Objective: This study aims to describe antimicrobial prescribing patterns in HD patients and evaluate the role of clinical pharmacists in an antimicrobial stewardship program in such patients.

Methods: This was a retrospective chart review study in John Hopkins Aramco Healthcare (JHAH) between April 2018 and April 2020. All adult hemodialysis patients who received antimicrobials either in the inpatient setting or as outpatients were included in the study. Pharmacy Interventions were retrieved from the electronic health record EPIC®. Data were analyzed using SPSS software version 22. P-value <0.05 was considered significant. The primary end-point was to describe the antimicrobials prescription among hemodialysis. The secondary end-point included describing antimicrobials-related pharmacist interventions and their economic impact.

Results: A total of 1545 antimicrobials orders were retrieved. Most prescribed antimicrobials were third-generation cephalosporin, vancomycin, and meropenem (20.3%, 19.3%, and 19.2%, respectively). A total of 655 (one pharmacist intervention per 2.46 orders) were identified during the study period with a 96.6% physicians’ acceptance rate. Unaccepted interventions were mainly in gram-negative cultures and staphylococcus aureus. The medication with the highest acceptance rate was vancomycin, while the highest unacceptance rate was for meropenem (p=0.0001). The most common category of pharmacy interventions was renal dosing and pharmacokinetic consultations (41.6% and 35.4%, respectively). Renal dosing resulted in the highest cost reduction (85722 USD), followed by Pharmacokinetic consultations (72848 USD) and drug-allergy contraindications (23430 USD). Changing the route of administration led to a reduction of drug cost by (11618 USD).

Conclusion: Clinical pharmacists can play a vital role in optimizing antimicrobial use among hemodialysis patients and reducing antimicrobial costs.