Association of Nephrotoxicity with Non-adherence to Therapeutic Drug Monitoring Guidelines of Antibiotics B

Abstract

Purpose: The main objective of this study was to evaluate therapeutic drug monitoring services of antibiotics at King Saud University Medical City (KSUMC) and investigate the association between non-adherence to therapeutic drug monitoring (TDM) guidelines and development of adverse effect. Method: This was a retrospective study conducted using electronic health records (HER), included all hospitalized patients who received antibiotics (vancomycin, gentamicin, and amikacin) with requested TDM over a one-year. The adherence to the TDM guidelines was measured by reviewing all the following: appropriate indication, sampling time (based on medication), results reports, and clinical pharmacist intervention. Descriptive analysis was performed for all variables within the study. All information analysis was conducted using SPSS for Windows (Chicago, Inc.). Results: A total of 1179 patients who have TDM requests during 2017 were included in our study, of that 65 % were male. The TDM service was the most commonly requested for vancomycin 72%, followed by gentamycin and amikacin with almost 14%. Over 25% of the patients in this study have sepsis, 11% endocarditis and 10 % pneumonia. Upon assessment of the appropriateness of sampling times, we found that around 15% were withdrawn at the wrong time, and over 40% of the TDM services did not adhere to the guidelines. Although the physicians accepted most of the pharmacists’ intervention related to TDM service, the pharmacist did not provide any recommendation in more than onethird of the cases. Nephrotoxicity was the most common adverse reaction, and it is observed in 20% of the patients. We detected a significant negative association between nephrotoxicity and guideline adherence (OR = 1.47; p 0.014). Conclusion: A reliable TDM service depends on the collaboration between the health care teams, including; doctors, nurses, clinical pharmacists, and lab staff. TDM service offers a great opportunity in improving clinical practice, optimizing treatment outcomes and minimize drug-related problems like toxicity, and prolong hospitalization. Improving TDM, service in this hospital would result in avoiding unnecessary costs to the patient and the health care system