Administration and Therapeutic Drug Monitoring of β-lactams and Vancomycin in Critical Care Units in Colombia: The ANTIBIOCOL Study

Abstract

Therapeutic drug monitoring (TDM) and continuous infusion strategies are effective interventions in clinical practice, but these practices are still largely unknown in Colombia, especially in the critical care setting. This study aims to describe the practices involved in the administration and TDM of β-lactams and vancomycin reported by specialists in critical care in Colombia and to explore the factors that are related to the use of extended infusion. An online nationwide survey was applied to 153 specialists, who were selected randomly. A descriptive, bivariate analysis and a logistic regression model were undertaken. In total, 88.9% of the specialists reported TDM availability and 21.57% reported access to results within 6 h. TDM was available mainly for vancomycin. We found that 85.62% of the intensivists had some type of institutional protocol; however, only 39.22% had a complete and socialized protocol. The odds of preferring extended infusions among those who did not have institutional protocols were 80% lower than those with complete protocols, OR 0.2 (95% CI: 0.06−0.61). The most important perceived barriers to performing continuous infusions and TDM were the lack of training and technologies. This pioneering study in Colombia could impact the quality of care and outcomes of critically ill patients in relation to the threat of antimicrobial resistance.

Therapeutic drug monitoring practices of anti-infectives: An Asia-wide cross-sectional survey

“…Whilst the role of many possible factors deserves further exploring to make TDM standard of care for anti-infective therapy, including Standard Operating Procedure compliance of sampling and determination, the time lag between serum sample and result, the development of point of care testing, and additional studies to standardize the approach for both reactive and proactive TDM ( Strohbehn et al, 2018 ; Sandaradura et al, 2021 ). Optimization assay also plays a positive role in the efficient TDM practice and should been encouraged, which will promote clinicians to work based on the guidelines rather than the availability of technology and supplies, especially in most developing countries in Asia ( Decosterd et al, 2020 ; Fuentes et al, 2021 ).…”

Why is the Implementation of Beta-Lactam Therapeutic Drug Monitoring for the Critically Ill Falling Short? A Multicenter Mixed-Methods Study

“…Multinational surveys suggest that only approximately 10%-20% of practices use beta-lactam TDM in their ICUs. [16][17][18] In the United States, the frequency is even less. 19 One potential explanation for the limited adoption is the lack of attention to the complexity of implementing betalactam TDM, which is needed for the routinization of a new evidence-based practice.…”

“…Multinational surveys suggest that only approximately 10%–20% of practices use beta-lactam TDM in their ICUs. 16–18 In the United States, the frequency is even less. 19…”

“How to” guide for pharmacist‐led implementation of beta‐lactam therapeutic drug monitoring in the critically ill

“…BL TDM reliably improves pharmacokinetic/pharmacodynamic (PK/PD) target attainment and, in some studies, clinical outcomes 7,8 . Numerous international guidelines have endorsed BL TDM particularly in the critically ill, 4,9,10 but in the United States, BL TDM use remains rare 11–14 …”

“…7,8 Numerous international guidelines have endorsed BL TDM particularly in the critically ill, 4,9,10 but in the United States, BL TDM use remains rare. [11][12][13][14] Recent publications have aimed to identify barriers and facilitators of BL TDM implementation. [15][16][17] Broadly, these appear to exist in three primary domains: building a supportive organizational foundation, establishing clinical workflows, and promoting 'individual internalization'.…”