Department of Infectious Diseases, Alfred Hospital, Alfred Health, Melbourne, Victoria, Australia.
Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Clin Infect Dis. 2022 Nov 14;75(10):1848-1860. doi: 10.1093/cid/ciac506.
Therapeutic drug monitoring (TDM) of beta-lactam antibiotics is recommended to address the variability in exposure observed in critical illness. However, the impact of TDM-guided dosing on clinical outcomes remains unknown. We conducted a systematic review and meta-analysis on TDM-guided dosing and clinical outcomes (all-cause mortality, clinical cure, microbiological cure, treatment failure, hospital and intensive care unit length of stay, target attainment, antibiotic-related adverse events, and emergence of resistance) in critically ill patients with suspected or proven sepsis. Eleven studies (n = 1463 participants) were included. TDM-guided dosing was associated with improved clinical cure (relative risk, 1.17; 95% confidence interval [CI], 1.04 to 1.31), microbiological cure (RR, 1.14; 95% CI, 1.03 to 1.27), treatment failure (RR, 0.79; 95% CI, .66 to .94), and target attainment (RR, 1.85; 95% CI, 1.08 to 3.16). No associations with mortality and length of stay were found. TDM-guided dosing improved clinical and microbiological cure and treatment response. Larger, prospective, randomized trials are required to better assess the utility of beta-lactam TDM in critically ill patients.
治疗药物监测（TDM）建议用于β-内酰胺类抗生素，以解决重症患者中观察到的暴露变异性。然而，TDM 指导剂量对临床结局的影响仍不清楚。我们对疑似或确诊脓毒症的重症患者进行了 TDM 指导剂量与临床结局（全因死亡率、临床治愈率、微生物学治愈率、治疗失败、住院和重症监护病房住院时间、目标达标率、抗生素相关不良事件和耐药性出现）的系统评价和荟萃分析。纳入了 11 项研究（n = 1463 名参与者）。TDM 指导剂量与临床治愈率（相对风险，1.17；95%置信区间[CI]，1.04 至 1.31）、微生物学治愈率（RR，1.14；95%CI，1.03 至 1.27）、治疗失败率（RR，0.79；95%CI，0.66 至 0.94）和目标达标率（RR，1.85；95%CI，1.08 至 3.16）相关。与死亡率和住院时间无相关性。TDM 指导剂量可改善临床和微生物学治愈率和治疗反应。需要更大规模的前瞻性随机试验来更好地评估 TDM 在重症患者中应用β-内酰胺类抗生素的效用。
