International survey of antibiotic dosing and monitoring in adult intensive care units.
Aminoglycosides
Beta-lactams
Drug monitoring
Intensive care units
Vancomycin
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
19 06 2023
19 06 2023
Historique:
received:
18
04
2023
accepted:
07
06
2023
medline:
20
6
2023
pubmed:
19
6
2023
entrez:
18
6
2023
Statut:
epublish
Résumé
In recent years, numerous dosing studies have been conducted to optimize therapeutic antibiotic exposures in patients with serious infections. These studies have led to the inclusion of dose optimization recommendations in international clinical practice guidelines. The last international survey describing dosing, administration and monitoring of commonly prescribed antibiotics for critically ill patients was published in 2015 (ADMIN-ICU 2015). This study aimed to describe the evolution of practice since this time. A cross-sectional international survey distributed through professional societies and networks was used to obtain information on practices used in the dosing, administration and monitoring of vancomycin, piperacillin/tazobactam, meropenem and aminoglycosides. A total of 538 respondents (71% physicians and 29% pharmacists) from 409 hospitals in 45 countries completed the survey. Vancomycin was mostly administered as an intermittent infusion, and loading doses were used by 74% of respondents with 25 mg/kg and 20 mg/kg the most favoured doses for intermittent and continuous infusions, respectively. Piperacillin/tazobactam and meropenem were most frequently administered as an extended infusion (42% and 51%, respectively). Therapeutic drug monitoring was undertaken by 90%, 82%, 43%, and 39% of respondents for vancomycin, aminoglycosides, piperacillin/tazobactam, and meropenem, respectively, and was more frequently performed in high-income countries. Respondents rarely used dosing software to guide therapy in clinical practice and was most frequently used with vancomycin (11%). We observed numerous changes in practice since the ADMIN-ICU 2015 survey was conducted. Beta-lactams are more commonly administered as extended infusions, and therapeutic drug monitoring use has increased, which align with emerging evidence.
Sections du résumé
BACKGROUND
In recent years, numerous dosing studies have been conducted to optimize therapeutic antibiotic exposures in patients with serious infections. These studies have led to the inclusion of dose optimization recommendations in international clinical practice guidelines. The last international survey describing dosing, administration and monitoring of commonly prescribed antibiotics for critically ill patients was published in 2015 (ADMIN-ICU 2015). This study aimed to describe the evolution of practice since this time.
METHODS
A cross-sectional international survey distributed through professional societies and networks was used to obtain information on practices used in the dosing, administration and monitoring of vancomycin, piperacillin/tazobactam, meropenem and aminoglycosides.
RESULTS
A total of 538 respondents (71% physicians and 29% pharmacists) from 409 hospitals in 45 countries completed the survey. Vancomycin was mostly administered as an intermittent infusion, and loading doses were used by 74% of respondents with 25 mg/kg and 20 mg/kg the most favoured doses for intermittent and continuous infusions, respectively. Piperacillin/tazobactam and meropenem were most frequently administered as an extended infusion (42% and 51%, respectively). Therapeutic drug monitoring was undertaken by 90%, 82%, 43%, and 39% of respondents for vancomycin, aminoglycosides, piperacillin/tazobactam, and meropenem, respectively, and was more frequently performed in high-income countries. Respondents rarely used dosing software to guide therapy in clinical practice and was most frequently used with vancomycin (11%).
CONCLUSIONS
We observed numerous changes in practice since the ADMIN-ICU 2015 survey was conducted. Beta-lactams are more commonly administered as extended infusions, and therapeutic drug monitoring use has increased, which align with emerging evidence.
Identifiants
pubmed: 37331935
doi: 10.1186/s13054-023-04527-1
pii: 10.1186/s13054-023-04527-1
pmc: PMC10278304
doi:
Substances chimiques
Anti-Bacterial Agents
0
Vancomycin
6Q205EH1VU
Meropenem
FV9J3JU8B1
Piperacillin, Tazobactam Drug Combination
157044-21-8
Aminoglycosides
0
Piperacillin
X00B0D5O0E
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
241Subventions
Organisme : Sunshine Coast Hospital and Health Service Study Education Research Trust Fund (SERTF) and Wishlist
ID : Clinician Researcher Fellowship
Organisme : Australian National Health and Medical Research Council
ID : APP2007007
Investigateurs
Alexander Brinkmann
(A)
Mahesh Ramanan
(M)
Despoina Koulenti
(D)
Mohan Gurjar
(M)
Helmi Sulaiman
(H)
Gentle Shrestha
(G)
Andrea Cortegiani
(A)
Monica Crespo
(M)
Lowell Ling
(L)
Khalid Abidi
(K)
Peter Schellongowski
(P)
Informations de copyright
© 2023. Crown.
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