ABSTRACT
Background and ImportanceThe high healthcare burden in the Intensive Care Unit (ICU) due to the SARS-CoV2 Coronavirus pandemic has created a work environment that increased medication errors. It is known that pharmaceutical interventions reduced medicantion errors.Aim and ObjectivesThe objective of this study is to know the impact of pharmaceutical intervention in critically ill patients.Material and MethodsRetrospective observational study carried out in a general hospital. All the pharmaceutical interventions performed in the Intensive Care Unit (ICU) between the months of October 2020 and April 2021 were analysed. It was registered in a database: Positive diagnosis of COVID-19 (SARS-CoV2 coronavirus disease), number of interventions, type of intervention and acceptance of the intervention.ResultsA total of 51 interventions were obtained in 169 patients admitted during the 7 months of the study (0.3 interventions / patient). 42.6% of the patients had a diagnosis of COVID-19. 17% of the patients admitted to the ICU had at least one intervention, of which 38% had more than 1 (mean 1.76 interventions per intervened patient). The most frequent reasons for intervention were dose modification due to inappropriate dose (35.3%) and inappropriate choice of presentation due to the route of administration (21.5%). 84% of the interventions were carried out in COVID-19 patients, with the mean number of interventions performed in these patients higher than in non-COVID-19 patients (1.87 vs 1.33). 92% of the interventions conducted by the pharmacist were accepted.Conclusion and RelevancePharmaceutical validation in the Intensive Care Unit (ICU) is essential to optimise the treatment of critical patients, increasing safety and efficacy of medications they receive and reducing medication errors. Patients diagnosed with COVID-19 are especially likely to benefit from pharmaceutical interventions, which are highly accepted by physicians.References and/or AcknowledgementsConflict of InterestNo conflict of interest
ABSTRACT
Background and ImportanceImmunosuppression due to SARS-CoV2 infection (COVID19) has caused an increase in identification of multi-resistant organisms in Intensive Care Units (ICU), among which multi-resistant Pseudomonas aeruginosa rise about others. Cefiderocol is a costly new cephalosporin against extensively resistant Gram-negative bacteria.Aim and ObjectivesThe objective of this study is to describe the characteristics and clinical results of patients treated with cefiderocol, as well as the dosage of this treatment, in ICU inpatients with COVID19 pneumonia and co-infected with pan-resistant Pseudomonas aeruginosa.Material and MethodsRetrospective observational study carried out in a general hospital from September 2020 to December 2021. Inpatients at ICU diagnosed with COVID-19 pneumonia that were treated with cefiderocol due to P. aeruginosa infection were included. Collected data were: days admitted in ICU, days of treatment with cefiderocol, concomitant treatment, cefiderocol dosage and results of the treatment.ResultsThree patients fulfilled the inclusion criteria among 70 patients admitted to ICU with COVID-19 in the study period (4.3%). All patients included were men and the median age was 66.6 ± 6.5 years old. They presented as comorbidities obesity, hypertension and diabetes mellitus. They were admitted during 87 ± 28.6 days, with detection of pan-resistant P. aeruginosa in the range of 32.5 ± 2.1 days after admission at ICU. All of these cultures were only sensitive to cefiderocol, being resistant to all other tested antibiotics. Due to that, all patients received cefiderocol during their stay and dose adjustment to their renal function or renal replacement therapy were applied. Every patient received a bolus of 2 grams in 30 minutes and the maintenance dose in at least 3 hours. The average of treatment days was 20.5 ± 4.5 days. In all cases, the isolated strains were sensitive to colistin, so cefiderocol was used in combination with it. The results of the treatment were disparate: one cure, one death, and one development of resistance to cefiderocol.Conclusion and RelevanceCefiderocol use for multi-resistant bacteria treatment requires prior knowledge of its pharmacokinetics, taking into account the physiological factors of patients in its dosage. New treatments are not exempt from the development of resistance.References and/or AcknowledgementsConflict of InterestNo conflict of interest