Evaluation of a protocol for rifaximin discontinuation in critically ill patients with liver disease receiving broad-spectrum antibiotic therapy
作者机构：Department of PharmacyCleveland ClinicClevelandOH 44195United States Department of Critical Care MedicineCleveland ClinicClevelandOH 44195United States Department of GastroenterologyHepatologyand NutritionCleveland ClinicClevelandOH 44195United States
出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)
年 卷 期：2023年第15卷第11期
页 面：1226-1236页
学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学]
主 题：Rifaximin Hepatic encephalopathy Critical illness Antibiotics Liver disease Cirrhosis
摘 要：BACKGROUND Rifaximin is frequently administered to critically ill patients with liver disease and hepatic encephalopathy,but patients currently or recently treated with antibiotics were frequently excluded from studies of rifaximin *** to overlapping spectrums of activity,combination therapy with broad-spectrum antibiotics and rifaximin may be unnecessary.A pharmacist-driven protocol was piloted to reduce potentially overlapping therapy in critically ill patients with liver *** was hypothesized that withholding rifaximin during broad-spectrum antibiotic therapy would be safe and reduce healthcare *** To determine the clinical,safety,and financial impact of discontinuing rifaximin during broad-spectrum antibiotic therapy in critically ill liver *** This was a single-center,quasi-experimental,pre-post study based on a pilot pharmacist-driven *** in the protocol group were prospectively identified via the medical intensive care unit(ICU)(MICU)protocol to have rifaximin withheld during broad-spectrum antibiotic *** were compared to a historical cohort who received combination therapy with broadspectrum antibiotics and *** data were collected *** primary outcome was days alive and free of delirium and coma(DAFD)to 14 *** outcomes included MICU length of stay,48-h change in vasopressor dose,and ICU *** outcomes characterized rifaximin cost savings and protocol *** analysis was utilized to evaluate the association between group assignment and the primary outcome while controlling for potential confounding *** Each group included 32 *** median number of delirium-and coma-free days was similar in the control and protocol groups[3 interquartile range(IQR 0,8)vs 2(IQR 0,9.5),P=0.93].In multivariable analysis,group assignment was not associated with a reduced ratio of days alive and free of delirium or coma at 14 *** protocol res
维普期刊数据库