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Évaluation de l’intérêt du nouvel antidiabétique dulaglutide chez les patients diabétiques de type 2 traités par liraglutide
Le Pharmacien Hospitalier et Clinicien 2017;52:e1-e46 R-PCL-50
Staphylococcus aureus carriage at admission predicts early-onset pneumonia after burn trauma A. Fournier1,2,*, P. Voirol1,2, M. Kra ¨henbu ¨hl1, C. Bonnemain1, C. Fournier1, E. Dupuis-Lozeron3, O. Pantet1, J. Pagani1, J. Revelly1, P. Eggimann1, Y. Que4, F. Sadeghipour1,2 1 Centre hospitalier universitaire Vaudois, Lausanne, Switzerland 2´ Ecole de pharmacie Gene`ve-Lausanne, universite´ de Gene`ve, universite´ de Lausanne, Switzerland 3 Centre de consultation en statistique, universite´ de Gene`ve, Switzerland 4 University Hospital Bern, Inselspital, Switzerland *Corresponding author. Rue du Bugnon 46, 1011 Lausanne, Switzerland. E-mail address: [email protected] (A. Fournier) Background and objectives Early-onset pneumonia (EOP) is frequent after burn trauma, increasing morbidity in the critical resuscitation phase, which may preclude early aggressive management of burn wounds. Currently, however, preemptive treatment is not recommended. The aim of this study was to identify predictive factors for EOP that may justify early empirical antibiotic treatment. Methods Data for all burn patients requiring 4 h mechanical ventilation (MV) who were admitted to our service between January 2001 and October 2012 were extracted from the hospital’s computerized information system. We reviewed EOP episodes (occurring within 7 days after admission) among patients who underwent endotracheal aspiration (ETA) within 5 days after admission. Univariate and multivariate analyses were performed to identify independent factors associated with EOP. Logistic regression was used to identify factors predicting EOP development. Results During the study period, 396 burn patients were admitted. ETA was performed within 5 days in 204/290 patients receiving 4 h MV. One hundred and eight patients developed EOP and 176 microorganisms were identified. The three most prevalent microorganisms isolated were S. aureus (n = 47, 26.7%), Haemophilus influenzae (n = 37, 21.0%), and Streptococcus pneumoniae (n = 23, 13.1%). All but one (n = 46, 97.9%) case of S. aureus EOP were caused by methicillin-sensitive S. aureus. Among the 33 patients showing S. aureus positivity on ETA samples, 16 (48.5%) developed S. aureus EOP. Among the 156, S. aureus non-carriers, 16 (10.2%) developed EOP. S. aureus carriage independently predicted EOP (P < 0.0001). The use of S. aureus carriage as a unique criterion for the initiation of early empirical treatment would have resulted in 17 unnecessary antibiotic treatments in this cohort. Discussion and conclusions We identified S. aureus carriage as an independent and strong predictor of EOP. As rapid point-of-care testing for S. aureus is readily available, we recommend testing of all patients at admission for burn trauma and the consideration of early preemptive treatment in all positive patients. Further studies are needed to evaluate this new strategy. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/http://dx.doi.org/10.1016/j.phclin.2017.01.056 R-PCL-51
E´valuation de l’inte´reˆt du nouvel antidiabe´tique dulaglutide chez les patients diabe´tiques de type 2 traite´s par liraglutide E. Cheli1,*, R. Tang1, A. Cransac1, A. Lazzarotti1, J. Petit2 1 Service pharmacie, CHU de Dijon, Dijon, France 2 Service d’endocrinologie, diabe´tologie et maladies me´taboliques, CHU de Dijon, Dijon, France
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*Auteur correspondant. 3, rue Jean-sans-peur, Dijon, France. Adresse e-mail : [email protected] (E. Cheli) Introduction et objectifs La strate´gie de prise en charge du diabe`te de type 2 repose dans un premier temps sur le respect des re`gles hygie´no-die´te´tiques puis sur la mise en place d’un traitement me´dicamenteux si celles-ci ne suffisent pas. Les analogues du Glucagon Like Peptide-1 (GLP-1) constituent une option the´rapeutique dans la strate´gie de prise en charge. Parmi eux, liraglutide est utilise´ en une injection sous-cutane´e quotidienne. Le nouvel analogue du GLP-1, dulaglutide, pre´sente la meˆme indication que liraglutide mais est utilise´ en une seule administration hebdomadaire du fait de ses proprie´te´s pharmacocine´tiques. Notre travail a pour objectif d’e´valuer l’inte´reˆt de dulaglutide chez les patients actuellement traite´s par liraglutide. Me´thodes Un questionnaire destine´ aux patients suivis en hospitalisation conventionnelle et de semaine du service d’endocrinologie a e´te´ re´alise´ et distribue´ sur la pe´riode de mai a` juillet 2016 inclus. Les patients inclus dans ce travail ont e´te´ les patients diabe´tiques de type 2 sous liraglutide depuis au moins 3 mois, ayant accepte´ de re´pondre au questionnaire. Re´sultats Sur les 20 questionnaires re´cupe´re´s, 70 % des patients sont inte´resse´s par l’injection hebdomadaire du dulaglutide, 65 % ont entre 60 et 70 ans, 55 % sont diabe´tiques depuis plus de 20 ans. Concernant le traitement par liraglutide, 40 % des patients sont traite´s par ce me´dicament depuis plus de 5 ans, les me´dicaments en association sont majoritairement les biguanides (85 %) et l’insuline lente (65 %). Quatre-vingt-cinq pour cent des patients de l’e´tude n’e´prouvent aucune contrainte particulie`re a` l’administration par voie sous-cutane´e alors que 3 patients la conside`rent comme une contrainte difficile a` vivre. Discussion et conclusions Ce travail nous a permis de de´montrer que dulaglutide a un inte´reˆt chez les patients initialement traite´s par liraglutide. Cependant, l’effectif peu significatif de notre travail limite l’interpre´tation a` plus grande e´chelle. En ce qui concerne les patients non inte´resse´s, les raisons qui ressortent sont : un diabe`te bien e´quilibre´ sous liraglutide, un quotidien qui leur convient bien. Cette e´tude pilote met en e´vidence que dulaglutide, au meˆme titre que liraglutide, peut eˆtre propose´ aux patients diabe´tiques de type 2 lorsque celui-ci est indique´. De´claration de liens d’inte´reˆts Les auteurs n’ont pas pre´cise´ leurs e´ventuels liens d’inte´reˆts. http://dx.doi.org/http://dx.doi.org/10.1016/j.phclin.2017.01.057 OP1/F-PCL-52
Handling of drug–drug interactions in clinical pharmacy practice M. Lutters*, S. Widmer, L. Bru ¨hwiler, C. Belenda, K. Waldner-Knogler, P. Wiedemeier Kantonsspital, Baden, Switzerland *Corresponding author. Im Ergel, 5404 Baden, Switzerland. E-mail address: [email protected] (M. Lutters) Introduction Potential drug-drug interactions (DDI) are an important risk factor for adverse drug events (ADE). Automatic interaction check systems have been implemented in many hospitals but they are often not used by physicians due to ‘‘alert fatigue’’. We tried to find out how often clinical pharmacists intervene because of DDI, and what are the reasons for this decision. Methods 1. All interventions of clinical pharmacists in our hospital in 2015, routinely documented with the GSASA-tool, were analysed for DDI. 2. A sample of medication profiles was checked for DDI (classes 1–4) using the ABDA database provided by emediat (integrated in our electronic prescribing tool) and compared to documented interventions of DDI. 3. Using a structured form, clinical pharmacists were asked after ward rounds, whether and why they did an interaction check, whether and why they intervened and whether the intervention was accepted by the physician. Results 1. One hundred and forty-six of 1170 (12%) interventions concerned DDI. Acceptance rate of DDI interventions was 93% compared to 87% of
Staphylococcus aureus carriage at admission predicts early-onset pneumonia after burn trauma A. Fournier1,2,*, P. Voirol1,2, M. Kra ¨henbu ¨hl1, C. Bonnemain1, C. Fournier1, E. Dupuis-Lozeron3, O. Pantet1, J. Pagani1, J. Revelly1, P. Eggimann1, Y. Que4, F. Sadeghipour1,2 1 Centre hospitalier universitaire Vaudois, Lausanne, Switzerland 2´ Ecole de pharmacie Gene`ve-Lausanne, universite´ de Gene`ve, universite´ de Lausanne, Switzerland 3 Centre de consultation en statistique, universite´ de Gene`ve, Switzerland 4 University Hospital Bern, Inselspital, Switzerland *Corresponding author. Rue du Bugnon 46, 1011 Lausanne, Switzerland. E-mail address: [email protected] (A. Fournier) Background and objectives Early-onset pneumonia (EOP) is frequent after burn trauma, increasing morbidity in the critical resuscitation phase, which may preclude early aggressive management of burn wounds. Currently, however, preemptive treatment is not recommended. The aim of this study was to identify predictive factors for EOP that may justify early empirical antibiotic treatment. Methods Data for all burn patients requiring 4 h mechanical ventilation (MV) who were admitted to our service between January 2001 and October 2012 were extracted from the hospital’s computerized information system. We reviewed EOP episodes (occurring within 7 days after admission) among patients who underwent endotracheal aspiration (ETA) within 5 days after admission. Univariate and multivariate analyses were performed to identify independent factors associated with EOP. Logistic regression was used to identify factors predicting EOP development. Results During the study period, 396 burn patients were admitted. ETA was performed within 5 days in 204/290 patients receiving 4 h MV. One hundred and eight patients developed EOP and 176 microorganisms were identified. The three most prevalent microorganisms isolated were S. aureus (n = 47, 26.7%), Haemophilus influenzae (n = 37, 21.0%), and Streptococcus pneumoniae (n = 23, 13.1%). All but one (n = 46, 97.9%) case of S. aureus EOP were caused by methicillin-sensitive S. aureus. Among the 33 patients showing S. aureus positivity on ETA samples, 16 (48.5%) developed S. aureus EOP. Among the 156, S. aureus non-carriers, 16 (10.2%) developed EOP. S. aureus carriage independently predicted EOP (P < 0.0001). The use of S. aureus carriage as a unique criterion for the initiation of early empirical treatment would have resulted in 17 unnecessary antibiotic treatments in this cohort. Discussion and conclusions We identified S. aureus carriage as an independent and strong predictor of EOP. As rapid point-of-care testing for S. aureus is readily available, we recommend testing of all patients at admission for burn trauma and the consideration of early preemptive treatment in all positive patients. Further studies are needed to evaluate this new strategy. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/http://dx.doi.org/10.1016/j.phclin.2017.01.056 R-PCL-51
E´valuation de l’inte´reˆt du nouvel antidiabe´tique dulaglutide chez les patients diabe´tiques de type 2 traite´s par liraglutide E. Cheli1,*, R. Tang1, A. Cransac1, A. Lazzarotti1, J. Petit2 1 Service pharmacie, CHU de Dijon, Dijon, France 2 Service d’endocrinologie, diabe´tologie et maladies me´taboliques, CHU de Dijon, Dijon, France
e22
*Auteur correspondant. 3, rue Jean-sans-peur, Dijon, France. Adresse e-mail : [email protected] (E. Cheli) Introduction et objectifs La strate´gie de prise en charge du diabe`te de type 2 repose dans un premier temps sur le respect des re`gles hygie´no-die´te´tiques puis sur la mise en place d’un traitement me´dicamenteux si celles-ci ne suffisent pas. Les analogues du Glucagon Like Peptide-1 (GLP-1) constituent une option the´rapeutique dans la strate´gie de prise en charge. Parmi eux, liraglutide est utilise´ en une injection sous-cutane´e quotidienne. Le nouvel analogue du GLP-1, dulaglutide, pre´sente la meˆme indication que liraglutide mais est utilise´ en une seule administration hebdomadaire du fait de ses proprie´te´s pharmacocine´tiques. Notre travail a pour objectif d’e´valuer l’inte´reˆt de dulaglutide chez les patients actuellement traite´s par liraglutide. Me´thodes Un questionnaire destine´ aux patients suivis en hospitalisation conventionnelle et de semaine du service d’endocrinologie a e´te´ re´alise´ et distribue´ sur la pe´riode de mai a` juillet 2016 inclus. Les patients inclus dans ce travail ont e´te´ les patients diabe´tiques de type 2 sous liraglutide depuis au moins 3 mois, ayant accepte´ de re´pondre au questionnaire. Re´sultats Sur les 20 questionnaires re´cupe´re´s, 70 % des patients sont inte´resse´s par l’injection hebdomadaire du dulaglutide, 65 % ont entre 60 et 70 ans, 55 % sont diabe´tiques depuis plus de 20 ans. Concernant le traitement par liraglutide, 40 % des patients sont traite´s par ce me´dicament depuis plus de 5 ans, les me´dicaments en association sont majoritairement les biguanides (85 %) et l’insuline lente (65 %). Quatre-vingt-cinq pour cent des patients de l’e´tude n’e´prouvent aucune contrainte particulie`re a` l’administration par voie sous-cutane´e alors que 3 patients la conside`rent comme une contrainte difficile a` vivre. Discussion et conclusions Ce travail nous a permis de de´montrer que dulaglutide a un inte´reˆt chez les patients initialement traite´s par liraglutide. Cependant, l’effectif peu significatif de notre travail limite l’interpre´tation a` plus grande e´chelle. En ce qui concerne les patients non inte´resse´s, les raisons qui ressortent sont : un diabe`te bien e´quilibre´ sous liraglutide, un quotidien qui leur convient bien. Cette e´tude pilote met en e´vidence que dulaglutide, au meˆme titre que liraglutide, peut eˆtre propose´ aux patients diabe´tiques de type 2 lorsque celui-ci est indique´. De´claration de liens d’inte´reˆts Les auteurs n’ont pas pre´cise´ leurs e´ventuels liens d’inte´reˆts. http://dx.doi.org/http://dx.doi.org/10.1016/j.phclin.2017.01.057 OP1/F-PCL-52
Handling of drug–drug interactions in clinical pharmacy practice M. Lutters*, S. Widmer, L. Bru ¨hwiler, C. Belenda, K. Waldner-Knogler, P. Wiedemeier Kantonsspital, Baden, Switzerland *Corresponding author. Im Ergel, 5404 Baden, Switzerland. E-mail address: [email protected] (M. Lutters) Introduction Potential drug-drug interactions (DDI) are an important risk factor for adverse drug events (ADE). Automatic interaction check systems have been implemented in many hospitals but they are often not used by physicians due to ‘‘alert fatigue’’. We tried to find out how often clinical pharmacists intervene because of DDI, and what are the reasons for this decision. Methods 1. All interventions of clinical pharmacists in our hospital in 2015, routinely documented with the GSASA-tool, were analysed for DDI. 2. A sample of medication profiles was checked for DDI (classes 1–4) using the ABDA database provided by emediat (integrated in our electronic prescribing tool) and compared to documented interventions of DDI. 3. Using a structured form, clinical pharmacists were asked after ward rounds, whether and why they did an interaction check, whether and why they intervened and whether the intervention was accepted by the physician. Results 1. One hundred and forty-six of 1170 (12%) interventions concerned DDI. Acceptance rate of DDI interventions was 93% compared to 87% of