International survey of antibiotic dosing and monitoring in adult intensive care units
Paul G. Williams,
Alexis Tabah,
Menino Osbert Cotta,
Indy Sandaradura,
Salmaan Kanji,
Marc H. Scheetz,
Sahand Imani,
Muhammed Elhadi,
Sònia Luque-Pardos,
Natalie Schellack,
Cristina Sanches,
Jean-Francois Timsit,
Jiao Xie,
Andras Farkas,
Kathryn Wilks,
Jason A. Roberts,
National Coordinators on behalf of the European Society of Intensive Care Medicine (ESICM) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients [ESGCIP]
Affiliations
Paul G. Williams
Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland
Alexis Tabah
Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland
Menino Osbert Cotta
Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland
Indy Sandaradura
Sydney Medical School, University of Sydney
Salmaan Kanji
The Ottawa Hospital and Ottawa Hospital Research Institute
Marc H. Scheetz
Pharmacometric Center of Excellence, Departments of Pharmacy Practice and Pharmacology, College of Pharmacy, Midwestern University
Sahand Imani
Nepean Blue Mountains Local Health District, Nepean Hospital
Muhammed Elhadi
Faculty of Medicine, University of Tripoli
Sònia Luque-Pardos
Pharmacy Department, Parc de Salut Mar
Natalie Schellack
Department of Pharmacology, Faculty of Health Sciences, University of Pretoria
Cristina Sanches
Campus Centro Oeste Dona Lindu, Federal University of Sao João del Rei
Jean-Francois Timsit
Assistance Publique Hôpitaux de Paris – Bichat hospital Medical and infectious diseases ICU (MI2)
Jiao Xie
Department of Pharmacy, The Second Affiliated Hospital of Xi’an Jiaotong University
Andras Farkas
Optimum Dosing Strategies
Kathryn Wilks
Infectious Diseases Department, Sunshine Coast University Hospital
Jason A. Roberts
Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland
National Coordinators on behalf of the European Society of Intensive Care Medicine (ESICM) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients [ESGCIP]
Abstract 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.
