Colistin Utilization Evaluation in a Major Teaching Hospital in Iran

Objectives: Colistin is an old antibacterial agent which is used in multiple drug resistant (MDR) infections. Due to increased rate of MDR infections, the use of this agent is raised in worldwide. The aim of this study was to identify colistin utilization patterns in a teaching hospital and to demonstrate the importance of the need to reconsider prescribing strategies for colistin administration. Methods: This retrospective cross-sectional study was performed between Augusts 2017and December 2017 at Firoozgar hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. All colistin prescriptions for adult patients during the study period were enrolled for appropriateness evaluation according to the Lexi comp acquired by Wolters Kluwer and NHS guideline. Results: Among 70 patients who received colistin, pneumonia (70%) was the chief indication of colistin prescription. In 93% of cases, colistin was prescribed according to microbiological laboratory results. In 14% of patients, colistin administration was before providing microbiological laboratory evidence. Seventeen percent of the patients received loading dose of colistin. The indication of colistin therapy was inappropriate in 16% of patients.  The initial and end dose, and duration of treatment of colistin were appropriate in 20%, 40%, and 52% of patients, respectively. Among 70 cases, 24 (34%) and 36 (51%) patients required dose adjustment in first and end dose of colistin therapy which only dose correction was performed in 13 (18%) and 15 (21%) cases, respectively.    Conclusions: These findings, along with aforementioned guidelines supports the requirement for physicians’ educational programs, proper strategies for appropriate prescriptions

Increasing the Number of Adverse Drug Reactions Reporting: the Role of Clinical Pharmacy Residents

Abstract Detection of adverse drug reactions (ADRs) in hospitals provides an important measure of the burden of drug related morbidity on the healthcare system. Spontaneous reporting of ADRs is scare and several obstacles to such reporting have been identified formerly. This study aimed to determine the role of clinical pharmacy residents in ADR reporting within a hospital setting.Clinical pharmacy residents were trained to report all suspected ADRs through ADRreporting yellow cards. The incidence, pattern, seriousness, and preventability of the reported ADRs were analyzed. During the period of 12 months, for 8559 patients, 202 ADR reports were received. The most frequently reported reactions were due to anti-infective agents (38.38%). Rifampin accounted for the highest number of the reported ADRs among anti-infective agents. The gastro-intestinal system was the most frequently affected system (21.56%) of all reactions. Fifty four of the ADRs were reported as serious reactions. Eighteen of the ADRs were classified as preventable. Clinical pharmacy residents involvement in the ADR reporting program could improve the ADR reporting system

Evaluation of Antimicrobial Susceptibility of Gram Negative Organisms by Minimum Inhibitory Concentration Method in Bandar Abbas, South of Iran

Background: Antibiotic-resistant pathogens are problem in many geographic areas. The emergence of antimicrobial drug resistant organisms needs special attention. Methods: In a cross sectional prospective study during one year clinical samples were cultured and evaluated in general hospital, south of Iran. Samples were cultured and Organisms were identified by microbiologic methods. Minimum Inhibitory Concentration for seven antibiotics were evaluated. Results:  In this study 494 positive samples were evaluated. The most common site of isolation was urinary system. The most common isolated organisms were E.coli, Kelebsiela pneumonia and Pseudomona aeroginosa. Resistance to ceftrixone, ceftazidime and cefepime was more than %50. Conclusions: Resistance to ceftrixone, ceftazidime and cefepime was high in our study

Albumin utilization evaluation in a major teaching hospital in Iran: Recommendations for guideline development

Objective: Human albumin solution is an expensive colloidal preparation which is commonly used in clinical practice. Due to high cost of albumin, increased rate of the inappropriate use worldwide, and many other reasons, it is imperative to establish a practical protocol to use albumin products and limit its usage. The aim of this study was to identify albumin utilization patterns in a teaching hospital and to demonstrate the importance of the need to reconsider prescribing strategies for albumin administration. Methods: This retrospective cross-sectional study was performed between August 2016 and December 2016 at Firoozgar Hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. All albumin prescriptions for adult patients during the study period were enrolled for appropriateness evaluation according to the latest evidence-based studies and guidelines. Findings: Among 320 albumin prescriptions, 168 (52.5%) were inappropriate according to the current evidence. The most common irrational causes for the albumin usage were hypoalbuminemia (23.4%), nutritional support (13.7%), neuroprotection in subarachnoid hemorrhage (3%), pretreatment for cancer surgery (2.8%), edema (1.6%), hepatic failure (1.6%), and paracentesis (3%). The total amount of albumin used for 320 patients was 52,050 g, from which 28,470 g was inappropriate resulting in $97,398 wastage. Conclusion: These findings, along with aforementioned guidelines, support the requirement for physicians' educational programs and proper strategies for appropriate prescriptions and could also be important in modifying the available guidelines concerning expensive drugs such as albumin

The content of plasma selenium in early admitted septic patients

Objective: Selenium depletion has been reported in critical illness correlates with an increase in mortality and morbidity. In this study, we aimed to access the selenium plasma levels of septic patients early at the Intensive Care Unit (ICU) admission in order to compare with reference range. Methods: We conducted a cross-sectional study in a university affiliated hospital aiming to assess the early plasma level of selenium in ICU admitted patients. eighty patients diagnoses with sepsis were included and considered for characteristic evaluation, monitoring criteria assessment and also blood sampling. All blood sampling was performed during 48 hours of the ICU admission in order to determined the plasma Selenium level by atomic absorption method. Findings: The mean plasma levels of selenium in male and female was 98.14 ± 23.52 and 78.1 ± 24.46 μ/L, respectively. Although selenium plasma levels was higher in the ICU male patients significantly, both had near normal range (80 μ/L). Conclusion: In this study we found that in early admitted Iranian ICU patients in Tehran, selenium deficiency has not routinely seen but probably will happen during ICU hospitalization

Instant thyroid crisis of autonomously functioning thyroid nodule after radio frequency ablation and ethanol injection

Radiofrequency ablation (RFA) is acknowledged as an effective and safe technique for the treatment of benign thyroid nodules. However, recently there have been some reports of thyroid dysfunction related to this technique, especially thyrotoxicosis. Here, we report a case of a 34-year-old woman's thyroid crisis instantly (about 20 minutes) after RFA and ethanol injection for an autonomous functional thyroid nodule. Fortunately, her symptoms improved with treatment (hydration, corticosteroid, propylthiouracil, and propranolol), and after three days, she was discharged from the hospital in good condition