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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
An international, multicentre survey of β-lactam antibiotic therapeutic drug monitoring practice in intensive care units
Journal of Antimicrobial Chemotherapy, Volume 69, No. 5, Article dkt523, Year 2014
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Description
Objectives: Emerging evidence supports the use of therapeutic drug monitoring (TDM) of β-lactams for intensive care unit (ICU) patients to optimize drug exposure, although limited detail is available on how sites run this service in practice. This multicentre survey study was performed to describe the various approaches used for β-lactam TDM in ICUs. Methods: A questionnaire survey was developed to describe various aspects relating to the conduct of β-lactam TDM in an ICU setting. Data sought included: β-lactams chosen for TDM, inclusion criteria for selecting patients, blood sampling strategy, analytical methods, pharmacokinetic (PK)/pharmacodynamic (PD) targets and dose adjustment strategies. Results: Nine ICUs were included in this survey. Respondents were either ICU or infectious disease physicians, pharmacists or clinical pharmacologists. Piperacillin (co-formulated with tazobactam) and meropenem (100% of units surveyed) were the β-lactams most commonly subject to TDM, followed by ceftazidime (78%), ceftriaxone (43%) and cefazolin (43%). Different chromatographic and microbiological methods were used for assay of β-lactam concentrations in blood and other biological fluids (e.g. CSF). There was significant variation in the PK/PD targets (100% fT>MIC up to 100% fT>4×MIC) and dose adjustment strategies used by each of the sites. Conclusions: Large variations were found in the type of β-lactams tested, the patients selected for TDM and drug assay methods. Significant variation observed in the PK/PD targets and dose adjustment strategies used supports the need for further studies that robustly define PK/PD targets for ICU patients to ensure a greater consistency of practice for dose adjustment strategies for optimizing β-lactam dosing with TDM. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Authors & Co-Authors
De Waele, Jan J.
Belgium, Ghent
Universitair Ziekenhuis Gent
Harbarth, Stéphan Jürgen
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Huttner, Angela Csaki
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Misset, Benoıˆt Y.
France, Paris
Université Paris Cité
France, Paris
Groupe Hospitalier Paris Saint-joseph
Roberts, Michael S.
Australia, Woodville South
The Queen Elizabeth Hospital, North Western Adelaide Health Service
Taccone, Fabio Silvio S.
Belgium, Brussels
Université Libre de Bruxelles
Ungerer, Jacobus Petrus Johannes
Unknown Affiliation
Lipman, Jeffrey
Australia, Brisbane
The University of Queensland
Australia, Brisbane
Royal Brisbane and Women's Hospital
Roberts, Jason A.
Australia, Brisbane
The University of Queensland
Australia, Brisbane
Royal Brisbane and Women's Hospital
Statistics
Citations: 180
Authors: 9
Affiliations: 11
Identifiers
Doi:
10.1093/jac/dkt523
ISSN:
03057453
Research Areas
Cancer
Study Design
Cross Sectional Study
Study Approach
Quantitative