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Impact of electronic health record‐based, pharmacist‐driven valganciclovir dose optimization in solid organ transplant recipients
Author(s) -
Hensler David,
Richardson Chad L.,
Brown Joslyn,
Tseng Christine,
DeCamp Phyllis J.,
Yang Amy,
Pawlowski Anna,
Ho Bing,
Ison Michael G.
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12849
Subject(s) - valganciclovir , medicine , dosing , incidence (geometry) , pharmacist , kidney transplant , ganciclovir , kidney transplantation , emergency medicine , pharmacy , transplantation , immunology , human cytomegalovirus , family medicine , virus , physics , optics
Background Prophylaxis with valganciclovir reduces the incidence of cytomegalovirus ( CMV ) infection following solid organ transplant ( SOT ). Under‐dosing of valganciclovir is associated with an increased risk of CMV infection and development of ganciclovir‐resistant CMV . Methods An automated electronic health record ( EHR )‐based, pharmacist‐driven program was developed to optimize dosing of valganciclovir in solid organ transplant recipients at a large transplant center. Two cohorts of kidney, pancreas‐kidney, and liver transplant recipients from our center pre‐implementation (April 2011‐March 2012, n = 303) and post‐implementation of the optimization program (September 2012‐August 2013, n=263) had demographic and key outcomes data collected for 1 year post‐transplant. Results The 1‐year incidence of CMV infection dropped from 56 (18.5%) to 32 (12.2%, P = .05) and the incidence of breakthrough infections on prophylaxis was cut in half (61% vs 34%, P = .03) after implementation of the dose optimization program. The hazard ratio of developing CMV was 1.64 (95% CI 1.06‐2.60, P = .027) for the pre‐implementation group after adjusting for potential confounders. The program also resulted in a numerical reduction in the number of ganciclovir‐resistant CMV cases (2 [0.7%] pre‐implementation vs 0 post‐implementation). Conclusions An EHR ‐based, pharmacist‐driven valganciclovir dose optimization program was associated with reduction in CMV infections.