Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.
BMC Infect Dis. 2022 Jul 13;22(1):611. doi: 10.1186/s12879-022-07587-w.
Recent studies demonstrated that failure of achieving pharmacodynamic targets of commonly used antibiotics is common in critically ill patients. Therapeutic drug monitoring (TDM) can contribute to optimize the exposure of beta-lactams and ciprofloxacin. While evidence for TDM of these antibiotics is growing, translation into clinical implementation remains limited. Therefore, perceived barriers and facilitators are important for implementing TDM in this population. The primary aim of this study was to identify healthcare professionals' barriers and facilitators for the implementation of TDM of beta-lactams and ciprofloxacin in Dutch intensive care units (ICU).
We conducted a nationwide cross-sectional online survey among healthcare professionals (HCPs) involved in antibiotic treatment of ICU patients. An adapted version of the Measurement Instrument for Determinants of Innovations was sent out. Items were considered barriers when ≥ 20% of participants responded with a negative answer. If ≥ 80% of the participants responded with a positive answer, the item was considered a facilitator.
Sixty-four HCPs completed the survey, of which 14 were from academic hospitals, 25 from general hospitals, and 25 from teaching hospitals. Most participants were hospital pharmacists (59%) or medical specialists (23%). Eleven barriers and four facilitators for implementation of TDM of beta-lactams were identified; 17 barriers for TDM of ciprofloxacin and no facilitators. The most important barriers were a lack of conclusive evidence, organizational support, and low availability of assays. Additional barriers were a lack of consensus on which specific patients to apply TDM and which pharmacodynamic targets to use. Identified facilitators for beta-lactam TDM implementation are low complexity and high task perception, combined with the perception that TDM is important to prevent side effects and to adequately treat infections. Twenty-eight percent of participants reported that flucloxacillin could be analyzed in their hospital. Assay availability of other beta-lactams and ciprofloxacin was lower (3-17%).
Several barriers were identified that could obstruct the implementation of TDM of beta-lactams and ciprofloxacin in the ICU. In particular, education, clear guidelines, and organizational support should be considered when creating tailored implementation strategies. Finally, evidence of beneficial clinical outcomes on TDM of beta-lactams and ciprofloxacin can enhance further implementation.
最近的研究表明，在危重症患者中，常用抗生素未能达到药效学目标的情况很常见。治疗药物监测（TDM）有助于优化β-内酰胺类和环丙沙星的暴露。虽然越来越多的证据支持这些抗生素的 TDM，但在临床实施方面仍存在局限性。因此，对于在这一人群中实施 TDM，了解相关的障碍和促进因素是很重要的。本研究的主要目的是确定荷兰重症监护病房（ICU）中医疗保健专业人员在实施β-内酰胺类和环丙沙星 TDM 方面的障碍和促进因素。
我们对参与 ICU 患者抗生素治疗的医疗保健专业人员（HCPs）进行了一项全国范围的横断面在线调查。我们发送了一份经过改编的创新衡量工具。如果有≥20%的参与者回答否定答案，则将项目视为障碍。如果有≥80%的参与者回答肯定答案，则该项目被视为促进因素。
64 名 HCPs 完成了调查，其中 14 名来自学术医院，25 名来自综合医院，25 名来自教学医院。大多数参与者是医院药剂师（59%）或医学专家（23%）。确定了 11 项β-内酰胺类 TDM 实施的障碍和 4 项促进因素；17 项环丙沙星 TDM 的障碍，没有促进因素。最重要的障碍是缺乏确凿的证据、组织支持和检测方法的低可用性。其他障碍包括缺乏共识，即哪些特定患者需要进行 TDM 以及使用哪些药效学目标。确定的β-内酰胺类 TDM 实施促进因素是低复杂性和高任务感知度，以及 TDM 对预防副作用和充分治疗感染很重要的认知。28%的参与者报告说，他们的医院可以分析氟氯西林。其他β-内酰胺类和环丙沙星的检测方法可用性较低（3-17%）。
确定了一些可能阻碍 ICU 中β-内酰胺类和环丙沙星 TDM 实施的障碍。特别是在制定定制实施策略时，应考虑教育、明确的指南和组织支持。最后，关于β-内酰胺类和环丙沙星 TDM 的有益临床结果的证据可以增强进一步的实施。
