Evaluation of antimicrobial dose adjustment based on renal function in intensive care units
DOI:
https://doi.org/10.21527/2176-7114.2024.48.14510Keywords:
Anti-infective agents, Acute kidney injury, Calculation of drug dosageAbstract
Objetive: To identify the factors associated with the adjustment of the dose of antimicrobials based on renal function in patients admitted to Intensive Care Units (ICUs). Method: Cross-sectional, descriptive-analytical study with data collection referring to the period from July to December 2019 in three ICUs. Patients hospitalized in these units with prescription of antimicrobials were included, and subjects with a stay of less than 24 hours in the ICU and aged less than 18 years were excluded. The association between dependent and independent variables was tested through univariate analysis, using a binary logistic regression model. The magnitude of the association was calculated using odds ratios (OR) with 95% confidence intervals (CI) and p < 0.05. Results: Of the total of 290 patients, 55.0% were male and 54.1% older adults (≥ 60 years). A total of 738 antimicrobials were used; 276 of them required dose adjustment, and 99.6% were adjusted. Piperacillin + Tazobactam, and Ampicillin + Sulbactam wre the most frequently adjusted. Altered creatinine (OR=9.753 CI=6.876–13.833), consultation with the Nephrologist (OR=4.431 CI=3.035–6.470) and pharmaceutical follow-up (OR=1.415 CI=1.046-1.914) were statistically associated with performing dose adjustment based on glomerular filtration rate (GFR). Conclusion: The findings revealed a significant association between changes in GFR and creatinine and the adjustment of the antimicrobial dose. There was a high level of dose adjustment and a statistical association between altered creatinine, consultation with a nephrologist and pharmacotherapeutic follow-up with the adjustment, reinforcing the importance of specialists and clinical pharmacists in the ICU.
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