Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nimes University Hospital, University of Montpellier, Nimes, France; Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia.
Anaesth Crit Care Pain Med. 2023 Dec;42(6):101296. doi: 10.1016/j.accpm.2023.101296. Epub 2023 Aug 12.
Broad-spectrum antibiotics such as beta-lactams and vancomycin are frequently used to treat critically ill patients, however, a significant number do not achieve target exposures. Therapeutic drug monitoring (TDM) combined with Bayesian forecasting dosing software may improve target attainment in these patients. This study aims to describe the efficiency of dosing software for achieving target exposures of selected beta-lactam antibiotics and vancomycin in critically ill patients.
A prospective cohort study was undertaken in an adult intensive care unit (ICU). Patients prescribed vancomycin, piperacillin-tazobactam and meropenem were included if they exhibited a subtherapeutic or supratherapeutic exposure informed by TDM. The dosing software, ID-ODS™, was used to generate dosing recommendations which could be either accepted or rejected by the treating team. Repeat antibiotic TDM were requested to determine if target exposures were achieved.
Between March 2020 and December 2021, 70 were included in the analysis. Software recommendations were accepted for 56 patients (80%) with 50 having repeated antibiotic measurements. Forty-three of the 50 patients (86%) achieved target exposures after one software recommendation, with 3 of the remaining 7 patients achieving target exposures after 2. Forty-seven patients out of the 50 patients (94%) achieved the secondary outcome of clinical cure. There were no antibiotic exposure-related adverse events reported.
The use of TDM combined with Bayesian forecasting dosing software increases the efficiency for achieving target antibiotic exposures in the ICU. Clinical trials comparing this approach with other dosing strategies are required to further validate these findings.
广谱抗生素，如β-内酰胺类和万古霉素，常用于治疗重症患者，但相当一部分患者无法达到目标暴露水平。治疗药物监测（TDM）联合贝叶斯预测剂量软件可能会提高这些患者的目标达标率。本研究旨在描述贝叶斯预测剂量软件在实现重症患者选定β-内酰胺类抗生素和万古霉素目标暴露方面的效率。
一项前瞻性队列研究在成人重症监护病房（ICU）进行。如果 TDM 提示患者的暴露水平低于或高于治疗范围，即存在亚治疗或超治疗暴露，则将接受万古霉素、哌拉西林他唑巴坦和美罗培南治疗的患者纳入研究。使用 ID-ODS™ 剂量软件生成剂量建议，治疗团队可接受或拒绝该建议。重复进行抗生素 TDM 以确定是否达到目标暴露水平。
2020 年 3 月至 2021 年 12 月，共纳入 70 例患者进行分析。56 例患者（80%）接受了软件推荐，其中 50 例患者重复进行了抗生素测量。在接受软件推荐的 50 例患者中，有 43 例（86%）达到了目标暴露水平，其余 7 例患者中的 3 例在接受 2 次推荐后达到了目标暴露水平。在 50 例接受软件推荐的患者中，有 47 例（94%）达到了临床治愈的次要结局。未报告与抗生素暴露相关的不良事件。
TDM 联合贝叶斯预测剂量软件的使用提高了 ICU 中实现目标抗生素暴露的效率。需要进行临床试验比较这种方法与其他剂量策略，以进一步验证这些发现。
