At the Crossroads of Stewardship and Technology: Impact of Pharmacokinetic-Pharmacodynamic (PK-PD) Integrated Electronic Decision Support Software (EDSS) on the Treatment of Patients Infected with Pneumonia

Abstract

Background

While many have advocated for the use of EDSS to enhance patient care, EDSS that incorporates PK-PD, the science behind antimicrobial stewardship, has thus far been an unattainable goal. Herein, we describe the use of such a technology and clinicians’ therapy decisions when treating patients with pneumonia.

Methods

Data for patients with pneumonia entered into EDSS over a 20-month period that were evaluated included: 1) patient demographics, creatinine clearance, and pneumonia severity score; 2) pneumonia type; 3) pathogen; 4) clinician-selected antimicrobials; 5) EDSS-presented regimens; and 6) clinician-reported outcomes. Clinicians were provided probabilities of attaining PK-PD targets associated with efficacy for both clinician-selected and EDSS-presented regimens. A regimen with a probability of PK-PD target attainment ≥90% was considered PK-PD optimized.

Results

Data for 126 cases were available. The median (min, max) age and creatinine clearance were 56.5 (18, >90) years and 72.5 (2.5, 193.3) mL/minute/1.73 m ², respectively. Pneumonia types included community-acquired (39%), healthcare-associated (30%), ventilator-associated (18%), and hospital-acquired (13%). CURB-65 pneumonia scoring was used in 66% of cases with a median (min, max) score of 3 (0, 5). The most common pathogens were P. A eruginosa (32%), MRSA (15%), and S. pneumoniae (14%). Multi-drug-resistant pathogens comprised 15% of all pathogens. PK-PD optimized regimens were selected in only 65% of cases despite such a regimen being presented in 91% of cases. For those cases in which outcome data were available ( n = 36), 81% of patients were considered improved at 48 hours while only 64% were deemed clinically improved or a success at the final outcome assessment on Days 7–10. Among those cases for whom PK-PD optimized and non-optimized regimens were selected (64 and 36%, respectively), 78 and 62% of patients had successful clinical outcomes on Days 7–10, respectively.

Conclusion

Given that patients with pneumonia represent a vulnerable population and that options for therapy can be limited, selection of optimal early therapy is crucial. PK-PD integrated EDSS presents clinicians the opportunity to optimize therapy and improve outcomes for patients with pneumonia.

Disclosures

S. M. Bhavnani, ICPD Technologies: Shareholder, stock options. C. M. Rubino, ICPD Technologies: Shareholder, stock options. P. G. Ambrose, ICPD Technologies: Shareholder, stock options.