Healthcare-associated ventriculitis and meningitis is a common complication in patients who suffer from head trauma or have undergone a neurosurgery. Healthcare-associated ventriculitis and meningitis is associated with significant morbidity and mortality. Complications of healthcare-associated ventriculitis and meningitis include persistent vegetative state, moderate and severe disability, and death.
Acinetobacter baumannii
is the causative pathogen in 3.6–11.2% of cases of healthcare-associated ventriculitis and meningitis. Cases of difficult-to-treat healthcare-associated
A. baumannii
ventriculitis and meningitis are being reported more frequently. However, in most of these cases, a combination of intravenous (IV) and intraventricular (IVT)/intrathecal colistin achieves good therapeutic outcome. This report describes a clinical case of difficult-to-treat healthcare-associated
A. baumannii
ventriculitis. The
A. baumannii
strain was sensitive to colistin and trimethoprim-sulfamethoxazole, intermediate to tigecycline, and resistant to other antibiotics. While colistin was the drug of choice in our case, the patient developed anaphylactoid reaction during the IV administration of the loading dose of colistin, which mandated us to discontinue colistin and complicated the treatment of our patient. The patient did not respond to a combination of IV antibiotics that included meropenem, trimethoprim-sulfamethoxazole, and tigecycline. However, when IVT tigecycline was added as a last-resort therapeutic option, the patient’s ventriculitis dramatically improved, and the patient was discharged from the hospital. Physicians who treat patients with healthcare-associated
A. baumannii
ventriculitis might resort to IVT tigecycline when they run out of therapeutic options.
Background: The emergency department (ED) is a complex environment presenting unique challenges for high-risk populations such as critically ill patients who often require the use of high-risk medications. One study suggests that clinical pharmacists (CPs) may improve the fulfillment of safety goals for the ED patient as per the Joint International Commission. Some published reports have asserted that ED-based CPs would have the potential to increase patient safety. In our hospital, the number of CPs covering the ED increased from 2 to 9 starting from November 2019. Methods: This is a retrospective audit covering the period from January 1st 2019 till October 25th 2020 at Hamad General Hospital (HGH) in Doha, Qatar, to determine the impact of increasing the number of CPs covering the ED on the number of identified, solved, and documented drug related problems (DRPs) on the electronic medical records of ED patients. The interventions retrieved from pharmacy reports were analyzed and evaluated in terms of numbers by classification and percentages by the investigators. Results: A total number of 8,946 interventions covering 6,284 patients were carried out in 2020 compared with 1,515 interventions covering 1,001 patients in 2019 which represents a 6-fold increment by increasing the CPs from 2 to 9. Even the detection of adverse drug reactions increased by 1.5 times with only 38 documented in 2019 compared to 64 in 2020. Classifications and quantities of interventions were also analyzed in detail. Conclusion: This audit demonstrates that pharmaceutical intervention can positively contribute to the identification and resolution of DRPs. The benefit of CP involvement in patient care was observed based on the number of interventions that occurred. Studies are needed to assess the impact of those interventions on patients’ outcomes and cost effectiveness.
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