Background There is a gap in antimicrobial stewardship in transitions of care. Objectives To assess the appropriateness of antibiotics utilized and prescribing habits at hospital discharge. Methods A retrospective, observational study was conducted at our quaternary care hospital between January 2021 and March 2021. During the study period, all patients discharged on antibiotics for pneumonia (PNA), skin and soft tissue infections (SSTI), urinary tract infections (UTI) and intra-abdominal infections (IAI) were included. The overall appropriateness of therapy was assessed based on the following combined criteria: agent, dose, frequency, duration of therapy, and ability to meet diagnostic criteria. Results One hundred and forty-five subjects met the inclusion criteria. Of these, 44 (30.3%) were determined to have received overall appropriate antibiotic therapy. The most common infections were UTI, followed by IAI, PNA, and SSTI, respectively. Further, from the group deemed to have received overall inappropriate therapy, 26 of the 101 (25.7%) patients received an inappropriate antibiotic choice, 6 (5.9%) an inappropriate dose, and 84 (83.2%) an inappropriate duration of therapy. Conclusions Inappropriate duration of therapy represented the most challenging problem with antibiotic regimens at discharge. Larger studies are needed to identify potential interventions that are effective, and can be implemented in all settings, including resource-limited ones.

Introduction: The purpose of our report is to describe the design and implementation of the first antimicrobial stewardship certificate program (ASCP) in the United Arab Emirates (UAE). Methods: The ASCP was implemented in January 2019. A needs assessment was conducted before the implementation of the program. The program delivery utilized a blended learning format with both a live and an experiential component. Learner assessments consisted of pre- and post-course assessments, as well as structured feedback throughout the course. Course assessments and post-course evaluation results were utilized to assess the certificate program (CP) outcomes. Results: Between January 2019 to March 2020, 24 pharmacists were trained through the program. All participants passed the post-course assessment. Participants scored a median of 40 percent on the pre-course assessment at the start of the program and a median of 80 percent on the post-course assessment (p-value < 0.0001), demonstrating a significant improvement in their baseline knowledge. Overall, participants were highly satisfied with the program and felt that it would enhance their ability to take care of patients and/or result in practice change in their institution. Conclusions: The ASCP enhanced the knowledge of pharmacists in antimicrobial stewardship. The implemented model provides a sustainable blueprint for future CPs in specialty areas of practice for the Middle East region.

There has been a substantial increase in the use of extracorporeal membrane oxygenation (ECMO) support in critically ill adults. Understanding the complex changes that could affect drugs’ pharmacokinetics (PK) and pharmacodynamics (PD) is of suitable need. Therefore, critically ill patients on ECMO represent a challenging clinical situation to manage pharmacotherapy. Thus, clinicians’ ability to predict PK and PD alterations within this complex clinical context is fundamental to ensure further optimal and, sometimes, individualized therapeutic plans that balance clinical outcomes with the minimum drug adverse events. Although ECMO remains an irreplaceable extracorporeal technology, and despite the resurgence in its use for respiratory and cardiac failures, especially in the era of the COVID-19 pandemic, scarce data exist on both its effect on the most commonly used drugs and their relative management to achieve the best therapeutic outcomes. The goal of this review is to provide key information about some evidence-based PK alterations of the drugs used in an ECMO setting and their monitoring.