Yanık Yalçın Tuğba, Pehlivanlı Aysel, Yeşiler Fatma İrem, Şahintürk Helin, Azap Özlem, Arslan Hande, Başgut Bilgen, Zeyneloğlu Pınar
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Baskent University, Ankara, Turkey.
Department of Pharmacology, Faculty of Pharmacy, Baskent University, Ankara, Turkey.
Antimicrob Agents Chemother. 2025 Oct;69(10):e0023825. doi: 10.1128/aac.00238-25. Epub 2025 Aug 18.
Antimicrobial dosing in patients undergoing continuous renal replacement therapy (CRRT) is a clinical challenge. The study aimed to investigate the factors that influence appropriate antimicrobial doses in CRRT and to address gaps in current knowledge and practice. The mixed-method design involved two phases. For the quantitative phase, infectious disease, intensive care, and clinical pharmacy professionals completed a questionnaire assessing demographics and practice details, as well as their knowledge, attitudes, and practices on antibiotic dosing in CRRT. In the qualitative phase, online focus groups were conducted using a question schedule based on the Theoretical Domains Framework to explore challenges and expectations. A structured questionnaire was completed by 160 participants, most of whom were infectious disease specialists (61.3%) with over 10 years of experience (38.8%). Despite a high knowledge level of antimicrobial dosing during CRRT, the sieving coefficient was unclear at 74.4%. Although 96.3% reported adjusting doses, 78.8% lacked institutional guidelines, and 68.1% did not monitor drug levels. CRRT experience positively influenced knowledge and attitude scores, and different dosing practices were reported for meropenem, piperacillin-tazobactam, and vancomycin. Qualitative findings highlighted the need for standard guidelines and CRRT-specific training. Multidisciplinary collaboration and real-time monitoring of therapeutic drugs were emphasized. This study identifies key gaps in knowledge and practice regarding antimicrobial dosing in CRRT. Addressing these gaps requires targeted training programs, real-time drug monitoring, and the development of evidence-based dosing guidelines to enhance patient safety and antimicrobial efficacy. Future research should evaluate the impact of these interventions on clinical outcomes.
接受持续肾脏替代疗法（CRRT）的患者的抗菌药物给药是一项临床挑战。该研究旨在调查影响CRRT中适当抗菌药物剂量的因素，并填补当前知识和实践中的空白。混合方法设计包括两个阶段。在定量阶段，传染病、重症监护和临床药学专业人员完成了一份问卷，评估人口统计学和实践细节，以及他们对CRRT中抗生素给药的知识、态度和实践。在定性阶段，使用基于理论领域框架的问题清单进行在线焦点小组讨论，以探索挑战和期望。160名参与者完成了一份结构化问卷，其中大多数是传染病专家（61.3%），有超过10年的经验（38.8%）。尽管对CRRT期间的抗菌药物给药知识水平较高，但74.4%的人对筛选系数不清楚。虽然96.3%的人报告调整了剂量，但78.8%的人缺乏机构指南，68.1%的人没有监测药物水平。CRRT经验对知识和态度得分有积极影响，美罗培南、哌拉西林-他唑巴坦和万古霉素的给药实践存在差异。定性研究结果强调了标准指南和CRRT特定培训的必要性。强调了多学科协作和治疗药物的实时监测。本研究确定了CRRT中抗菌药物给药在知识和实践方面的关键差距。解决这些差距需要有针对性的培训计划、实时药物监测以及制定基于证据的给药指南，以提高患者安全性和抗菌疗效。未来的研究应该评估这些干预措施对临床结果的影响。
