Fuentes Yuli V, Blanco Jhosep, Díaz-Quijano Diana Marcela, Lechtig-Wasserman Sharon, Liebisch-Rey Hans, Díaz-Pinilla Nicolas, Vergara-Ramirez Peter, Bustos Rosa-Helena
Master's Student in Epidemiology, Faculty of Medicine, Universidad de La Sabana, Chía 140013, Colombia.
Evidence-Based Therapeutics Group, Department of Clinical Pharmacology, Faculty of Medicine, Universidad de La Sabana and Clínica Universidad de La Sabana, Chía 140013, Colombia.
Pharmaceutics. 2021 Sep 28;13(10):1577. doi: 10.3390/pharmaceutics13101577.
Therapeutic drug monitoring (TDM) and continuous infusion strategies are effective interventions in clinical practice, but these practices are still largely unknown in Colombia, especially in the critical care setting. This study aims to describe the practices involved in the administration and TDM of and vancomycin reported by specialists in critical care in Colombia and to explore the factors that are related to the use of extended infusion. An online nationwide survey was applied to 153 specialists, who were selected randomly. A descriptive, bivariate analysis and a logistic regression model were undertaken. In total, 88.9% of the specialists reported TDM availability and 21.57% reported access to results within 6 h. TDM was available mainly for vancomycin. We found that 85.62% of the intensivists had some type of institutional protocol; however, only 39.22% had a complete and socialized protocol. The odds of preferring extended infusions among those who did not have institutional protocols were 80% lower than those with complete protocols, OR 0.2 (95% CI: 0.06-0.61). The most important perceived barriers to performing continuous infusions and TDM were the lack of training and technologies. This pioneering study in Colombia could impact the quality of care and outcomes of critically ill patients in relation to the threat of antimicrobial resistance.
治疗药物监测(TDM)和持续输注策略是临床实践中的有效干预措施,但在哥伦比亚,这些做法仍鲜为人知,尤其是在重症监护环境中。本研究旨在描述哥伦比亚重症监护专家报告的万古霉素给药和TDM所涉及的做法,并探讨与延长输注使用相关的因素。对153名随机挑选的专家进行了一项全国性在线调查。进行了描述性、双变量分析和逻辑回归模型。总体而言,88.9%的专家报告有TDM可用,21.57%的专家报告能在6小时内获得结果。TDM主要用于万古霉素。我们发现,85.62%的重症监护医生有某种类型的机构方案;然而,只有39.22%有完整且已推广的方案。没有机构方案的人更喜欢延长输注的几率比有完整方案的人低80%,比值比为0.2(95%置信区间:0.06 - 0.61)。进行持续输注和TDM最重要的感知障碍是缺乏培训和技术。这项在哥伦比亚开展的开创性研究可能会对抗菌药物耐药性威胁下重症患者的护理质量和预后产生影响。