Incidence and associated risk factors for systemic drug levels with inhaled aminoglycoside therapy.

OBJECTIVES: To characterize the incidence of and risk factors for a detectable drug level (DDL) in patients that received inhaled aminoglycoside therapy. METHODS: This retrospective, single-centre study included adult patients who received at least one dose of an inhaled aminoglycoside with a drug level during inpatient hospitalization. Patients were excluded if they received an aminoglycoside intravenously within 7 days or if the drug level was not drawn within 4 h of the next dose. A repeated measures logistic regression model evaluated the association between potential risk factors and a DDL. RESULTS: Among 286 drug levels, 88 (30.8%) drug levels were detectable. In multivariable analysis, cystic fibrosis (CF) (OR: 3.03; 95% CI: 1.10-8.35), chronic kidney disease (CKD) (OR: 4.25; 95% CI: 1.84-9.83), lung transplant recipient (OR: 3.08; 95% CI: 1.09-8.73), mechanical ventilation (OR: 2.99; 95% CI: 1.25-7.15) and tobramycin (OR: 5.26; 95% CI: 2.35-11.78) were associated with higher odds of a DDL. Among those with a DDL, inhaled aminoglycoside type and drug level concentration were not associated with acute kidney injury (P = 0.161). CONCLUSIONS: Among 286 drug levels identified among inpatients receiving inhaled aminoglycoside therapy, 88 (30.8%) unique drug levels were detectable. Based on the results of this study, periodic trough concentrations should be considered for patients receiving inhaled aminoglycoside therapy with CF, CKD, lung transplantation, mechanical ventilation or tobramycin.

Evidence of burnout in health-system pharmacists.

PURPOSE: Results of a study to determine levels of and risk factors for professional burnout among health-system pharmacists are reported. METHODS: The Maslach Burnout Inventory Human Services Survey (MBI-HSS) was distributed to a target population of health-system pharmacists to assess study participants for burnout, which is characterized by feelings of emotional exhaustion, depersonalization, and reduced personal accomplishment. Health-system pharmacists were solicited via email through a professional network listserver to complete an anonymous, electronic questionnaire regarding burnout. Demographic information, employment characteristics, and responses to the MBI-HSS were collected using a cross-sectional cohort survey methodology. Descriptive statistics were used to assess MBI-HSS scores and risk factors associated with burnout. RESULTS: Of the 371 survey responses received, 329 were complete and included in the final analysis. Overall, 175 study participants (53.2%) reported scores indicating a high degree of burnout on at least 1 subscale of the MBI-HSS. Twenty-eight respondents (8.5%) had scores indicating burnout on all 3 subscales. Average scores were 22.9, 6.2, and 36.3 for feelings of emotional exhaustion, depersonalization, and reduced personal accomplishment, respectively. Modifiable and nonmodifiable risk factors for burnout were identified. The findings warrant further research on burnout prevention and action to promote resilience in the profession. CONCLUSION: Half of health-system pharmacists assessed using the MBI-HSS in this study identified themselves as being at risk for burnout.