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General and Risk Management, Patient Safety (including: medication errors, quality control)
Adjustment of imipenem therapy to renal function
  1. V. Martínez Santana,
  2. A.M. López González,
  3. M.T. Sánchez Sánchez,
  4. M. Fernández Prieto
  1. 1Hospital Clínico Universitario, Pharmacy, Valladolid, Spain


Background Postoperative infections are very common complications. Considering patient's renal function is important when prescribing antibiotics, but this is not a usual practice.

Purpose To evaluate the use of Imipenem in hospitalised patients in the Vascular Surgery Unit of the General Hospital.

Materials and Methods A retrospective observational study of 3 months duration was undertaken (June–August 2011) in 51 beds of Vascular Surgery with Unit Dose Distribution System. All patients treated with Imipenem are included and patients with creatinine clearance (CrCl) lower than 60 ml/min are evaluated. Age, genre, CrCl, estimated by the Cockcroft–Gault method, empirical treatment or not and drug related problem (DRP) were registered. The authors took as standard weight 70 kg in men and 60 kg in women. Dose and posology are adjusted to CrCl according to two sources of information. Patients are classified according to the K/DOQI guidelines criteria: stage 1 and 2 CrCl≥60 ml/min, stage 3 CrCl 30–59 ml/min and stage 4 and 5 CrCl<30 ml/min).

Results The authors evaluated 30/61 patients (21 men, 9 women), average age of 75 years old (51–92). 51 DRP were identified in 30 patients. It would be necessary to decrease the dose in 4/30 patients; to increase the therapeutic interval in 3/30 and to apply both measures in 22/30 patients. 8/30 patients have confirmed infection and in 22/30 patients Imipenem is prescribed empirically. Classification of patients according to K/DOQI guidelines: 34 patient's stage 1 and 2; 21 patient's stage 3; 6 patients stage 4 and 5.

Conclusions Imipenem does not adjust to renal function in 50% of the patients.

  • Imipenem is used empirically in Vascular Surgery Unit due to medical and surgical complexity of the patients

  • An improvement multidisciplinary program for the quality of antibiotic pharmacotherapy in patients with renal disease must be implemented.

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