Lanckohr Christian, Boeing Christian, De Waele Jan J, de Lange Dylan W, Schouten Jeroen, Prins Menno, Nijsten Maarten, Povoa Pedro, Morris Andrew Conway, Bracht Hendrik
Antibiotic Stewardship Team, Department of Hygiene, University Hospital Münster, Munster, Germany.
Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.
Ann Intensive Care. 2021 Aug 26;11(1):131. doi: 10.1186/s13613-021-00917-2.
Severe infections and multidrug-resistant pathogens are common in critically ill patients. Antimicrobial stewardship (AMS) and therapeutic drug monitoring (TDM) are contemporary tools to optimize the use of antimicrobials. The A-TEAMICU survey was initiated to gain contemporary insights into dissemination and structure of AMS programs and TDM practices in intensive care units.
This study involved online survey of members of ESICM and six national professional intensive care societies.
Data of 812 respondents from mostly European high- and middle-income countries were available for analysis. 63% had AMS rounds available in their ICU, where 78% performed rounds weekly or more often. While 82% had local guidelines for treatment of infections, only 70% had cumulative antimicrobial susceptibility reports and 56% monitored the quantity of antimicrobials administered. A restriction of antimicrobials was reported by 62%. TDM of antimicrobial agents was used in 61% of ICUs, mostly glycopeptides (89%), aminoglycosides (77%), carbapenems (32%), penicillins (30%), azole antifungals (27%), cephalosporins (17%), and linezolid (16%). 76% of respondents used prolonged/continuous infusion of antimicrobials. The availability of an AMS had a significant association with the use of TDM.
Many respondents of the survey have AMS in their ICUs. TDM of antimicrobials and optimized administration of antibiotics are broadly used among respondents. The availability of antimicrobial susceptibility reports and a surveillance of antimicrobial use should be actively sought by intensivists where unavailable. Results of this survey may inform further research and educational activities.
严重感染和多重耐药病原体在重症患者中很常见。抗菌药物管理（AMS）和治疗药物监测（TDM）是优化抗菌药物使用的现代工具。发起A-TEAMICU调查旨在深入了解重症监护病房中AMS项目的传播情况和结构以及TDM实践。
本研究涉及对欧洲危重病医学会（ESICM）成员和六个国家专业重症监护学会进行在线调查。
来自大多数欧洲高收入和中等收入国家的812名受访者的数据可供分析。63%的受访者所在的重症监护病房开展了AMS查房，其中78%每周或更频繁地进行查房。虽然82%有感染治疗的当地指南，但只有70%有累积抗菌药物敏感性报告，56%监测了抗菌药物的使用量。62%的受访者报告了对抗菌药物的限制。61%的重症监护病房使用了抗菌药物的TDM，主要是糖肽类（89%）、氨基糖苷类（77%）、碳青霉烯类（32%）、青霉素类（30%）、唑类抗真菌药（27%）、头孢菌素类（17%）和利奈唑胺（16%）。76%的受访者使用了抗菌药物的延长/持续输注。AMS的可用性与TDM的使用有显著关联。
该调查的许多受访者在其重症监护病房开展了AMS。抗菌药物的TDM和抗生素的优化给药在受访者中广泛使用。在没有抗菌药物敏感性报告和抗菌药物使用监测的情况下，重症监护医生应积极寻求获取。本次调查结果可为进一步的研究和教育活动提供参考。
