Charlotte Quintens

In 2019, the European Committee on Antimicrobial Susceptibility Testing (EUCAST) redefined the “I” category from “intermediate susceptibi

Although the addition of buffers provides improved stability to flucloxacillin (FLU) solutions, unbuffered solutions are often preferred in clinical practice. The first purpose of this study was to investigate whether a 50 mg/mL solution of FLU in normal saline is stable for 24 h at 33 °C so that it can be applied for outpatient parenteral antimicrobial therapy (OPAT) using portable elastomeric infusion pumps (PEIPs). When the PEIPs were stored in an oven at 33 °C and deflated over 24 h, the volume of the collected solution, pH, and FLU concentration were checked every 4 h. Obtaining better results than expected based on the literature data, other storage conditions, such as refrigeration, room temperature (RT), 37 °C, refrigeration followed by 24 h at 33 °C and 37 °C, and different batches/brands, were also tested. This study confirmed the pronounced effect of temperature on the stability of FLU and also showed the relationship between the stability of FLU and the initial pH of the solution. FLU was quite stable at refrigeration and RT conditions, with more than 99% and 95% remaining. After 24 h at 33 °C, more than 92% of FLU was still present in the solution, while this number decreased to less than 85% when the storage temperature reached 37 °C. The remaining percentage was found to be even lower when the solution was stored at 2–8 °C for 6 days, followed by 24 h storage at 33 °C or 37 °C, with losses of 17% and 30%, respectively. The stability of FLU became worse when the initial pH of the solution was lower than 5.9 since the concentration of FLU dropped to less than 90% after 24 h at 33 °C, and a precipitate started to form when the initial pH of the solution was around 5.3. Therefore, FLU in PEIPs could be employed for 24 h if the temperature was ideally not more than 33 °C, while the pH should be not less than 5.9 upon reconstituting the FLU solution.

Fixed and broad screening intervals for drug-drug interaction (DDI) alerts lead to false positive alerts, thereby contributing to alert fatigue among healthcare professionals. Hence, we aimed to investigate the impact of customized screening intervals on the daily incidence of DDI alerts. An interrupted time series analysis was performed at the University Hospitals Leuven to evaluate the impact of a pragmatic intervention on the daily incidence of DDI alerts per 100 prescriptions. The study period encompassed 100 randomly selected days between April 2021 and December 2022. Preceding the intervention, a fixed and broad screening interval of 7 days before and after prescribing an interacting drug was applied. The intervention involved implementing customized screening intervals for a subset of highly prevalent or clinically relevant DDIs into the hospital information system. Additionally, the sensitivity of the tailored approach was evaluated. During the study period, a mean of 5731 (± 2909) new prescriptions per day was generated. The daily incidence of DDI alerts significantly decreased from 9.8% (95% confidence interval (CI) 8.4;11.1) before the intervention, to 6.3% (95% CI 5.4;7.2) afterwards, p < 0.0001. This corresponded to avoiding 201 (0.035*5731) false positive DDI alerts per day. Sensitivity was not compromised by our intervention. Defining and implementing customized screening intervals was feasible and effective in reducing the DDI alert burden without compromising sensitivity.

Implementation of outpatient parenteral antimicrobial therapy (OPAT), also known as intravenous (IV) antimicrobial treatment at home, has increased in recent years. Ensuring OPAT quality is crucial to achieve positive patient outcomes. However, data on the Belgian quality of OPAT organisation is lacking. We aimed to monitor the organisational quality of OPAT in Belgian hospitals and identify roles of hospital pharmacists involved in OPAT. A cross-sectional study applying a web-based survey on OPAT quality was conducted from 2 to 29 April 2024. The survey assessed the presence of six core and five non-core structure indicators, and OPAT-related tasks of hospital pharmacists. Almost two-thirds (64%; 65/101) of Belgian hospitals answered the survey, with 77% of these hospitals providing OPAT, with an increase since 2023. All 11 structure indicators were present in 6% of hospitals, while 18% had all six core structure indicators.Three of the six core structure indicators were formally present in the majority of the hospitals: a policy on patient selection criteria (76%), a structured OPAT programme (70%), and a dedicated team (64%). In contrast, a system for fast communication between the patient and OPAT team members (50%), a mechanism for urgent clinical discussions (42%), and monitoring of quality indicators (28%) were not formally present in the majority of the hospitals. The primary tasks for hospital pharmacists included overseeing OPAT prescriptions and supplying antimicrobials and related materials. While the adoption of OPAT is increasing among Belgian hospitals, significant opportunities remain for improving the quality of the OPAT organisation and expanding the OPAT-related tasks of Belgian hospital pharmacists.

Purpose Bacterial isolation is associated with worse outcomes after lung transplantation (LTx), and successful bacterial eradication is shown to improve long-term survival and pulmonary function. Outpatient Parenteral Antibiotic Therapy (OPAT) may be an effective therapeutic modality for bacterial eradication post-LTx. Methods A single-center, retrospective analysis of OPAT characteristics, efficacy, safety, and costs in non-cystic fibrosis LTx recipients. Results A total of 156 OPAT courses (from June 2019 to December 2022) were evaluated in 108 distinct LTx recipients. OPAT mainly consisted of dual antibiotic therapy (69%) for pulmonary bacterial isolation (97%), mostly Pseudomonas aeruginosa (66%). Successful eradication at 3 months post-OPAT was achieved in 71%. Eradication rate was significantly higher in patients treated after the first post-operative year (79%), compared to patients within the first year (61%) (p = 0.017). Eradication rate was similar for multidrug resistance (eradication rate 61%) versus no multidrug resistance (74%) (p = 0.116). Spirometry remained stable at 90 days post-OPAT. A statistically significant, but clinically negligible, increase in serum creatinine at 90 days post-OPAT was observed (1.33 mg/dL vs. 1.39 mg/dL, p < 0.001), yet unrelated to the antibiotic regimen used. OPAT-related hospital admissions occurred in 13% and line-related adverse events in 6%. Median number of hospitalization days saved per OPAT-course was 10 days (range 2–92), accounting for a total of 1841 avoided admission days and an estimated net cost reduction of 47% per treatment course. Conclusion OPAT is an effective and safe therapeutic modality for bacterial eradication post-LTx, associated with a significant reduction in hospitalization days and treatment costs.

Purpose We aimed to develop and implement dosing recommendations for antimicrobials in obese and underweight patients within an academic hospital, and assess their impact on antibiotic prescribing. Methods A multi-step approach project was performed. First, obese and underweight patient prevalence and antimicrobial prescription frequency was determined in a point prevalence study. Second and third, a literature review and e-survey provided dosing evidence. Fourth, a consensus meeting was organized to formulate dosing recommendations. Fifth, these were implemented in our clinical validation service as six clinical rules continuously screening patients’ records for potentially inappropriate prescriptions (PIPs). Uptake was evaluated by documenting the number of advices and acceptance rate. Last, an interrupted time series analysis (ITS) compared pre- and post-implementation periods to measure the impact of the intervention on residual PIPs/day. A residual PIP was defined as a PIP which persisted up to 48 h. Results First, 41% of 15.896 hospitalized patients received antimicrobials over 20 days; of which 12% were obese and 9% underweight. Antibiotics were predominantly prescribed according to standard dosing regimens, adjusted to renal function. Next, six dosing recommendations, derived from literature, survey, and consensus, were implemented. In the fifth step, during an 18-week period, 219 advices were given, with 86% acceptance rate. Last, in the ITS analysis, at preintervention, a median of 75% residual PIPs/day existed, reduced to 0% postintervention. Use of clinical rules resulted in a significant immediate 84% relative reduction in residual PIPs (95% CI 0.55–0.94). Conclusion After conducting a literature review, e-survey, and seeking consensus from a panel of experts, dosing recommendations for antimicrobial treatment in both obese and underweight patients were developed. These recommendations have been successfully implemented into clinical practice, addressing the specific needs of these patient populations.

Objectives: The overall prevalence of antimicrobial therapy (AMT) in nursing homes is well described. However, less is known about the appropriateness of AMT in nursing home residents. Therefore, the Check of APpropriaTeness of antimicrobial therapy in nursing homes (CAPTAIN) study aimed to assess both prevalence and appropriateness of AMT in Belgian nursing homes. Methods: In a prospective, observational, point prevalence study, researchers documented prevalence and identified potentially inappropriate prescriptions (PIPs) by evaluating accordance of AMT with national guidelines. The severity of inappropriateness was assessed by a modified Delphi expert panel. Results: Eleven nursing homes, including 1178 residents, participated in this study. On the survey day, 8.0% of residents took systemic AMT, primarily for urinary tract infections (54.2%), respiratory tract infections (36.5%), and skin and skin-structure infections (6.3%). About half of these prescriptions were used in prophylaxis (52.1%). Registration of indication and stop date was missing in 58.3% and 56.3% of AMTs, respectively. In 89.6% of the systemic AMTs, at least one discordance with national guidelines was identified, resulting in a total of 171 PIPs, with 49 unique PIPs. Of all unique PIPs, 26.5% were assessed with a high severity score (≥4). According to the expert panel, most inappropriate practice was starting AMT for cough without other symptoms. Inappropriate timing of time-dependent AMTs was common, but assessed as ‘moderately severe’. One-third of systemic AMT exceeded the recommended duration. Conclusions: AMT in nursing homes is often not prescribed according to national guidelines, highlighting the need for future interventions to promote the rational use of AMT in this setting.

Background and Importance Medication errors (MEs) occur in 5% of drug administrations in inpatients. Avoiding MEs is key to improve patient safety. Our centre implemented the Check of Medication Appropriateness (CMA), a back-office validation service, which significantly reduces potentially inappropriate prescriptions (PIPs). However, prescriptions for compounded medicines are lacking in this validation system. Aim and Objectives The aim of this study was to evaluate which checks are currently performed in a spontaneous and implicit way for prescriptions of compounded medicines. These checks identify possibilities for future development of an explicit and standardised service called the ‘Check of Compounding Appropriateness’ (CCA). Material and Methods An anonymous e-questionnaire was implemented at the compounding unit of our centre. Pharmacists and pharmacy technicians were asked to complete the e-questionnaire for every prescription of compounded medicines for which they performed implicit and spontaneous checks. Results Data saturation was obtained after two months yielding registrations for 315 prescriptions, accounting for 30% of total compounded prescriptions. Top category formulations included capsules (n = 240) and ointments & creams (n = 26), accounting for 84%. Eighty-nine percent (n = 281) of the prescriptions were ordered electronically instead of paper prescriptions. In total 1002 (clinical) checks were performed for the 315 prescriptions leading to the identification of 120 PIPs (38.1%). Ninety-four PIPs accounted for a logistic problem, mainly substitution (n = 58) or double order (n = 11); 25 were clinical PIPs, mainly incorrect dosing (n = 15); one PIP contained both a clinical and logistic problem. In 67.5% of PIPs, colleagues were contacted. In prescriptions with PIPs, the final action included cancellation of the preparation because of substitution to a commercially available drug/stock preparation (50.0%), cancellation of the preparation due to other reasons than substitution (23.3%), compounding of an adapted prescription (13.3%) and compounding of the original prescription (13.3%). Conclusion and Relevance PIPs also occur in prescriptions for compounded medicines. At our centre, these PIPs mainly include logistic and dosing problems. Next to the set-up of back-office CCA, this survey revealed that prescribing support, such as a substitution or dosing module, should be implemented to increase the efficiency at the compounding unit and patient safety. Conflict of Interest No conflict of interest