Imagine if we could integrate patient demographic, pathogen susceptibility, and PK-PD data, and stewardship documentation into one simple-to-use interface. What if you could carry such a powerful tool in your pocket? We would like to introduce you to the PK-PD Compass, a patent-pending mobile app that allows you to develop PK-PD driven treatment plans.
Incorporate the science of PK-PD into your daily decisions with the PK-PD Compass, an educational tool designed to augment your antimicrobial stewardship practice through a patient-centric approach.
Behind the scenes, the PK-PD Compass integrates population pharmacokinetics, exposure-response relationships, and pathogen susceptibility data, using Monte Carlo simulation, to evaluate antibiotic regimens through the lens of PK-PD.
Pathogen susceptibility information is often unavailable at the time of initial treatment. Solve this dilemma with data from the SENTRY Antimicrobial Surveillance Program, a database of over 1 million clinical isolates. SENTRY allows you to utilize region-specific susceptibility data to refine your stewardship practice.
Record antimicrobial stewardship events and track your patients’ progress using My Service. Reminders for clinical follow-up at 48 hours and 7-14 days after the start of therapy allow you to document your interventions and resulting patient outcomes.
An Example Patient Case
The first step in using the PK-PD Compass is to select the infection of interest. You are presented with a list of infections selected from treatment guidelines and other reference literature, encompassing the majority of bacterial infectious diseases requiring inpatient intravenous therapy.
The second step is to select the pathogen of interest. The list provided represents, in alphabetical order, the pathogens most commonly-associated with a given infection, as identified in contemporary treatment guidelines (e.g., Infectious Disease Society of America) and other reference literature.
The third step is to select the antibiotic(s) of interest. The list provided identifies appropriate antibiotic choices, based on treatment guidelines and other reference literature, for the selected infection and pathogen. In the application’s main settings, you can customize the list of antibiotics to indicate which are on your institution’s formulary.
The fourth step in using the PK-PD Compass is to select the minimum inhibitory concentration (MIC) for the antibiotic(s) and pathogen combination you specified. Determining a pathogen’s susceptibility is a challenge and different institutions report pathogen susceptibilities in different ways. Some institutions provide exact MIC values while others only report if the pathogen is susceptible, intermediate, or resistant. In addition to the differences in how pathogen susceptibility is reported, oftentimes information regarding the pathogen’s susceptibility is not yet available at the time of the patient’s presentation. The PK-PD Compass addresses these varied needs by providing three choices for considering pathogen susceptibility.
1) The Specific MIC option may be utilized when the MIC value for a specific antibiotic-pathogen pair is known. This specific MIC value will then be utilized by the PK-PD Compass in the estimation of PK-PD target attainment
2) The Susceptibility Breakpoint option should be chosen if the pathogen has been reported to be susceptible (S) to the antibiotic, but the actual MIC value is still unknown. The PK-PD Compass will then utilize the MIC distribution, taken from the SENTRY Antimicrobial Surveillance Program, up to and including the MIC susceptibility breakpoint in order to calculate PK-PD target attainment. This calculation will be weighted by the probability of occurrence of the MIC values in that range of the MIC distribution.
3) The SENTRY 2015 option should be chosen when no susceptibility information is available for the selected antibiotic-pathogen pair. This option allows the PK-PD Compass to utilize the entire distribution of MIC values taken from the SENTRY Antimicrobial Surveillance Program, specific to your area of the country, in order to estimate PK-PD target attainment. This calculation will be weighted by the probability of occurrence of the MIC values in that range of the MIC distribution.
The fifth step is to enter patient demographic information that is required to estimate the elimination of the antibiotic from the body. This information allows the PK-PD Compass to select appropriate antibiotic dosing regimens and estimate target attainment values which are relevant to the patient in question.
The summary page allows you to review all information prior to estimation of PK-PD target attainment for each antibiotic-pathogen pair. If an error(s) is identified, you simply swipe backward to the applicable pages and make corrections as needed.
The results page displays the percent probability of PK-PD target attainment for a simulated patient population similar to yours for every antibiotic-pathogen pair you selected. The dosing regimens for antibiotics presented are adjusted for kidney disease or known severe liver disease and are listed in rank order.
The PK-PD Compass allows you to record Antimicrobial Stewardship events and outcomes. Once you select the antibiotic dosing regimen from the Result Details page, you may select to receive a follow-up reminder after 48 hours to review the patient’s status and adjust therapy accordingly. This feature utilizes My Service, a logbook of all information and calculations utilized for your patients.
Selecting to receive an initial 48 hour follow-up will also trigger a second follow-up. Depending on the infection selected, you will be reminded to review the patient’s status after 7 to 14 days of antibiotic therapy. Given that the duration of antibiotic therapy for certain infections may exceed 14 days, the PK-PD Compass allows you to record this second outcome at any time after 6 days of antibiotic therapy.