Pharmacoepidemiology

Background: Bacterial skin infections frequently require systemic antibiotic therapy, and adherence to clinical guidelines is important for optimizing treatment outcomes and antimicrobial stewardship. This study evaluated systemic pharmacotherapy for bacterial skin infections, guideline adherence, and factors associated with treatment outcomes. Materials and Methods: This retrospective observational study included 300 patients treated in a regional hospital in Kosovo between January 2025 and August 2026. Demographic, clinical, laboratory, microbiological, and pharmacotherapeutic data were obtained from medical records. Guideline adherence and clinical outcomes were evaluated, and Firth penalized multivariable logistic regression was used to identify factors independently associated with guideline non-adherence and unfavorable clinical outcomes. Results: Guideline-adherent pharmacotherapy was documented in 269 patients (89.7%), while 266 (88.7%) achieved a favorable clinical outcome. Guideline non-adherence was independently associated with younger age (AOR 0.89 per year; 95% CI 0.83–0.95; p < 0.001), female sex (AOR 2.44; 95% CI 1.05–5.98; p = 0.038), higher CRP (AOR 1.23 per 10 mg/L increase; 95% CI 1.11–1.38; p < 0.001), and antibiotic modification (AOR 3.29; 95% CI 1.37–7.89; p = 0.008). Unfavorable clinical outcomes were independently associated with male sex (AOR 4.37; 95% CI 1.84–11.40; p < 0.001), higher CRP (AOR 1.22 per 10 mg/L increase; 95% CI 1.09–1.37; p < 0.001), intravenous administration (AOR 3.06; 95% CI 1.29–7.63; p = 0.011), and guideline non-adherence (AOR 3.12; 95% CI 1.16–8.23; p = 0.025). Conclusions: Guideline adherence and favorable clinical outcomes were high. Nevertheless, non-adherence remained independently associated with unfavorable outcomes, while higher CRP was associated with both study outcomes. These findings support continued optimization of systemic antibiotic pharmacotherapy and antimicrobial stewardship in dermatological practice.

Background: Medication errors (MEs) are an important cause of preventable harm but remain insufficiently quantified in emergency care. This study assessed the frequency, characteristics, and clinical impact of MEs among adverse drug reaction (ADR)–related emergency department (ED) admissions in Germany. Methods: We conducted a prospective multicenter study across six EDs between 2015 and 2021 (n = 7967). ADRs and MEs were classified using standard causality (World Health Organization-Uppsala Monitoring Centre (WHO-UMC)) and preventability criteria (Schumock). Patient, medicine, symptom, and outcome characteristics were compared between ADRs caused by MEs and ADRs without documented MEs. Regression models assessed factors associated with ME involvement among ADR cases and length of hospital stay. Results: 20.1% of ADR-related cases involved an ME. Clinical presentation, symptom burden, triage severity, and discharge outcomes were similar between groups. MEs clustered around commonly used chronic medications, including pantoprazole, torasemide, metoprolol, ramipril, phenprocoumon, and ibuprofen. Schumock analysis showed preventability as primarily linked to dosing errors (30%), non-adherence (28%), contraindications (26%), and monitoring (20%). Medicine-specific symptom clusters mirrored expected pharmacological effects but were not specific to ME involvement. Multimorbidity was associated with slightly lower odds of ME attribution, although the estimate was borderline (OR 0.84, 95% CI 0.71–1.00); no robust associations were identified for the other patient-level characteristics examined. Adjusted length of hospital stay was slightly longer in cases involving MEs (+4.8%; p = 0.025), corresponding to an adjusted difference of 0.33 days. Conclusions: MEs were identified in a substantial proportion of ADR-related ED admissions. Most MEs arose from routine prescribing and monitoring processes involving commonly used medicines, suggesting that preventive efforts should focus on upstream safeguards, including medication reviews, electronic prescribing support, pharmacist involvement, and adherence support, rather than detection at emergency presentation.

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been shown to reduce the rate of chronic kidney disease (CKD) progression and provide cardioprotective benefits beyond glycemic control. However, evidence regarding their effects on kidney disease progression in advanced CKD patients remains limited. Objectives: To determine the proportion of patients who developed adverse renal outcomes (AROs) and identify factors associated with AROs among patients with advanced CKD following SGLT2 inhibitor initiation. Methods: This retrospective cohort study was conducted in a tertiary-care hospital in Thailand. Patients with advanced CKD who initiated SGLT2 inhibitor therapy between 1 January 2021 and 31 March 2025 were included. Descriptive statistics were used to summarize the data. Factors associated with AROs were evaluated using Cox proportional hazards regression analysis. Results: A total of 132 patients were included for analysis. All patients received empagliflozin. Most patients were aged ≥60 years (77.27%), and 53.79% were female. During the follow-up period, 24.2% of patients experienced AROs. Multivariable analysis identified CKD stage 5 (aHR = 4.02, 95% CI: 1.92–8.44, p < 0.001) and concomitant use of low-dose aspirin (aHR = 2.35, 95% CI: 1.05–5.26, p = 0.038) as factors independently associated with an increased risk of AROs. Conclusions: Approximately one-quarter of patients with advanced CKD experienced an ARO, following empagliflozin initiation. CKD stage 5 and concomitant low-dose aspirin use were independently associated with AROs. Patients with these characteristics may warrant closer monitoring of renal function, particularly in those with more advanced disease during empagliflozin therapy.