Faculty of Medicine, University of Queensland Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, QLD, 4029, Australia.
Pharmacy Department, Sunshine Coast University Hospital, Birtinya, QLD, Australia.
Crit Care. 2023 Jun 19;27(1):241. doi: 10.1186/s13054-023-04527-1.
In recent years, numerous dosing studies have been conducted to optimize therapeutic antibiotic exposures in patients with serious infections. These studies have led to the inclusion of dose optimization recommendations in international clinical practice guidelines. The last international survey describing dosing, administration and monitoring of commonly prescribed antibiotics for critically ill patients was published in 2015 (ADMIN-ICU 2015). This study aimed to describe the evolution of practice since this time.
A cross-sectional international survey distributed through professional societies and networks was used to obtain information on practices used in the dosing, administration and monitoring of vancomycin, piperacillin/tazobactam, meropenem and aminoglycosides.
A total of 538 respondents (71% physicians and 29% pharmacists) from 409 hospitals in 45 countries completed the survey. Vancomycin was mostly administered as an intermittent infusion, and loading doses were used by 74% of respondents with 25 mg/kg and 20 mg/kg the most favoured doses for intermittent and continuous infusions, respectively. Piperacillin/tazobactam and meropenem were most frequently administered as an extended infusion (42% and 51%, respectively). Therapeutic drug monitoring was undertaken by 90%, 82%, 43%, and 39% of respondents for vancomycin, aminoglycosides, piperacillin/tazobactam, and meropenem, respectively, and was more frequently performed in high-income countries. Respondents rarely used dosing software to guide therapy in clinical practice and was most frequently used with vancomycin (11%).
We observed numerous changes in practice since the ADMIN-ICU 2015 survey was conducted. Beta-lactams are more commonly administered as extended infusions, and therapeutic drug monitoring use has increased, which align with emerging evidence.
近年来，进行了许多旨在优化严重感染患者治疗性抗生素暴露量的剂量研究。这些研究导致了在国际临床实践指南中纳入了剂量优化建议。最后一次描述重症患者常用抗生素剂量、给药和监测的国际调查于 2015 年发表（ADMIN-ICU 2015）。本研究旨在描述自那时以来实践的演变。
通过专业协会和网络进行的横断面国际调查，用于获取关于万古霉素、哌拉西林/他唑巴坦、美罗培南和氨基糖苷类药物剂量、给药和监测的实践信息。
来自 45 个国家 409 家医院的 538 名受访者（71%为医生，29%为药剂师）完成了调查。万古霉素主要作为间歇性输注给药，74%的受访者使用负荷剂量，分别为 25mg/kg 和 20mg/kg，作为间歇性和连续输注的最常用剂量。哌拉西林/他唑巴坦和美罗培南最常作为延长输注给药（分别为 42%和 51%）。90%、82%、43%和 39%的受访者分别对万古霉素、氨基糖苷类、哌拉西林/他唑巴坦和美罗培南进行了治疗药物监测，在高收入国家更频繁地进行。受访者很少在临床实践中使用剂量软件来指导治疗，并且最常与万古霉素一起使用（11%）。
自 ADMIN-ICU 2015 调查以来，我们观察到实践中发生了许多变化。β-内酰胺类药物更常作为延长输注给药，治疗药物监测的使用增加，这与新出现的证据一致。
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