"DRUG INTERACTION STEWARDSHIP" (DIS) AND "THERAPEUTIC DRUG MONITORING" (TDM) FOR STANDARD ANTBIOTICS/ANTIMYCOTICS (TDMSA) IN ABDOMINOSURGICAL PATIENTS UNDERGOING INTENSIVE CARE IN A TERTIARY CENTER
Uwe Lodes2, Florian Neuling2, Uwe Troeger3, David Jacob2, Frank Meyer*1
1Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital of Magdeburg, Magdeburg, Germany; 2Dept. of Anesthesiology and Intensive Care, University Hospital of Magdeburg, Magdeburg, Germany; 3Institute of Clinical Pharmacology, University Hospital of Magdeburg, Magdeburg, Germany
Disturbed organ functions and organ failure, pathophysiological changes in severily ill patients as well as in case of sepsis, ongoing hemodialysis for renal and hepatic insufficiency, varying pharmacokinetics/-dynamics (PK/PD) of drugs as well as numerous drug interactions can be considered an increasing problem in the appropriate medication of intensive care patients also oft he abdominosurgical profile.
Aim: Illustration of an interdisciplinary approach in daily clinical practice to optimize the regular "polymedication" as well as the ongoing medication of patients prior to surgical interventions as indicated and as part of the appropriate peri- and postoperative intensive care management.
Method: A so-called "Drug Interaction Stewardships" (DIS) very similar to the already established "Antibiotic Stewardship" (ABS) during daily clinical routine of an intensive care unit has been implemented in addition to the standard TDM extended by antibiotics/antimycotics (such as Meronem, Piperacillin-Tazobactam, Ceftazidim, Linezolid, Vorikonazol, Fluconazol, Caspofungin), for which a TDM has not been established yet (TDMSA) in a consecutive patient cohort of abdominosurgical proifile over a defined time period as part of a systematic prospective clinical single-center observational study (tertiary center) to reflect daily practice in abdominosurgical intensive care and as contribution to abdominosurgical quality assurance.
Results: From 01-2012 to 08-2016, 1,454 single pharmacological patient consultations led to 385 (26.5 %) changes of a medical treatment, which had been previously initiated by an experienced intensive care physician, most frequently in 156 cases (10.7 %) due to newly calculated PK/PD. Analysis of 2,333 TDMSA samples resulted in a lowest serum level within the adequate range in 1,130 cases (48.4 %). In 427 cases (18.3 %), a too low and in 776 subjects (33.3 %) a too high drug serum level was found prompting to a change in type, dose, dose interval and application route.
Conclusion: DIS and TDMSA can lead to a high rate of therapeutic changes in treatment protocols, which had been previously prescribed by an experienced colleague. Thus, quality, in particular, effect of medical treatment can be significantly improved in abdominosurgical intensive care patients.
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