Antimicrobial Therapeutic Drug Monitoring in critically ill adult patients -an international perspective on access, utilisation, and barriers.

antimicrobial barriers intensive care units survey therapeutic drug monitoring

Journal

International journal of antimicrobial agents
ISSN: 1872-7913
Titre abrégé: Int J Antimicrob Agents
Pays: Netherlands
ID NLM: 9111860

Informations de publication

Date de publication:
09 May 2024
Historique:
received: 19 11 2023
revised: 25 04 2024
accepted: 30 04 2024
medline: 12 5 2024
pubmed: 12 5 2024
entrez: 11 5 2024
Statut: aheadofprint

Résumé

Therapeutic drug monitoring (TDM) is an effective method for individualizing antimicrobial therapy in critically ill patients. The 2021 ADMIN-ICU survey studied a wide range of intensive care unit (ICU) clinicians worldwide to gain their perspectives on antimicrobial TDM. This paper reports the responses from this survey relating to TDM access, utilisation, barriers, and clinical value. An online survey consisted of multiple-choice questions and 5-point Likert scales. The survey examined respondent's access to minimum inhibitory concentration (MIC) results, drug assays and dosing software, as well as barriers to TDM. The survey included 538 clinicians from 409 hospitals in 45 countries, with 71% physicians and 29% pharmacists. Despite most respondents having access to assays, 21% and 26% of respondents lacked access to vancomycin and aminoglycosides, respectively. In lower-income countries, almost 40% reported no access. Delayed drug assay turnaround time was the most significant barrier to TDM, particularly in lower-income countries. Routine access to MIC results was unavailable for 41% of respondents, with 25% of lower-income country respondents having no access to MIC or susceptibility reports. This global survey indicated that consistent TDM usage is hindered by assay access in some sites, and timeliness of assay results in others. Addressing barriers to TDM, particularly in low-income countries, should be a priority to ensure equitable access to affordable TDM.

Sections du résumé

BACKGROUND BACKGROUND
Therapeutic drug monitoring (TDM) is an effective method for individualizing antimicrobial therapy in critically ill patients. The 2021 ADMIN-ICU survey studied a wide range of intensive care unit (ICU) clinicians worldwide to gain their perspectives on antimicrobial TDM. This paper reports the responses from this survey relating to TDM access, utilisation, barriers, and clinical value.
METHODS METHODS
An online survey consisted of multiple-choice questions and 5-point Likert scales. The survey examined respondent's access to minimum inhibitory concentration (MIC) results, drug assays and dosing software, as well as barriers to TDM.
RESULTS RESULTS
The survey included 538 clinicians from 409 hospitals in 45 countries, with 71% physicians and 29% pharmacists. Despite most respondents having access to assays, 21% and 26% of respondents lacked access to vancomycin and aminoglycosides, respectively. In lower-income countries, almost 40% reported no access. Delayed drug assay turnaround time was the most significant barrier to TDM, particularly in lower-income countries. Routine access to MIC results was unavailable for 41% of respondents, with 25% of lower-income country respondents having no access to MIC or susceptibility reports.
CONCLUSIONS CONCLUSIONS
This global survey indicated that consistent TDM usage is hindered by assay access in some sites, and timeliness of assay results in others. Addressing barriers to TDM, particularly in low-income countries, should be a priority to ensure equitable access to affordable TDM.

Identifiants

DOI: 10.1016/j.ijantimicag.2024.107192 PMID: 38734215
pubmed: 38734215
pii: S0924-8579(24)00110-9
doi: 10.1016/j.ijantimicag.2024.107192
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

107192

Informations de copyright

Copyright © 2024. Published by Elsevier Ltd.

Déclaration de conflit d'intérêts

Declaration of Competing Interest None to declare for all authors.

Auteurs

Paul Williams (P)

University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Pharmacy Department, Sunshine Coast University Hospital, Birtinya, Queensland, Australia. Electronic address: p.g.williams@uq.edu.au.

Menino Osbert Cotta (MO)

University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.

Alexis Tabah (A)

University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland.

Indy Sandaradura (I)

Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia; Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, New South Wales, Australia.

Salmaan Kanji (S)

The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Marc H Scheetz (MH)

Pharmacometric Center of Excellence, Departments of Pharmacy Practice and Pharmacology, College of Pharmacy, Midwestern University, Downers Grove, IL, USA.

Sahand Imani (S)

Nepean Blue Mountains Local Health District, Nepean Hospital, Sydney, New South Wales, Australia.

Muhammed Elhadi (M)

Faculty of Medicine, University of Tripoli, Tripoli, Libya.

Sònia Luque Pardos (SL)

Pharmacy Department, Parc de Salut Mar, Barcelona, Spain; Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER of Pharmacy, Saint Clare's Infectious Diseases (CIBERINFEC CB21/13/0002) Institute of Health Carlos III, Madrid, Spain.

Natalie Schellack (N)

Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.

Cristina Sanches (C)

Campus Centro Oeste Dona Lindu, Federal University of Sao João del Rei, Divinópolis, Minas Gerais, Brasil.

Jean Francois Timsit (JF)

Assistance Publique Hôpitaux de Paris - Bichat hospital Medical and infectious diseases ICU (MI2), F75018, Paris France; IAME U 1137 université Paris-Cité Site Bichat; F75018, Paris France.

Jiao Xie (J)

Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Andras Farkas (A)

Optimum Dosing Strategies, Bloomingdale, NJ, USA; Department of Pharmacy, Saint Clare's Health, Denville, New Jersey, USA.

Kathryn Wilks (K)

Infectious Diseases Department, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.

Jason A Roberts (JA)

University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Departments of Intensive Care Medicine and Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes France.

Classifications MeSH