Miscellanea. Folyóirat-referátumok. Beszámoló

Hypertonia A déli sziesztának (alvás-szunyókálás) és időtartamának hatása a vérnyomás alakulására magas vérnyomásban szenvedő betegek körében (Asociation of mid-day naps occurence and duration with blood pressure levels in hypertensive patients. A prospective study) Kallistratos, M., Poulimenos, L., Karamanou, A., et al. (Asklepeion General Hospital, Cardiology Department, 1 Vasileos Pavlou Ave Voula, Athens, 16673, Görögország; e-mail: [email protected]): J. Hypertension, June 2015. doi: 10.1097/01. hjh.0000468209. 39013.ca | Kardiológia Túlélés hirtelen szívleállás után a sportpályán vagy azon kívül (Survival from sports-related sudden cardiac arrest: In sports facilities versus outside of sports facilities) Marijon, E., Bougouin, W., Karam, N., et al. Cardiology Department, European Georges Pompidou Hospital, 20–40 rue Leblanc, 75908 Paris, CEDEX 15, Franciaország; e-mail: [email protected]): Am. Heart J., 2015, 170 (2), 339–345.e1. | Szülészet-nőgyógyászat Az alsó húgyúti elzáródás (AHE) – klinikai kép, praenatalis kórisme és kezelési lehetőségek (Lower urinary tract obstruction [LUTO] – Krankheitsbild, pränatale Diagnostik, und Therapiemöglichkeiten) Bildau, J., Enzensberger, C., Degenhardt, J., et al. (Levelező szerző: R. Axt- Fliedner, R.: Abteilung für Pränatalmedizin und gynäkologische Sonografie, Zentrum für Frauenheilkunde und Geburtshilfe, Justus-Liebig Universität Gießen und UKGM, Klinikstrasse 33, 35392 Gießen, Németország): Z. Geburtsh. Neonatol., 2014, 218 (1), 18–26. | Magzati terápia – tudományos alap és a jelenlegi klinikai előny kritikus felmérése (Fetale Therapie – wissenschaftliche Basis und kritische Bestandsaufnahme des derzeitigen klinischen Nutzens) Axt-Fliedner, R., Schmidt, S. (Abteilung für Pränatalmedizin, Klinikstrasse 33, 35392 Gießen, Németország): Z. Geburtsh. Neonatol., 2014, 218 (1), 1. | Nem gyermekágyi emlőgyulladás (Mastitis non-puerperalis) Böhm, D. (e-mail: [email protected]): Geburtshilfe Frauenheilkd., 2014, 74 (2), 134–137. | Gondolatmozaikok a Magyar Endokrin Társaság 50 éves jubileumi kongresszusáról Szeged, 2016. május 5–7. | A NICE pozitív szakmai irányelvtervezetet tett közzé | A Coeliakia Nemzetközi Napja 2016. május 16. | Az ARNA projekthez kapcsolódó hazai antibiotikum szakmai na

Hazai kórházi antibiotikum-alkalmazás az elmúlt két évtizedben (1996–2015) | Antibiotic use in the Hungarian hospitals in the last two decades (1996–2015)

Absztrakt Bevezetés: A bakteriális rezisztencia közegészségügyet fenyegető probléma, amely mérsékelhető, lassítható megfelelő antibiotikum-alkalmazással. Célkitűzés: A hazai fekvőbeteg-ellátás szisztémás antibiotikum-felhasználásának bemutatása. Módszer: A kórházi antibiotikum-felhasználási adatokat az Egészségügyi Világszervezet anatómiai-terápiás-kémiai rendszere szerint osztályozták és a Defined Daily Dose metodika szerint kvantifikálták. A standardizálás kórházi betegforgalmi mutatókra, valamint – a nemzetközi összehasonlítás végett – populációra történt. Eredmények: A fekvőbetegszektor antibiotikum-felhasználása az elmúlt 20 évben mennyiségileg kiegyenlített volt (22,4 ± 1,5 DDD/100 ápolási nap), mintázata folyamatos változáson ment keresztül. Megfigyelhettük a parenteralis készítmények alkalmazásának emelkedését (1996-ban 26,4%, 2015-ben 41,6%). Kiemelendő a felhasználás összetételének homogenizálódása az amoxicillin-klavulánsav térnyerése miatt, a fluorokinolon (2,3 vs. 4,2 DDD/100 ápolási nap) és a harmadik generációs cefalosporinfelhasználás (1,0 vs. 2,9 DDD/100 ápolási nap) jelentős emelkedése, valamint a szűk spektrumú penicillinek kiszorulása. Következtetés: A hazai kórházi antibiotikum-felhasználás mennyiségileg alacsony. Ez, illetve a felhasználás mintázatában tapasztalt, nemzetközi mércével is alátámasztott alul- vagy felülreprezentált felhasználás okának és indokoltságának megítélése további vizsgálatot igényel. Orv. Hetil., 2016, 157(46), 1839–l846. | Abstract Introduction: Growing bacterial resistance threatens public health, which can be tempered by prudent antibiotic use. Aim: To quantify systemic antibacterial use in Hungarian hospitals. Method: Consumption data were analysed using the Anatomical-Therapeutic-Chemical – Defined Daily Dose (ATC/DDD) methodology. Data were standardized for patient turnover and also for population to enable international benchmarking. Results: Hospital antibiotic use was quite constant (22.4 ± 1.5 DDD/100 patient-days), but its composition changed substantially. The use of parenteral products rose gradually (in 1996 26.4% and in 2015 41.6%). The pattern of use was homogenised due to the headway of co-amoxiclav use. A substantial increase of fluoroquinolone (2.3 vs. 4.2 DDD/100 patient-days) and third generation cephalosporin (1.0 vs. 2.9 DDD/100 patient-days) use was detected. In parallel the use of narrow spectra penicillins diminished. Conclusion: Hungarian hospital antibiotic use is low. The causes and the justification of this low use together with the internationally outstanding use of certain antibacterials should be addressed in future studies. Orv. Hetil., 2016, 157(46), 1839–1846

Impact of Guideline Adherence on Outcomes in Patients Hospitalized with Community‐Acquired Pneumonia (CAP) in Hungary: A Retrospective Observational Study

Community‐acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. This retrospective observational study evaluated the antibiotic prescription patterns and associations between guideline adherence and outcomes in patients hospitalized with CAP in Hungary. Main outcome measures were adherence to national and international CAP guidelines (agent choice, dose) when using empirical antibiotics, antibiotic exposure, and clinical outcomes. Demographic and clinical characteristics of patients with CAP in the 30‐day mortality and 30‐day survival groups were compared. Fisher’s exact test and t‐test were applied to compare categorical and continuous variables, respectively. Adherence to the national CAP guideline for initial empirical therapies was 30.61% (45/147) for agent choice and 88.89% (40/45) for dose. Average duration of antibiotic therapy for CAP was 7.13 ± 4.37 (mean ± SD) days, while average antibiotic consumption was 11.41 ± 8.59 DDD/patient (range 1–44.5). Adherence to national guideline led to a slightly lower 30‐day mortality rate than guideline non‐adherence (15.56% vs. 16.67%, p > 0.05). In patients aged ≥ 85 years, 30‐day mortality was 3 times higher than in those aged 65–84 years (30.43% vs. 11.11%). A significant difference was found between 30‐day non‐survivors and 30‐day survivors regarding the average CRP values on admission (177.28 ± 118.94 vs. 112.88 ± 93.47 mg/L, respectively, p = 0.006) and CCI score (5.71 ± 1.85 and 4.67 ± 1.83, p = 0.012). We found poor adherence to the national and international CAP guidelines in terms of agent choice. In addition, high CRP values on admission were markedly associated with higher mortality in CAP. © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)

Hospital Antibiotic Consumption before and during the COVID-19 Pandemic in Hungary

The aim of this study was to assess antibiotic use in the Hungarian hospital care sector during and before the pandemic. Aggregated systemic antibiotic (ATC: J01) utilisation data were obtained for the 2010–2021 period. Classifications and calculations were performed according to the WHO ATC/DDD index and expressed as DDD per 1000 inhabitants and per day (DID), DDD per 100 patient-days (DHPD) and DDD/discharge. A linear regression (trend analysis) was performed for the pre-COVID years (2010–2019) and a prediction interval was set up to assess whether the pandemic years’ observed utilisation fit in. Antibiotic utilisation was constant in DID before and during the pandemic (2019: 1.16; 2020: 1.21), while we observed a substantial increase in antibiotic use when expressed in DDD per 100 patient-days (2019: 23.3, 2020: 32.2) or DDD/discharge (2019: 1.83, 2020: 2.45). The observed utilisation level of penicillin combinations; first-, third- and fourth-generation cephalosporins; carbapenems; glycopeptides; nitroimidazoles and macrolides exceeded the predicted utilisation values in both pandemic years. Before the pandemic, co-amoxiclav headed the top list of antibiotic use, while during the pandemic, ceftriaxone became the most widely used antibiotic. Azithromycin moved up substantially on the top list of antibiotic use, with a 397% increase (2019: 0.45; 2020: 2.24 DHPD) in use. In summary, the pandemic had a major impact on the scale and pattern of hospital antibiotic use in Hungary

Consumption of antibiotics in the community, European Union/European Economic Area, 1997-2017: data collection, management and analysis

This article introduces a series of articles on antibiotic consumption in the community between 1997 and 2017, which provide an update of previous articles covering the periods 1997-2003 and 1997-2009.In this article, differences in participating countries, the ATC/DDD classification system, and data collection, validation and analysis between the current and previous series are described.In the previous series, 33 European countries provided valid data for further analysis, while the current series focused on 30 countries belonging to the EU or the European Economic Area (EEA). For both series, data were collected in accordance with the WHO ATC classification system. While the previous series reported data in accordance with the ATC/DDD index 2011, the current series employed the ATC/DDD index 2019. Both series focused on consumption of antibacterials for systemic use (ATC J01) and collected data expressed in DDD per 1000 inhabitants per day and packages per 1000 inhabitants per day. When studying consumption expressed in packages per 1000 inhabitants per day, countries reporting total care data, i.e. community and hospital sector combined, were included in the previous series but excluded in the current series. While the previous series used non-linear mixed models to evaluate time trends in antibiotic consumption, the current series allowed for inclusion of change-points with a data-driven location. In addition, both series assessed the composition and quality of antibiotic consumption in the EU/EEA.The updated analyses of two decades of ESAC-Net data provide the most comprehensive and detailed description of antibiotic consumption in the community in Europe

Developing a Tool for Auditing the Quality of Antibiotic Dispensing in Community Pharmacies: A Pilot Study

Background: The European Centre for Disease Prevention and Control describes the community pharmacist as the gatekeeper to the quality of antibiotic use. The pharmacist has the responsibility to guard safe and effective antibiotic use; however, little is known about how this is implemented in practice. Aims: To assess the feasibility of a method to audit the quality of antibiotic dispensing in community pharmacy practice and to explore antibiotic dispensing practices in Greece, Lithuania, Poland, and Spain. Methods: The Audit Project Odense methodology to audit antibiotic dispensing practice was adapted for use in community pharmacy practice. Community pharmacists registered antibiotic dispensing on a specifically developed registration chart and were asked to provide feedback on the registration method. Results: Altogether, twenty pharmacists were recruited in four countries. They registered a total of 409 dispenses of oral antibiotics. Generally, pharmacists were positive about the feasibility of implementing the registration chart in practice. The frequency of checking for allergies, contraindications and interactions differed largely between the four countries. Pharmacists provided little advice to patients. The pharmacists rarely contacted prescribers. Conclusion: This tool seems to make it possible to get a useful picture of antibiotic dispensing patterns in community pharmacies. Dispensing practice does not seem to correspond with EU guidelines according to these preliminary results

Impact of the COVID-19 Pandemic on Ambulatory Care Antibiotic Use in Hungary: A Population-Based Observational Study

The COVID-19 pandemic and related restrictions have potentially impacted the use of antibiotics. We aimed to analyze the use of systemic antibiotics (J01) in ambulatory care in Hungary during two pandemic years, to compare it with pre-COVID levels (January 2015–December 2019), and to describe trends based on monthly utilization. Our main findings were that during the studied COVID-19 pandemic period, compared to the pre-COVID level, an impressive 23.22% decrease in the use of systemic antibiotics was detected in ambulatory care. A significant reduction was shown in the use of several antibacterial subgroups, such as beta-lactam antibacterials, penicillins (J01C, −26.3%), and quinolones (J01M, −36.5%). The trends of antibiotic use moved in parallel with the introduction or revoking of restriction measures with a nadir in May 2020, which corresponded to a 55.46% decrease in use compared to the previous (pre-COVID) year’s monthly means. In general, the systemic antibiotic use (J01) was lower compared to the pre-COVID periods’ monthly means in almost every studied pandemic month, except for three months from September to November in 2021. The seasonal variation of antibiotic use also diminished. Active agent level analysis revealed an excessive use of azithromycin, even after evidence of ineffectiveness for COVID-19 emerged