative review was to present the very latest information on topical and systemic treatments for acne vulgaris. Information from systematic reviews and well-designed clinical trials, obtained through a systematic search of the major medical databases, is emphasized. There are important issues regarding the clinical management of acne that still lack consistent grounding in scientific evidence. Among these are the optimum dose and duration of treatment with oral antibiotics that can be given without inducing bacterial resistance, and the safety of oral isotretinoin.