Clinically Relevant Interactions with Anti-Infectives on Intensive Care Units-A Multicenter Delphi Study.

Joachim Andreas Koeck,Christina König,Ruediger Warlich,Dagmar Horn,Damaris Meyn,Heike Hilgarth,Andreas Münstedt,Andreas von Ameln-Mayerhofer

doi:10.3390/antibiotics10111330

Abstract

Patients in intensive care units (ICUs) are at high risk of drug–drug interactions (DDIs) due to polypharmacy. Little is known about type and frequency of DDIs within German ICUs. Clinical pharmacists’ interventions (PI) recorded in a national database (ADKA-DokuPIK) were filtered for ICU patients. Binary DDIs involving ≥1 anti-infective agent with >1 database entry were selected. A modified two-step Delphi process with a group of senior hospital pharmacists was employed to evaluate selected DDIs for clinical relevance by using a five-point scale and to develop guidance for clinical practice. In total, 16,173 PI were recorded, including 1836 (11%) DDIs in the ICU setting. Of the latter, 41% (756/1836) included ≥1 anti-infective agent, 32% (590/1836) were binary DDIs, and 25% (455/1836) were listed at least twice. This translates into 88 different DDIs, 74% (65/88) of which were rated as being clinically relevant by our expert panel. The majority of DDIs (76% [67/88]) included macrolides, antifungals, or fluoroquinolones. This percentage was even higher in DDIs being rated as clinically relevant by the experts (85% [55/65]). It is noted that an inter-professional discussion and approach is needed in the individual patient management of DDIs. The guidance developed might be a tool for decision support.

Highlights

Ill patients typically receive polypharmacy and are at high risk for drug– drug interactions (DDIs) [1,2,3]
The German ADKA-DokuPIK database comprised 16,173 pharmacists’ interventions (PI) from intensive care units (ICUs) that were recorded over 13.5 years until 2021
Nineteen DDIs required therapy modification as they may not be controlled by additional monitoring (Categories 4 and 5)

Summary

Introduction

Ill patients typically receive polypharmacy and are at high risk for drug– drug interactions (DDIs) [1,2,3]. Two recent reviews reported a prevalence of DDIs between 58–67% during ICU stays [4,5]. Due to the patients’ critical condition and continuous monitoring in the ICU, not all DDIs are considered clinically relevant [6]. 38% of ICU patients will experience at least one clinically relevant DDI during their ICU stay [6]. Since infections are an important issue in the ICU, a significant number of patients will receive at least one anti-infective agent at some stage during their treatment [7]. Adequate knowledge of most common interactions between anti-infectives and other drugs and their clinical consequences is necessary [7]. DDIs can lead to patient harm or to potentially fatal adverse events [7]

Methods

Results

Discussion

Conclusion