Antimicrobial therapeutic drug monitoring in critically ill adult patients: a Position Paper#

被引:730
作者
Abdul-Aziz, Mohd H. [1 ]
Alffenaar, Jan-Willem C. [2 ,3 ,4 ]
Bassetti, Matteo [5 ,6 ]
Bracht, Hendrik [7 ]
Dimopoulos, George [8 ]
Marriott, Deborah [9 ]
Neely, Michael N. [10 ,11 ]
Paiva, Jose-Artur [12 ,13 ]
Pea, Federico [14 ]
Sjovall, Fredrik [15 ]
Timsit, Jean F. [16 ,17 ]
Udy, Andrew A. [18 ,19 ]
Wicha, Sebastian G. [20 ]
Zeitlinger, Markus [21 ]
De Waele, Jan J. [22 ]
Roberts, Jason A. [1 ,23 ,24 ,25 ]
机构
[1] Univ Queensland, Univ Queensland Ctr Clin Res UQCCR, Fac Med, Brisbane, Qld 4029, Australia
[2] Univ Sydney, Fac Med & Hlth, Sch Pharm, Sydney, NSW, Australia
[3] Westmead Hosp, Westmead, NSW, Australia
[4] Univ Sydney, Marie Bashir Inst Infect Dis & Biosecur, Sydney, NSW, Australia
[5] Univ Genoa, Dept Hlth Sci, Infect Dis Clin, Genoa, Italy
[6] Hosp Policlin San Martino IRCCS, Genoa, Italy
[7] Univ Ulm, Dept Anaesthesiol, Ulm, Germany
[8] Natl & Kapodistrian Univ Athens, Univ Hosp Attikon, Dept Crit Care, Athens, Greece
[9] St Vincents Hosp, Dept Microbiol & Infect Dis, Sydney, NSW, Australia
[10] Univ Southern Calif, Keck Sch Med, Dept Paediat, Los Angeles, CA 90007 USA
[11] Childrens Hosp Los Angeles, Div Infect Dis, Los Angeles, CA 90027 USA
[12] Fac Med Porto, Dept Med, Porto, Portugal
[13] Ctr Hosp Univ Sao Joao, Dept Emergency & Intens Care Med, Porto, Portugal
[14] SM Misericordia Univ Hosp, Inst Clin Pharmacol, ASUFC, Udine, Italy
[15] Skane Univ Hosp, Dept Perioperat Med, Malmo, Sweden
[16] Bichat Claude Bernard Univ Hosp, AP HP, Dept Intens Care Med & Infect Dis, Paris, France
[17] Paris Diderot Univ, Infect Antimicrobials Modelling Evolut IAME, Paris, France
[18] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia
[19] The Alfred, Dept Intens Care & Hyperbar Med, Melbourne, Vic, Australia
[20] Univ Hamburg, Inst Pharm, Dept Clin Pharm, Hamburg, Germany
[21] Med Univ Vienna, Dept Clin Pharmacol, Vienna, Austria
[22] Ghent Univ Hosp, Dept Crit Care Med, Ghent, Belgium
[23] Royal Brisbane & Womens Hosp, Dept Intens Care Med & Pharm, Brisbane, Qld, Australia
[24] Univ Queensland, Ctr Translat Antiinfect Pharmacodynam, Sch Pharm, Brisbane, Qld, Australia
[25] Univ Montpellier, Nimes Univ Hosp, Div Anaesthesiol Crit Care Emergency & Pain Med, Nimes, France
基金
英国医学研究理事会;
关键词
Antibacterials; Antifungals; Antivirals; Pharmacokinetics; Pharmacodynamics; Sepsis; SUSTAINED VIROLOGICAL RESPONSE; HUMAN-IMMUNODEFICIENCY-VIRUS; INVASIVE FUNGAL-INFECTIONS; HEPATITIS-C VIRUS; CARE-UNIT PATIENTS; VANCOMYCIN TROUGH CONCENTRATIONS; ACYCLOVIR-INDUCED NEUROTOXICITY; RIBAVIRIN PLASMA-CONCENTRATION; AUGMENTED RENAL CLEARANCE; STEM-CELL TRANSPLANTATION;
D O I
10.1007/s00134-020-06050-1
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose This Position Paper aims to review and discuss the available data on therapeutic drug monitoring (TDM) of antibacterials, antifungals and antivirals in critically ill adult patients in the intensive care unit (ICU). This Position Paper also provides a practical guide on how TDM can be applied in routine clinical practice to improve therapeutic outcomes in critically ill adult patients. Methods Literature review and analysis were performed by Panel Members nominated by the endorsing organisations, European Society of Intensive Care Medicine (ESICM), Pharmacokinetic/Pharmacodynamic and Critically Ill Patient Study Groups of European Society of Clinical Microbiology and Infectious Diseases (ESCMID), International Association for Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT) and International Society of Antimicrobial Chemotherapy (ISAC). Panel members made recommendations for whether TDM should be applied clinically for different antimicrobials/classes. Results TDM-guided dosing has been shown to be clinically beneficial for aminoglycosides, voriconazole and ribavirin. For most common antibiotics and antifungals in the ICU, a clear therapeutic range has been established, and for these agents, routine TDM in critically ill patients appears meritorious. For the antivirals, research is needed to identify therapeutic targets and determine whether antiviral TDM is indeed meritorious in this patient population. The Panel Members recommend routine TDM to be performed for aminoglycosides, beta-lactam antibiotics, linezolid, teicoplanin, vancomycin and voriconazole in critically ill patients. Conclusion Although TDM should be the standard of care for most antimicrobials in every ICU, important barriers need to be addressed before routine TDM can be widely employed worldwide.
引用
收藏
页码:1127 / 1153
页数:27
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