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

Gloria Wong, Alexander Brinkman, Russell J Benefield, Mieke Carlier, Jan De Waele UGent, Najoua El Helali, Otto Frey, Stephan Harbarth, Angela Huttner, Brett McWhinney, et al. (2014) JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY. 69(5). p.1416-1423
abstract
Emerging evidence supports the use of therapeutic drug monitoring (TDM) of -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 -lactam TDM in ICUs. A questionnaire survey was developed to describe various aspects relating to the conduct of -lactam TDM in an ICU setting. Data sought included: -lactams chosen for TDM, inclusion criteria for selecting patients, blood sampling strategy, analytical methods, pharmacokinetic (PK)/pharmacodynamic (PD) targets and dose adjustment strategies. 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 -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 -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(4MIC)) and dose adjustment strategies used by each of the sites. Large variations were found in the type of -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 -lactam dosing with TDM.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
antimicrobial, dosing, TDM, critical care, pharmacokinetics, CRITICALLY-ILL PATIENTS, PERFORMANCE LIQUID-CHROMATOGRAPHY, FEBRILE NEUTROPENIC PATIENTS, GRAM-NEGATIVE INFECTIONS, SEVERE SEPSIS, SEPTIC SHOCK, BETA-LACTAMS, POPULATION PHARMACOKINETICS, PSEUDOMONAS-AERUGINOSA, CONTINUOUS-INFUSION
journal title
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
J. Antimicrob. Chemother.
volume
69
issue
5
pages
1416 - 1423
Web of Science type
Article
Web of Science id
000334688400034
JCR category
PHARMACOLOGY & PHARMACY
JCR impact factor
5.313 (2014)
JCR rank
17/255 (2014)
JCR quartile
1 (2014)
ISSN
0305-7453
DOI
10.1093/jac/dkt523
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
5698635
handle
http://hdl.handle.net/1854/LU-5698635
date created
2014-09-09 09:39:19
date last changed
2016-12-19 15:39:34
@article{5698635,
  abstract     = {Emerging evidence supports the use of therapeutic drug monitoring (TDM) of -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 -lactam TDM in ICUs.
A questionnaire survey was developed to describe various aspects relating to the conduct of -lactam TDM in an ICU setting. Data sought included: -lactams chosen for TDM, inclusion criteria for selecting patients, blood sampling strategy, analytical methods, pharmacokinetic (PK)/pharmacodynamic (PD) targets and dose adjustment strategies.
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 -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 -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(4MIC)) and dose adjustment strategies used by each of the sites.
Large variations were found in the type of -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 -lactam dosing with TDM.},
  author       = {Wong, Gloria and Brinkman, Alexander and Benefield, Russell J and Carlier, Mieke and De Waele, Jan and El Helali, Najoua and Frey, Otto and Harbarth, Stephan and Huttner, Angela and McWhinney, Brett and Misset, Benoit and Pea, Federico and Preisenberger, Judit and Roberts, Michael S and Robertson, Thomas A and Roehr, Anka and Sime, Fekade Bruck and Taccone, Fabio Silvio and Ungerer, Jacobus PJ and Lipman, Jeffrey and Roberts, Jason A},
  issn         = {0305-7453},
  journal      = {JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY},
  keyword      = {antimicrobial,dosing,TDM,critical care,pharmacokinetics,CRITICALLY-ILL PATIENTS,PERFORMANCE LIQUID-CHROMATOGRAPHY,FEBRILE NEUTROPENIC PATIENTS,GRAM-NEGATIVE INFECTIONS,SEVERE SEPSIS,SEPTIC SHOCK,BETA-LACTAMS,POPULATION PHARMACOKINETICS,PSEUDOMONAS-AERUGINOSA,CONTINUOUS-INFUSION},
  language     = {eng},
  number       = {5},
  pages        = {1416--1423},
  title        = {An international, multicentre survey of \ensuremath{\beta}-lactam antibiotic therapeutic drug monitoring practice in intensive care units},
  url          = {http://dx.doi.org/10.1093/jac/dkt523},
  volume       = {69},
  year         = {2014},
}

Chicago
Wong, Gloria, Alexander Brinkman, Russell J Benefield, MIEKE CARLIER, Jan De Waele, Najoua El Helali, Otto Frey, et al. 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.
APA
Wong, G., Brinkman, A., Benefield, R. J., CARLIER, M., De Waele, J., El Helali, N., Frey, O., et al. (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.
Vancouver
1.
Wong G, Brinkman A, Benefield RJ, CARLIER M, De Waele J, El Helali N, et al. An international, multicentre survey of β-lactam antibiotic therapeutic drug monitoring practice in intensive care units. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY. 2014;69(5):1416–23.
MLA
Wong, Gloria, Alexander Brinkman, Russell J Benefield, et al. “An International, Multicentre Survey of Β-lactam Antibiotic Therapeutic Drug Monitoring Practice in Intensive Care Units.” JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 69.5 (2014): 1416–1423. Print.