Venugopalan Veena, Hamza Malva, Santevecchi Barbara, DeSear Kathryn, Cherabuddi Kartikeya, Peloquin Charles A, Alshaer Mohammad H
Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.
University of Florida Health Shands Hospital, Gainesville, FL, USA.
Am J Health Syst Pharm. 2022 Sep 7;79(18):1586-1591. doi: 10.1093/ajhp/zxac171.
To describe the implementation and operationalization of a β-lactam (BL) therapeutic drug monitoring (TDM) program at a large academic center.
BLs are the most used class of antibiotics. Suboptimal antibiotic exposure is a significant concern in hospitalized patients, particularly in those with altered pharmacokinetics. BL-TDM provides clinicians the opportunity to optimize drug concentrations to ensure maximal therapeutic efficacy while minimizing toxicity. However, BL-TDM has not been widely adopted due to the lack of access to assays. The University of Florida Shands Hospital developed a BL-TDM program in 2015. This is a consultative service primarily run by pharmacists and is conducted in all patient care areas. An analysis was performed on the first BL-TDM encounter for 1,438 patients. BL-TDM was most frequently performed for cefepime (61%, n = 882), piperacillin (15%, n = 218), and meropenem (11%, n = 151). BL-TDM was performed a median of 3 days (interquartile range, 1-5 days) from BL initiation. Among patients with available minimum inhibitory concentration (MIC) values and trough concentrations, the pharmacokinetic/pharmacodynamic (PK/PD) target of 100% fT>MIC was attained in 308 patients (88%). BL-TDM resulted in a dosage adjustment in 25% (n = 361) of patients.
Implementation of a BL-TDM program requires the concerted efforts of physicians, pharmacists, nursing staff, phlebotomists, and personnel in the analytical laboratory. Standard antibiotic dosing failed to achieve optimal PK/PD targets in all patients; utilizing BL-TDM, dose adjustments were made in 1 of every 4 patients.
描述在一家大型学术中心实施和开展β-内酰胺类（BL）治疗药物监测（TDM）项目的情况。
BL类药物是使用最为广泛的抗生素类别。抗生素暴露不足是住院患者尤其是药代动力学发生改变的患者的一个重大问题。BL-TDM为临床医生提供了优化药物浓度的机会，以确保最大治疗效果并将毒性降至最低。然而，由于缺乏检测方法，BL-TDM尚未得到广泛应用。佛罗里达大学珊兹医院于2015年制定了BL-TDM项目。这是一项主要由药剂师提供的咨询服务，在所有患者护理区域开展。对1438例患者的首次BL-TDM情况进行了分析。BL-TDM最常用于头孢吡肟（61%，n = 882）、哌拉西林（15%，n = 218）和美罗培南（11%，n = 151）。从开始使用BL起，BL-TDM的中位执行时间为3天（四分位间距，1 - 5天）。在有可用最低抑菌浓度（MIC）值和谷浓度的患者中，308例患者（88%）达到了药代动力学/药效学（PK/PD）目标即100% fT>MIC。BL-TDM导致25%（n = 361）的患者进行了剂量调整。
实施BL-TDM项目需要医生、药剂师、护理人员、采血人员和分析实验室人员的共同努力。标准抗生素给药未能使所有患者达到最佳PK/PD目标；利用BL-TDM，每4名患者中有1名进行了剂量调整。
