The aim of this study is to evaluate the risk factors for colonisation by multidrug resistant (MDR) K. pneumoniae in a critical care unit and the relationship between colonisation and the antibiotic pressure exerted by the antimicrobial treatments received by patients. A prospective observational was designed. Patients admitted for more than 48 h to an intensive care unit were included. Samples for surveillance cultures were obtained from all the patients upon admission and once a week. The association between risk factors and colonisation by MDR K. pneumoniae was determined by logistic regression. A Cox regression model was used to evaluate the effect of the use of antimicrobials on the colonisation rate. An ARMIA model was used to investigate the association between the incidence of colonisation by MDR strains and the global consumption of antimicrobials in the unit. One thousand seven hundred twenty-five patients were included, from which 308 (17.9%) were positive for MDR K. pneumoniae. In the multivariate analysis, hospitalisation for longer than 7 days together with respiratory infection and administration of any antibiotic was associated with increased MR K. pneumoniae colonisation. Patients who received antibiotics for more than 48 h were colonised earlier than patients who did not receive antibiotic treatment [HR: 2.16 (95%CI:1.55–3.03)]. The ARIMA model found a significant association between the monthly colonisation rate for MR K. pneumoniae and the consumption of cephalosporins and carbapenems in the previous month. Individual antibiotic administration and the global antibiotic pressure of cephalosporins and carbapenems are associated to an increased colonisation by MDR K. pneumoniae strains.

Isavuconazole is used to treat fungal infections. This study aims to describe isavuconazole pharmacokinetics in critically ill patients and evaluate their relationship with clinical efficacy and patient safety. We conducted a prospective, observational study in patients treated with intravenous isavuconazole. Samples were collected at predose (Cmin), 1 h (Cmax) and 12 h (C50) after the last dose. The plasma concentration was determined by high-performance liquid chromatography. The relationship between plasma concentration and clinical and microbiological outcomes and safety was evaluated. The influence of covariates (age, sex, weight, SAPS3, creatinine, liver enzymes and extracorporeal devices: continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO)) was analysed. Population pharmacokinetic modelling was performed using NONMEN^®. A total of 71 isavuconazole samples from 24 patients were analysed. The mean Cmin was 1.76 (1.02) mg/L; 87.5% reached the optimal therapeutic target and 12.5% were below 1 mg/L. Population pharmacokinetics were best described by a one-compartment model with first-order elimination. No factor had a significant impact on the plasma concentration or pharmacokinetic parameters. Thus, isavuconazole could be safely used in a critically ill population, even in those treated with CRRT and ECMO, from a pharmacokinetic standpoint. Therefore, routine therapeutic drug monitoring may not be strictly necessary in daily clinical practice.

Medication reconciliation is an essential process in the care of critically ill patients, ensuring that patients' chronic medication is adapted to the patient's clinical situation and administered safely during hospitalisation. Given the profile of the patient admitted to a critical care unit (ICU), this becomes even more relevant. Reconciliation minimises possible medication errors and adverse effects, improving safety in the critically ill patient. The project, carried out between 2021 and 2024, was led by the FarMIC (Pharmacists in Intensive Care Medicine and Critical Care) and RedFaster (Pharmaceutical Care in Emergencies) groups of the Spanish Society of Hospital Pharmacy (SEFH), and included: selection of the drugs, review of the available literature and previous conciliation guidelines in similar areas of application, preparation of the drug information with the recommendations issued by the working group, the review of the same and the development of the mobile application. In October 2024, the app 'Conciliation Guide for Critically Ill Patients®' was published, available free of charge for iOS and Android. It provides a drug index with detailed information on medication reintroduction schedules, routes of administration, monitoring, and drug-specific considerations. In addition, the tool includes information on withdrawal syndromes, drug-drug interactions with the usual ICU drugs and hazardous drugs information according to the NIOSH list. This app facilitates pharmacotherapeutic reconciliation process in the ICU, supporting healthcare professionals in making personalised decisions. Its use can optimise patient safety, reduce adverse events and improve critical patient care. Finally, this tool reinforces the role of the clinical pharmacist in the ICU, who must lead this process in all care transitions and adapt it to the clinical situation of the patient.

Medication reconciliation is an essential process in the care of critically ill patients, ensuring that patients' chronic medication is adapted to the patient's clinical situation and administered safely during hospitalisation. Given the profile of the patient admitted to a critical care unit (ICU), this becomes even more relevant. Reconciliation minimises possible medication errors and adverse effects, improving safety in the critically ill patient. The project, carried out between 2021 and 2024, was led by the FarMIC (Pharmacists in Intensive Care Medicine and Critical Care) and RedFaster (Pharmaceutical Care in Emergencies) groups of the Spanish Society of Hospital Pharmacy (SEFH), and included: selection of the drugs, review of the available literature and previous conciliation guidelines in similar areas of application, preparation of the drug information with the recommendations issued by the working group, the review of the same and the development of the mobile application. In October 2024, the app 'Conciliation Guide for Critically Ill Patients®' was published, available free of charge for iOS and Android. It provides a drug index with detailed information on medication reintroduction schedules, routes of administration, monitoring, and drug-specific considerations. In addition, the tool includes information on withdrawal syndromes, drug-drug interactions with the usual ICU drugs and hazardous drugs information according to the NIOSH list. This app facilitates pharmacotherapeutic reconciliation process in the ICU, supporting healthcare professionals in making personalised decisions. Its use can optimise patient safety, reduce adverse events and improve critical patient care. Finally, this tool reinforces the role of the clinical pharmacist in the ICU, who must lead this process in all care transitions and adapt it to the clinical situation of the patient.

Intensive Care Units (ICU) are recognized as high-risk settings for medication errors, primarily due to the complex pharmacological regimens and the critical condition of patients. It is estimated that the probability of errors occurring in these units is two to three times higher than in general hospital patients, with prescribing and administration being the stages most frequently associated with such incidents. To evaluate the applicability and satisfaction with electronic prescribing systems in Intensive Care Units of hospitals in Spain. A nationwide survey was conducted targeting pharmacists to assess the functionalities of the electronic prescribing systems used in these units. The evaluation covered hospital characteristics, features of the prescribing software, and healthcare professionals' satisfaction, with the aim of understanding the current situation and proposing improvement strategies to enhance medication safety through prescribing systems in the context of critically ill patients. A total of 64 surveys were completed across 55 different hospitals. In 50.8% of cases, a prescribing system different from that used in general hospital wards was employed. In 84.4% of cases, the system had been developed by a commercial vendor. In 65.1% of hospitals, the system enabled communication with the pharmacy, and in 57.7% it allowed for pharmaceutical validation. However, 50.8% of the systems were not capable of interfacing with automated dispensing or administration systems. In 71.9% of cases, the system allowed for direct data extraction. Pharmacists reported satisfactory overall perceptions in only 43.8% of cases, while 42.9% identified unmet needs requiring improvement. Despite significant heterogeneity in the functionalities of electronic prescribing systems across Spanish ICUs, such systems are widely implemented nationwide and are regarded as a key element in ensuring medication safety within these units. Clinical pharmacists reported a generally acceptable level of satisfaction; however, there remains considerable scope for improvement.