The ANTIBIOPERF study: a nationwide cross-sectional survey about practices for β-lactam administration and therapeutic drug monitoring among critically ill patients in France

Abstract

Our objective was to assess current practices about the administration (intermittent, extended, or continuous infusions) and therapeutic drug monitoring (TDM) of β-lactam antibiotics and vancomycin in France. We conducted a nationwide cross-sectional survey in May-August 2015, using an online questionnaire, sent as an e-mail link to infectious disease specialists and intensive care specialists through national mailing lists. We used clinical vignettes of critically ill patients to assess physicians' practices about administration and TDM practices for amoxicillin, cloxacillin, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, meropenem and vancomycin. In all, 507 physicians participated (507/1200, response rate 42%). TDM was rarely available for β-lactams (from 16.5% (81/490) for cloxacillin to 30% (145/490) for ceftazidime), whereas vancomycin TDM was available in 97% (477/490) of the cases. In the clinical vignettes, ceftazidime and piperacillin/tazobactam were the β-lactams administered most frequently by extended or continuous infusions (76% (336/440) and 57% (252/444), respectively). Gaps in knowledge about the duration of stability of intravenous β-lactams were common (correct answers ranged from 8% (35/432) for cloxacillin to 33% (146/438) for ceftazidime). Most physicians (77%, 339/442) were convinced of the value of extended or continuous infusions for β-lactams in critically ill patients, but 48% (211/442) did not have access to practical guidelines. Our survey found that most infectious disease and intensive care specialists are favourable to optimized administration of β-lactams in critically ill patients. But the lack of guidelines and limited TDM availability for β-lactams in hospitals are potential barriers to its implementation.

Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations

“…Data on TDM implementation on hospitals is also scarce: in the last 10 years, only one paper concerning TDM implementation was identified. However, this paper describes that, in France, implementation of vancomycin TDM is quite high: vancomycin TDM was available in 97% (477/490) of hospitals . Unfortunately, a study carried out in Scandinavian countries showed that, in most cases, vancomycin TDM does not comply with recent recommendations/guidelines …”

“…However, this paper describes that, in France, implementation of vancomycin TDM is quite high: vancomycin TDM was available in 97% (477/490) of hospitals. 8 Unfortunately, a study carried out in Scandinavian countries showed that, in most cases, vancomycin TDM does not comply with recent recommendations/ guidelines. 9 Medical center implementation of the AME guideline, 2 with associated training, resulted in a significant short-term improvement in vancomycin dosing and TDM.…”

Acute kidney injury during treatment with high-dose cloxacillin: a report of 23 cases and literature review

“…Individualized treatment is probably necessary for this population of elderly patients with major comorbidities, and multiple comedications. A recent study showed that cloxacillin monitoring was routinely available only in 16.5% of cases in France[27], although the impact of therapeutic drug monitoring has been demonstrated for this betalactam agent as well as others, when prescribed at high doses[28]. One of the major caveats of therapeutic drug monitoring for cloxacillin is that the therapeutic target has not been validated.infections (e.g.…”

Pharmacokinetics/Pharmacodynamics of β-Lactams and Therapeutic Drug Monitoring: From Theory to Practical Issues in the Intensive Care Unit

“…56,57 Additionally, results from survey studies highlighted that clinicians frequently do not have adequate access to practical resources to inform how to best use prolonged infusions given the considerations of drug stability and compatibility, and that TDM is either not readily available or results are not timely. 58 Furthermore, only the minority of hospitals have access to clinicians with skills to interpret TDM and guide further therapy. 58 With this knowledge in hand, further investigation into the applicability of guideline-based dosing in critically ill patients is justified.…”

“…58 Furthermore, only the minority of hospitals have access to clinicians with skills to interpret TDM and guide further therapy. 58 With this knowledge in hand, further investigation into the applicability of guideline-based dosing in critically ill patients is justified.…”