Koeck Joachim Andreas, Hilgarth Heike, von Ameln-Mayerhofer Andreas, Meyn Damaris, Warlich Ruediger, Münstedt Andreas, Horn Dagmar, König Christina
Committee for Intensive Care Medicine and Clinical Nutrition, German Association of Hospital Pharmacists (ADKA), 10559 Berlin, Germany.
Department of Intensive Care and Intermediate Care, RWTH Aachen University Hospital, 52074 Aachen, Germany.
Antibiotics (Basel). 2021 Oct 31;10(11):1330. doi: 10.3390/antibiotics10111330.
Patients in intensive care units (ICUs) are at high risk of drug-drug interactions (DDIs) due to polypharmacy. Little is known about type and frequency of DDIs within German ICUs. Clinical pharmacists' interventions (PI) recorded in a national database (ADKA-DokuPIK) were filtered for ICU patients. Binary DDIs involving ≥1 anti-infective agent with >1 database entry were selected. A modified two-step Delphi process with a group of senior hospital pharmacists was employed to evaluate selected DDIs for clinical relevance by using a five-point scale and to develop guidance for clinical practice. In total, 16,173 PI were recorded, including 1836 (11%) DDIs in the ICU setting. Of the latter, 41% (756/1836) included ≥1 anti-infective agent, 32% (590/1836) were binary DDIs, and 25% (455/1836) were listed at least twice. This translates into 88 different DDIs, 74% (65/88) of which were rated as being clinically relevant by our expert panel. The majority of DDIs (76% [67/88]) included macrolides, antifungals, or fluoroquinolones. This percentage was even higher in DDIs being rated as clinically relevant by the experts (85% [55/65]). It is noted that an inter-professional discussion and approach is needed in the individual patient management of DDIs. The guidance developed might be a tool for decision support.
由于用药种类繁多，重症监护病房（ICU）的患者发生药物相互作用（DDI）的风险很高。对于德国ICU内DDI的类型和频率，人们了解甚少。在一个国家数据库（ADKA-DokuPIK）中记录的临床药师干预措施（PI）被筛选出用于ICU患者。选择了涉及≥1种抗感染药物且有>1条数据库记录的二元DDI。采用了一种经过改进的两步德尔菲法，与一组资深医院药师一起，使用五点量表评估所选DDI的临床相关性，并制定临床实践指南。总共记录了16173次PI，其中包括ICU环境中的1836次（11%）DDI。在后者中，41%（756/1836）包括≥1种抗感染药物，32%（590/1836）为二元DDI，25%（455/1836）至少被列出两次。这相当于88种不同的DDI，其中74%（65/88）被我们的专家小组评为具有临床相关性。大多数DDI（76%[67/88]）包括大环内酯类、抗真菌药或氟喹诺酮类。在被专家评为具有临床相关性的DDI中，这一比例甚至更高（85%[55/65]）。需要注意的是，在DDI的个体患者管理中需要跨专业的讨论和方法。制定的指南可能是一种决策支持工具。
