Luxton Timothy N, King Natalie, Wälti Christoph, Jeuken Lars J C, Sandoe Jonathan A T
School of Biomedical Sciences, University of Leeds, Leeds LS2 9JT, UK.
Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK.
Antibiotics (Basel). 2022 Sep 27;11(10):1311. doi: 10.3390/antibiotics11101311.
Adjusting dosing regimens based on measurements of carbapenem levels may improve carbapenem exposure in patients. This systematic review aims to describe the effect carbapenem therapeutic drug monitoring (TDM) has on health outcomes, including the emergence of antimicrobial resistance (AMR). Four databases were searched for studies that reported health outcomes following adjustment to dosing regimens, according to measurements of carbapenem concentration. Bias in the studies was assessed with risk of bias analysis tools. Study characteristics and outcomes were tabulated and a narrative synthesis was performed. In total, 2 randomised controlled trials (RCTs), 17 non-randomised studies, and 19 clinical case studies were included. Significant variation in TDM practice was seen; consequently, a meta-analysis was unsuitable. Few studies assessed impacts on AMR. No significant improvement on health outcomes and no detrimental effects of carbapenem TDM were observed. Five cohort studies showed significant associations between achieving target concentrations and clinical success, including suppression of resistance. Studies in this review showed no obvious improvement in clinical outcomes when TDM is implemented. Optimisation and standardisation of carbapenem TDM practice are needed to improve intervention success and enable study synthesis. Further suitably powered studies of standardised TDM are required to assess the impact of TMD on clinical outcomes and AMR.
根据碳青霉烯类药物水平测量结果调整给药方案可能会改善患者的碳青霉烯类药物暴露情况。本系统评价旨在描述碳青霉烯类治疗药物监测（TDM）对健康结局的影响，包括抗菌药物耐药性（AMR）的出现。检索了四个数据库，以查找根据碳青霉烯类药物浓度测量结果调整给药方案后报告健康结局的研究。使用偏倚风险分析工具评估研究中的偏倚。将研究特征和结局制成表格，并进行叙述性综合分析。总共纳入了2项随机对照试验（RCT）、17项非随机研究和19项临床病例研究。发现TDM实践存在显著差异；因此，荟萃分析并不适用。很少有研究评估对AMR的影响。未观察到健康结局有显著改善，也未观察到碳青霉烯类TDM有不利影响。五项队列研究表明，达到目标浓度与临床成功之间存在显著关联，包括耐药性的抑制。本综述中的研究表明，实施TDM时临床结局没有明显改善。需要对碳青霉烯类TDM实践进行优化和标准化，以提高干预成功率并实现研究综合。需要进一步开展标准化TDM的充分有力研究，以评估TMD对临床结局和AMR的影响。
