Department of Internal Medicine and Pediatrics, Ghent University Hospital , Ghent, Belgium.
Department of Diagnostic Sciences, Ghent University Hospital , Ghent, Belgium.
Expert Rev Anti Infect Ther. 2020 Nov;18(11):1155-1164. doi: 10.1080/14787210.2020.1788387. Epub 2020 Jul 5.
Individualizing antibiotic therapy is paramount to improve clinical outcomes while minimizing the risk of toxicity and antimicrobial therapy. β-lactam antibiotics are amongst the drugs most commonly prescribed in the Intensive Care Unit (ICU). The pharmacokinetics of β-lactam antibiotics are profoundly altered in critically ill patients, leading to the failure of standard drug dosing regimens to result in adequate drug concentrations. Therapeutic Drug Monitoring (TDM) of β-lactam antibiotics is a promising tool to help optimize β-lactam antibiotic therapy.
The rationale behind TDM for β-lactam antibiotics is explained, as well as some more practical aspects such as when to sample, what concentrations to strive for and how to use it in clinical practice. We also discuss microbiological and analytical considerations, knowledge gaps, and future perspectives of β-lactam antibiotics TDM in ICU patients.
TDM of β-lactam antibiotics has been studied intensively in recent years. While TDM may not yet be widely available, and targets need to be further refined, TDM of β-lactam antibiotics will help to optimize antibiotic therapy in the critically ill patient, as an integrated part of an antimicrobial stewardship program.
个体化抗生素治疗对于改善临床结局，同时最大限度降低毒性和抗菌治疗风险至关重要。β-内酰胺类抗生素是重症监护病房（ICU）中最常开具的药物之一。在危重病患者中，β-内酰胺类抗生素的药代动力学发生了深刻的变化，导致标准药物剂量方案无法达到足够的药物浓度，从而导致治疗失败。β-内酰胺类抗生素的治疗药物监测（TDM）是一种有前途的工具，可以帮助优化β-内酰胺类抗生素治疗。
解释了β-内酰胺类抗生素 TDM 的基本原理，以及一些更实际的方面，如何时采样、应争取达到的浓度以及如何在临床实践中使用。我们还讨论了 ICU 患者β-内酰胺类抗生素 TDM 的微生物学和分析考虑因素、知识空白以及未来展望。
近年来，β-内酰胺类抗生素的 TDM 已得到深入研究。虽然 TDM 可能尚未广泛应用，并且需要进一步细化目标，但 TDM 可以帮助优化危重病患者的抗生素治疗，作为抗菌药物管理计划的一个组成部分。
