Examinando por Autor "Giglio, Andres"

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    Activity and Outcomes of a Multidisciplinary Sepsis Unit: Fifty Thousand Consultations over Thirteen Years
    (MDPI, 0030-07-26) Borges-Sa, Marcio; Martin-Martinez, Elena; Aranda, Maria; Socias, Antonia; Tejada, Sofia; del Castillo, Alberto; Garau, Margarita; Pérez de Amezaga, Luis; Mena, Joana; Giglio, Andres
    Background. Sepsis is a leading, time-dependent cause of in-hospital death, and guidelines now prioritize organized care such as code-sepsis protocols. Yet little is known about the long-term activity, organization and outcomes of permanent, hospital-scale programs. We characterized the activity of a hospital-wide multidisciplinary sepsis unit (MSU) over thirteen years and evaluated mortality trends. Methods. Retrospective cohort study using the registry of a hospital-wide MSU (2011–2023). The analysis unit was the sepsis event. Activity, referral pathways, interventions, follow-up and mortality were analyzed; temporal trends used multivariable logistic regression and standardized mortality ratios (SMR). Results. The unit attended 10,874 patients across 15,723 events and 50,925 consultations (median age 67; 59.3% men), referred mainly through the sepsis code (45.0%) and, increasingly, proactive early-warning detection (15.2%). An antibiotic change was recommended in 57.2% of events, and 89.8% of all suggested changes were implemented. Follow-up was sustained (median 3 visits; 61.8%). In-hospital mortality was 7.6%, and 11.8% in protocol-confirmed sepsis. Crude mortality did not fall, but severity rose (organ dysfunctions 1.67 to 2.72; septic shock 8 to 13%; both p < 0.001) with stable age; after adjustment the calendar-year effect disappeared (adjusted OR 1.00/year, p = 0.70) and the SMR stayed near 1.0, including pandemic years. Age, ICU admission (OR 2.65) and organ-dysfunction count (OR 1.37) independently predicted death. Conclusions. Over thirteen years, this hospital-wide MSU delivered large-scale, multi-channel, longitudinal care to an increasingly severe population while maintaining stable risk-adjusted mortality, supporting the long-term feasibility of a model integrating early detection, multidisciplinary decision-making, antimicrobial stewardship and follow-up.
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    The ICU pharmacist’s contribution to antimicrobial optimization through routine pharmacist interventions
    (Revista Española de Quimioterapia, 2026-07-08) Sánchez-Ocaña, Natalia; Pérez-de-Amezaga-Tomás, Luis; Giglio, Andres; Borges, Marcio
    Background: Antimicrobials are among the medication groups most frequently involved in medication errors and adverse drug events in the Intensive Care Unit (ICU). Despite growing evidence supporting the role of Critical Care Pharmacists (CCPs) in antimicrobial stewardship, their integration into ICU teams remains inconsistent across European healthcare systems. Methods: A prospective observational study was conducted over five months in an 18-bed medical-surgical ICU at a tertiary-level hospital in Spain. All admitted patients were included. A specialist pharmacist reviewed daily antimicrobial prescriptions through the electronic prescribing system. Pharmaceutical interventions (PIs) were classified as proactive or reactive and categorised by intervention type according to a predefined taxonomy. A descriptive analysis was performed. Results: A total of 331 PIs were recorded, of which 150 (45.31%) corresponded to antimicrobial therapy, representing the most frequently involved medication group. This figure corresponds to a mean of 1.50 antimicrobial-related PIs per working day. Of these, 115 (76.67%) were proactive. The most frequent intervention type was dose adjustment for overdosing or excessive duration (47.33%), followed by dose adjustment for underdosing or insufficient duration (18.00%), therapeutic drug monitoring recommendations (10.67%), and drug information to clinical staff (6.66%). Conclusions: CCPs identify a substantial number of antimicrobial-related drug problems in the ICU through routine prospective review. The coexistence of overdosing and underdosing interventions reflects the pharmacokinetic complexity of this population. These findings support the formal integration of CCPs into ICU antimicrobial stewardship activities.