Pharmacists' Knowledge About the Impact of Augmented Renal Clearance on Antimicrobial Dosing in Critically Ill Patients: A Cross-Sectional Study

Abdulaziz S Almulhim; Batool A Al-Dahneen; Yazed S Alsowaida

doi:10.1007/s40121-020-00310-9

Pharmacists' Knowledge About the Impact of Augmented Renal Clearance on Antimicrobial Dosing in Critically Ill Patients: A Cross-Sectional Study

Infect Dis Ther. 2020 Sep;9(3):599-608. doi: 10.1007/s40121-020-00310-9. Epub 2020 Jun 27.

Authors

Abdulaziz S Almulhim¹, Batool A Al-Dahneen², Yazed S Alsowaida^{3

4}

Affiliations

¹ Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia. asaalmulhim@kfu.edu.sa.
² Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.
³ Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia.
⁴ Department of Pharmacy Services, Pharmacy Administration, Brigham and Women's Hospital, Boston, MA, USA.

Abstract

Background: Broad-spectrum antibiotics are commonly prescribed in critically ill patients. While it is commonly believed that only patients with impaired renal function need dose adjustment, augmented renal clearance (ARC) is a phenomenon that warrants dose adjustment as well. In critically ill patients ARC is often undetectable because it is associated with a normal or decreased serum creatinine concentration (SCr). This study's objective was to assess pharmacists' knowledge about ARC identification, risk factors, affected antimicrobials, and dosing of antibiotics in patients with ARC.

Methods: In January 2020, we carried out a cross-sectional study by sending out an online survey to the Saudi Pharmaceutical Society, Kuwait Pharmaceutical Association, and Oman Pharmaceutical Society. Due to the expected low response rate, we administered an electronic questionnaire to pharmacists attending Dubai International Pharmaceuticals and Technologies Conference and Exhibition 2020 (DUPHAT).

Results: Data were collected from 288 respondents. However, only 134 were included in the final analysis following the exclusion of incomplete responses, no experience working in in-patient settings, and respondents who chose "no" universal ARC definition. Those who chose "yes" or "I do not know" regarding the universal definition of ARC were asked about SCr status in ARC. Elevation in SCr was chosen by 67/134 (50%) compared to those who chose decreased or normal (48/134, 35.8%). Regarding risk factors, only 1/134 (0.7%) respondent selected all risk factors. Two/134 (1.4%) respondents chose all hydrophilic antibiotics that are likely to be affected by ARC. Concerning the appropriate dose and frequency of piperacillin-tazobactam and meropenem, they were selected by 60.4% and 30.5%, respectively.

Conclusion: Pharmacists' knowledge about ARC was limited. Implementation of educational programs targeting hospital pharmacists, especially those practicing in critical care settings, and developing antimicrobial institutional guidelines are important.

Keywords: Antibiotics; Augmented renal clearance; Beta-lactams; Critically ill patients; Pharmacist; Pharmacodynamic dosing; Pharmacokinetics/pharmacodynamics; Probability of target attainment.