Clinically Relevant Interactions with Anti-Infectives on Intensive Care Units-A Multicenter Delphi Study

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Intensive Care Medicine

Background:

• Intensive care unit (ICU) patients face high risks of drug-drug interactions (DDIs) due to polypharmacy.
• Limited data exists on the specific types and frequency of DDIs within German ICUs.

Purpose of the Study:

• To investigate the type and frequency of DDIs in German ICUs.
• To evaluate the clinical relevance of identified DDIs.
• To develop guidance for clinical practice regarding DDIs in the ICU setting.

Main Methods:

• Clinical pharmacists' interventions (PI) from a national database (ADKA-DokuPIK) were filtered for ICU patients.
• Binary DDIs involving at least one anti-infective agent were selected.
• A modified two-step Delphi process with senior hospital pharmacists evaluated DDIs for clinical relevance using a five-point scale.

Main Results:

• Out of 16,173 PIs, 1836 (11%) were DDIs in the ICU setting.
• 41% of ICU DDIs involved an anti-infective agent; 32% were binary DDIs.
• 88 different DDIs were identified, with 74% rated as clinically relevant by experts. Macrolides, antifungals, or fluoroquinolones were involved in 76% of DDIs.

Conclusions:

• A significant proportion of DDIs in German ICUs involve anti-infective agents and are clinically relevant.
• Expert evaluation highlighted macrolides, antifungals, and fluoroquinolones as key contributors to relevant DDIs.
• Inter-professional collaboration and developed guidance are crucial for managing DDIs and supporting clinical decision-making in ICUs.