An international, multicentre survey of β-lactam antibiotic therapeutic drug monitoring practice in intensive care units

Wong, Gloria, Brinkman, Alexander, Benefield, Russell J., Carlier, Mieke, De Waele, Jan J., Helali, Najoua, Frey, Otto, Harbarth, Stephan, Huttner, Angela, McWhinney, Brett, Misset, Benoit, Pea, Federico, Preisenberger, Judit, Roberts, Michael S., Robertson, Thomas A., Roehr, Anka, Sime, Fekade Bruck, Taccone, Fabio Silvio, Ungerer, Jacobus P. J., Lipman, Jeffrey and Roberts, Jason A. (2014) An international, multicentre survey of β-lactam antibiotic therapeutic drug monitoring practice in intensive care units. Journal of Antimicrobial Chemotherapy, 69 5: 1416-1423. doi:10.1093/jac/dkt523

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Author Wong, Gloria
Brinkman, Alexander
Benefield, Russell J.
Carlier, Mieke
De Waele, Jan J.
Helali, Najoua
Frey, Otto
Harbarth, Stephan
Huttner, Angela
McWhinney, Brett
Misset, Benoit
Pea, Federico
Preisenberger, Judit
Roberts, Michael S.
Robertson, Thomas A.
Roehr, Anka
Sime, Fekade Bruck
Taccone, Fabio Silvio
Ungerer, Jacobus P. J.
Lipman, Jeffrey
Roberts, Jason A.
Title An international, multicentre survey of β-lactam antibiotic therapeutic drug monitoring practice in intensive care units
Journal name Journal of Antimicrobial Chemotherapy   Check publisher's open access policy
ISSN 1460-2091
Publication date 2014-05-01
Year available 2014
Sub-type Article (original research)
DOI 10.1093/jac/dkt523
Open Access Status Not Open Access
Volume 69
Issue 5
Start page 1416
End page 1423
Total pages 8
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Formatted abstract
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.
Keyword Dosing
Critical care
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
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