APOTHEEK

ARTIKELS PRESENTATIES

ABSTRACT 1

Point prevalence survey of antimicrobial use and healthcare-associated infections in Belgian acute care hospitals: results of the global-PPS and ECDC-PPS 2017.

ABSTRACT 2

Concordance between guidelines on perioperative management of NOACs and its implementation and preventable causes of the occurence of ischemic stroke.

Vandael E, Latour K, Goossens H, Vanneste L, et al. Antimicrobial Resistance & Infection Control, 2020, 9(1), DOI: 10.1186/s13756-019-0663-7

Simons S

November 2020, European Stroke Organisation - World Stroke Organisation (ESO-WSO), Wenen – Oostenrijk, Online

INTRODUCTION The point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use organized by the European Centre for Disease Prevention and Control (ECDC-PPS) and the Global Point Prevalence Survey of antimicrobial consumption (Global-PPS) were simultaneously performed in Belgian acute care hospitals in 2017.

MATERIALS/METHODS Belgian acute care hospitals were invited to participate in either the ECDC or Global-PPS. Hospital/ward/patient-level data were collected between September-December 2017. All patients present in the wards at 8 a.m. on the day of the PPS were included. The data of the ECDC and Global-PPS on antimicrobial consumption were pooled. Detailed data on HAIs were analysed for ECDC-PPS.

RESULTS Overall, 110 Belgian acute care hospital sites participated in the ECDC and Global-PPS (countrywide participation rate: 81.4%, 28,007 patients). Overall, a crude prevalence of patients with at least one antimicrobial of 27.1% (95% confidence interval (CI) 26.5-27.6%) was found. The most frequently reported indications were pneumonia (23.2%), urinary tract infections (15.2%) and skin and soft tissue infections (11.9%). The reason for antimicrobial use was recorded for 81.9% of the prescriptions, a stop/review date for 40.8% and compliance with local antibiotic guidelines for 76.6%. In the ECDC-PPS, the crude prevalence of patients with at least one HAI was 7.3% (95%CI 6.8-7.7%). Most frequently reported HAIs were pneumonia (21.6%) and urinary tract infections (21.3%).

CONCLUSION HAI and antimicrobial use prevalence remained stable in comparison with the previous PPS (7.1% and 27.4% in 2011 and 2015, respectively). Belgian hospitals should be further stimulated to set local targets to improve antibiotic prescribing and reduce HAI. BACKGROUND Increasing numbers of patients receiving a novel oral anticoagulant (NOAC) are undergoing elective surgery. The extent to which perioperative interruption of NOAC therapy is concordant with best evidence is uncertain.

OBJECTIVE This study investigated whether inappropriate perioperative advice can lead to the occurrence of an ischaemic stroke. Furthermore, we examined the relation between inappropriate dosing, perioperative management and interactions.

MATERIALS/METHODS Data from all ischaemic stroke patients, previously treated with a NOAC, were retrospectively collected from the EVASBE-database (January to October 2019). The following data were retrieved: date of stroke, aetiology, previous stroke, posology and indication for NOAC, renal function, weight, age, concomitant drugs, surgery (indication, date, bleeding risk, preoperative advice), medication management poststroke and discharge therapy. Concordance of perioperative anticoagulation management with regional and EHRA guidelines was rated by a clinical pharmacist according to the explicit risk of thrombosis and bleeding.

RESULTS Of the 57 patients with an ischaemic stroke receiving a NOAC, nine (16%) had been planned to undergo surgery. The decision to interrupt anticoagulation was concordant with regional guidelines. Compared with EHRA guidelines: three cases stopped without indication (5 days–2 days), and three low and one high bleeding risk patient stopped too early. None of them were bridged.

Firstly, inappropriate dosing (30%) and posology (7%) based on the SmPC criteria was identified. Of the 17 inappropriately dosed patients, underdosing was the main factor (16 vs 1). Secondly, 16 patients (28%) showed one or more interactions with concomitant drugs. Due to the

pharmacodynamic interactions, a higher risk of thrombosis was seen in two patients. Four patients showed a pharmacokinetic interaction; one was a decreased effect. Thirdly, the greatest risk in the perioperative phase seemed to be post-surgery in comparison with pre-surgery, seen in seven and two patients, respectively. Medication adherence was questionable in five patients (9%).

CONCLUSION The occurrence of ischaemic stroke in the perioperative phase in patients treated with a NOAC was a major problem. The main issue seemed to be the discordance between our regional and EHRA guidelines regarding perioperative NOAC management. Apart from the perioperative transition phase, other reasons for occurrence were inappropriate dosing, drug interactions and non-compliance.

ABSTRACT 3

Occurrence of ischemic stroke in patients treated with NOAC: a neglected population group.

Vanacker P, Simons S, Verhaeghe A, Geebels A, Meeus G September 2020, ESO-WSO Conference 2020, Wenen - Oostenrijk, Online

ABSTRACT 4

Concordance between guidelines on perioperative management of NOACS and ITS implementation: preventable cause of ischemic stroke.

Vanacker P, Simons S, Verhaeghe A, Geebels A, Meeus G September 2020, ESO-WSO Conference 2020, Wenen - Oostenrijk, Online