Exploring determinants in deciding the optimal antimicrobial dose in patients undergoing CRRT: a mixed-methods study

Abstract

Antimicrobial dosing in patients undergoing continuous renal replacement therapy (CRRT) is a clinical challenge. The study aimed to investigate the factors that influence appropriate antimicrobial doses in CRRT and to address gaps in current knowledge and practice. The mixed-method design involved two phases. For the quantitative phase, infectious disease, intensive care, and clinical pharmacy professionals completed a questionnaire assessing demographics and practice details, as well as their knowledge, attitudes, and practices on antibiotic dosing in CRRT. In the qualitative phase, online focus groups were conducted using a question schedule based on the Theoretical Domains Framework to explore challenges and expectations. A structured questionnaire was completed by 160 participants, most of whom were infectious disease specialists (61.3%) with over 10 years of experience (38.8%). Despite a high knowledge level of antimicrobial dosing during CRRT, the sieving coefficient was unclear at 74.4%. Although 96.3% reported adjusting doses, 78.8% lacked institutional guidelines, and 68.1% did not monitor drug levels. CRRT experience positively influenced knowledge and attitude scores, and different dosing practices were reported for meropenem, piperacillin-tazobactam, and vancomycin. Qualitative findings highlighted the need for standard guidelines and CRRT-specific training. Multidisciplinary collaboration and real-time monitoring of therapeutic drugs were emphasized. This study identifies key gaps in knowledge and practice regarding antimicrobial dosing in CRRT. Addressing these gaps requires targeted training programs, real-time drug monitoring, and the development of evidence-based dosing guidelines to enhance patient safety and antimicrobial efficacy. Future research should evaluate the impact of these interventions on clinical outcomes.

Keywords: drug dosage calculations; pharmaceutical arithmetic; qualitative evaluation; quantitative evaluation; renal replacement therapies.

Fig 1

Mixed-method design schema.

Fig 2

Details of focus group session themes and subthemes.