RESUMEN
PURPOSE: Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting. MATERIALS & METHODS: In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting. RESULTS: The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when considering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs. CONCLUSIONS: Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients.
Asunto(s)
Cuidados Críticos , Preparaciones Farmacéuticas , Interacciones Farmacológicas , Humanos , Unidades de Cuidados Intensivos , Estudios RetrospectivosAsunto(s)
Aneurisma/complicaciones , Aorta Torácica/cirugía , Aneurisma de la Aorta/cirugía , Tronco Braquiocefálico/patología , Síndrome de Marfan/complicaciones , Estenosis Traqueal/etiología , Adulto , Broncoscopía , Humanos , Intubación Intratraqueal , Masculino , Complicaciones Posoperatorias , Desconexión del VentiladorRESUMEN
We present a 49-y-old male, with a history of Marfan's disease and aortic and mitral valve replacement surgery, who was operated for a type III thoracoabdominal aneurysm. The postoperative course was compromised by a Staphylococcus epidermidis mitral valve endocarditis, which was successfully treated only after intravenous linezolid was included in the therapy.
Asunto(s)
Acetamidas/uso terapéutico , Antiinfecciosos/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Prótesis Valvulares Cardíacas/microbiología , Oxazolidinonas/uso terapéutico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus epidermidis/efectos de los fármacos , Acetamidas/administración & dosificación , Antiinfecciosos/administración & dosificación , Quimioterapia Combinada , Endocarditis Bacteriana/microbiología , Humanos , Linezolid , Masculino , Persona de Mediana Edad , Válvula Mitral/microbiología , Válvula Mitral/cirugía , Oxazolidinonas/administración & dosificación , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Estafilocócicas/microbiología , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
A 55-year-old female patient is described who had recurrent retroperitoneal infections without an apparent focus. After a protracted period of illness the infection proved to be caused by actinomycosis. An unusual feature of the inflammatory process consisted of obstruction of the ureters, ultimately resulting in destruction of the left kidney. Hydronephrosis resulting from inflammatory fibrosis has not been reported in the literature before.