Exploring determinants in deciding the optimal antimicrobial dose in patients undergoing CRRT: a mixed-methods study.

Area of Science:

• Nephrology
• Infectious Diseases
• Clinical Pharmacy

Background:

• Antimicrobial dosing in continuous renal replacement therapy (CRRT) presents significant clinical challenges.
• Current knowledge and practices for antibiotic administration during CRRT have identified gaps.
• Effective antimicrobial therapy is crucial for critically ill patients with renal failure.

Purpose of the Study:

• To investigate factors influencing appropriate antimicrobial doses in patients undergoing CRRT.
• To identify and address existing gaps in knowledge and clinical practice related to CRRT antimicrobial dosing.
• To explore challenges and expectations among healthcare professionals regarding antibiotic administration in CRRT.

Main Methods:

• A mixed-method approach combining quantitative surveys and qualitative online focus groups.
• Quantitative phase: 160 infectious disease, intensive care, and clinical pharmacy professionals completed questionnaires on demographics, knowledge, attitudes, and practices.
• Qualitative phase: Focus groups explored challenges and expectations using the Theoretical Domains Framework.

Main Results:

• Despite high knowledge, 74.4% were unclear on the sieving coefficient, 78.8% lacked institutional guidelines, and 68.1% did not monitor drug levels.
• CRRT experience positively correlated with knowledge and attitude scores.
• Dosing practices varied for specific antibiotics like meropenem, piperacillin-tazobactam, and vancomycin.

Conclusions:

• Significant gaps in antimicrobial dosing guidelines and therapeutic drug monitoring exist for CRRT patients.
• Development of evidence-based dosing guidelines and CRRT-specific training are essential.
• Multidisciplinary collaboration and real-time drug monitoring are recommended to improve patient safety and antimicrobial efficacy.