Medication errors are a leading cause of mortality and morbidity worldwide. Patients in intensive care unit (ICU) are particularly vulnerable to adverse events resulting from intravenous (IV) medication errors. This study aims to evaluate the knowledge, attitudes, and behaviours of ICU nurses in Pakistan regarding IV drug administration and to identify strategies for preventing medication errors in ICU. A cross-sectional study was conducted using convenience snowball sampling, including 426 ICU nurses from various hospitals in Pakistan. Data were collected through a validated questionnaire assessing medication error knowledge, attitudes, and behaviours. Statistical analyses, including multiple logistic regression, were performed to identify significant associations. ICU nurses demonstrated satisfactory expertise in IV drug preparation and administration; however, gaps were observed in professional behaviors related to ensuring safe and effective patient care. Specifically, 93.9% of nurses accurately calculated IV medication dosages, and 89.6% emphasized the importance of periodic assessment of clinician’s medication therapy safety skills. However, only 73.5% adhered to hand hygiene practices during IV medication preparation and administration, despite 97.2% receiving formal training in these procedures during their education. Multivariate analysis revealed significant associations: nurses fluent in English demonstrated better understanding of medication instructions (odds ratio OR = 2.59, 95% CI: 1.26–5.31; p = 0.009). Female nurses showed higher knowledge levels (odds ratio OR = 2.62, 95% Confidence interval, CI: 1.20–5.70; p = 0.015). Additionally, nurses from Punjab exhibited 79% lower knowledge levels compared to those from other provinces (odds ratio OR = 0.214, 95% Confidence interval, CI: 0.077–0.595; p = 0.003). Overall, a strong positive association was observed between nurses’ knowledge, attitudes, and behaviors and the identified demographic factors. Improving nurses’ knowledge, attitudes, and behaviors through targeted education and continuous clinical practice monitoring is essential for enhancing medication safety in critical care. Regular training and evaluation programs are vital to minimizing medication errors and ensuring safe and effective healthcare practices in ICUs.

Empiric antibiotic dosing frequently relies on an estimate of kidney function based on age, serum creatinine, sex, and race (on occasion). New non-race-based estimated glomerular filtration rate (eGFR) equations have been published, but their role in supporting dosing is not known. Here, we report on a population pharmacokinetic model of vancomycin that serves as a useful probe substrate of eGFR in critically ill Thai patients. Data were obtained from medical records during a 10-year period. A nonlinear mixed-effects modeling approach was conducted to estimate vancomycin parameters. Data from 208 critically ill patients (58.2% men and 36.0% septic shock) with 398 vancomycin concentrations were collected. Twenty-three covariates including 12 kidney function estimates were tested and ranked on the basis of the model performance. The median (min, max) age, weight, and serum creatinine was 69 (18, 97) years, 60.0 (27, 120) kg, and 1.53 (0.18, 7.15) mg/dL, respectively. The best base model was a 1-compartment linear elimination with zero-order input and proportional error model. A Thai-specific eGFR equation not indexed to body surface area model best predicted vancomycin clearance (CL). The typical value for volume of distribution and CL was 67.5 L and 1.22 L/h, respectively. A loading dose of 2000 mg followed by maintenance dose regimens based on eGFR is suggested. The Thai GFR not indexed to BSA model best predicts vancomycin CL and dosing in the critically ill Thai population. A 5% to 10% absolute gain in the vancomycin probability of target attainment is expected with the use of this population-specific eGFR equation.

Background: Intravenous indomethacin has been used in infants for many years as the pharmacological closure of ductus arteriosus, but the incidence, risk, and risk factors of acute kidney injury (AKI) among infants treated with indomethacin, were still scarce. Objectives: To determine the incidence, risk, and risk factors of AKI among infants treated with indomethacin (exposed group) for patent ductus arteriosus (PDA) closure compared with the matched non-exposed infants. Methods: A matched retrospective cohort study of infants admitted to the neonatal intensive care unit of Songklanagarind Hospital from January 2003 to December 2018 was performed. All data were collected from computerized medical records. A non-exposed infant was matched (1:1) by gestational age and birth weight to each exposed infant. AKI, the outcome of interest, was diagnosed according to neonatal AKI definitions. The incidence (95% CI) of AKI was estimated for each group. Conditional logistic regression was used to estimate the odds ratio (OR) of developing AKI among those who received indomethacin compared with those who did not, adjusted for potential confounders (concomitantly used nephrotoxic potential medications including aminoglycosides, amphotericin B, vancomycin, furosemide, systemic corticosteroids, and systemic vasopressors and inotropes). Kaplan-Meier estimate was performed to examine probability of recovery from AKI after AKI events. Results: The matching resulted in 193 pairs of exposed and non-exposed infants. The incidences [95% CI] of AKI in the exposed and the non-exposed group, were 33.7% [27.0%:40.4%] and 15.5% [10.4%:20.7%], respectively. Indomethacin statistically increased the risk for developing AKI, crude OR 2.94[95%CI 1.77:4.90], McNemar's chi square p<0.001, and adjusted OR 2.73 [95%CI 1.55:4.80], p=0.001. The risk of AKI associated with potentially nephrotoxic medications were inconclusive. Time to recovery from AKI was relatively rapid, median recovery time was 3 days in both groups and all infants who developed AKI recovered within 6 days. Conclusions: The incidence of AKI among infants treated with indomethacin for PDA closure were doubled that in the indomethacin-nonexposed infants. Indomethacin significantly increased the risk of AKI, while the risk associated with other concomitant nephrotoxic medications were inconclusive. Transient nephrotoxicity associated with indomethacin should be balanced with the risk associated with delayed PDA closure. All infants receiving indomethacin should be routinely monitored for serum creatinine and/or urine output, throughout the treatment and one to two weeks after treatment cessation. Alternatives with better renal safety profiles should be considered in the population with higher risk of AKI.

Objective: This study aimed to investigate the characteristics, microbiological profile, and mortality of patients with sepsis and septic shock in the medical intensive care unit (MICU). Material and Methods: Demographic data, clinical characteristics, microbiological profiles, empirical antimicrobial regimen, and hospital mortality were collected retrospectively from patients with sepsis or septic shock that were admitted to the MICU in 2020. The National Early Warning Score (NEWS) of ≥5 was utilized for sepsis screening, and the Sepsis-3 definition was applied to categorize cases of sepsis and septic shock.Results: Out of the 642 patients admitted to the MICU, 123 patients (19.2%) were included in this study. From these, 70.7% were diagnosed with sepsis and 29.3% with septic shock. The hospital mortality rates of overall patients, sepsis, and septic shock were 28.5%, 20.7%, and 47.2%, respectively. Comorbidities were identified in 89.4%. Septic shock and mortality were associated with higher Sequential Organ Failure Assessment scores, NEWS, and lactate levels (p-value<0.05). The majority of cases were hospital-acquired infections. The respiratory tract was the most affected site of infection. Gram-negative bacteria; particularly Enterobacterales and multidrug-resistant Acinetobacter baumannii, were identified as major pathogens in this study. Carbapenems and vancomycin were primarily prescribed in patients with septic shock, while carbapenems and β-lactam-β-lactamase inhibitors were commonly prescribed for sepsis patients. Conclusion: Sepsis and septic shock are commonly observed in the MICU, and they are associated with a high mortality rate. The NEWS is a practical tool for sepsis screening in the MICU.

A broad-spectrum antibiotic known as piperacillin is often used with tazobactam to treat infections caused by anaerobic bacteria as well as different Gram-positive and Gram-negative bacteria. To ensure efficacy, it is important that piperacillin must reach therapeutic levels in the blood. An optimized, high-pressure liquid chromatography (HPLC) serves as an ideal technique for accurate drug concentration analysis. In the current study, a validated reverse-phase HPLC method was developed for the determination of piperacillin in pharmaceutical formulation and human plasma. Acetonitrile was used to deproteinized the plasma samples, vortexed them, and reconstituted the supernatant with the mobile phase prior to HPLC injection. The analysis was performed by using a Waters Alliance HPLC system, which had a UV detector set at 218 nm and a flow rate of 1 mL min ⁻¹ . The mobile phase consisted of methanol, water, tetrabutylammonium chloride buffer, and phosphoric acid. The method showed linearity from 0.5 μg mL ⁻¹ to 400 μg mL ⁻¹ , with 99.9% recovery rate. The detection and quantification limits were 0.25 μg mL ⁻¹ and 0.5 μg mL ⁻¹ , respectively. The Cmax exhibits variability among patients, even when the same dose is administered to adult individuals. The method is both accurate and reliable, and the findings highlights the importance of individualized dosing based on variations in patients' plasma concentrations.

Adverse Events Related to Kratom Discontinuation and the Utilization of Prescribed Medications During Hospitalization: A 4-year Retrospective Study in Thanyarak Songkhla Hospital, Thailand