Clinically relevant potential drug-drug interactions in intensive care patients: A large retrospective observational multicenter study

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.

Successful treatment of Staphylococcus epidermidis prosthetic valve endocarditis with linezolid after failure of treatment with oxacillin, gentamicin, rifampicin, vancomycin, and fusidic acid regimens

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.

Gastrointestinal actinomycosis: an unusual presentation with obstructive uropathy: report of a case and review of the literature

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.