(930) A Comparative Analysis After Implementation of a Pharmacy-Driven Dosing Protocol in CRRT

Introduction: Continuous renal replacement therapy (CRRT) is a common practice for critically ill patients with impaired renal function. Data regarding dosing for antimicrobial therapy is limited and controversial. The objective of this study is to determine if the implementation of a pharmacy-driven protocol will optimize dosing of antimicrobials in patients on CRRT.

Methods: This was a retrospective study evaluating data pre- and post-implementation of a pharmacy-driven CRRT dosing protocol. The pre-implementation and post-implementation studies were completed from January 2021 to December 2021 and January 2023 to May 2023, respectively. For analysis, eligible patients must meet the following criteria: be at least 18 years of age, admitted to the critical care unit, and receiving CRRT with one of the following medications prescribed for more that 48 hours - cefepime, levofloxacin, meropenem, and piperacillin-tazobactam. Patients were excluded if there was incomplete documentation of CRRT flow rates. The primary outcome for this study is the percent improvement of antibiotic dosing after the pharmacy-driven protocol was implemented.

Results: There were 40 medication orders in the pre-implementation group (16 (40%) cefepime, 18 (45%) meropenem, 4 (10%) piperacillin-tazobactam, 2 (5%) levofloxacin) of which 13 (33%) were appropriately dosed for CRRT. Therapeutic dosing by antimicrobial was as follows: 31% cefepime, 18% meropenem, 75% piperacillin-tazobactam, and 100% levofloxacin. There were 30 medication orders in the post-implementation group (17 (57%) cefepime, 12 (40%) meropenem, 1 (3%) piperacillin-tazobactam, 0 (0%) levofloxacin) of which 27 (90%) were properly dosed. Therapeutic dosing by antimicrobial was as follows: 94% cefepime, 83% meropenem, 100% piperacillin-tazobactam. Implementation of the pharmacy-driven protocol showed a 272% improvement in therapeutic dosing for antibiotic therapy in patients on CRRT.

Conclusions: As shown by the results, a pharmacy-driven CRRT dosing protocol may notably improve antimicrobial dosing in critically ill patients receiving CRRT treatment. Conducting larger studies using a pharmacy-driven protocol along with pharmacokinetic data should be considered in the future, due to the limited published dosing standards in CRRT.