Impact of Triazole Therapeutic Drug Monitoring Availability and Timing

被引：18
作者：
McCreary, Erin K. [1 ]
Bayless, Meg [2 ]
Van, Ahn P. [1 ]
Lepak, Alexander J. [2 ]
Wiebe, Donald A. [3 ]
Schulz, Lucas T. [1 ]
Andes, David R. [2 ]
机构：
[1] Univ Wisconsin Hlth, Dept Pharm, Madison, WI USA
[2] Univ Wisconsin, Dept Med, Div Infect Dis, Madison, WI 53706 USA
[3] Univ Wisconsin, Dept Pathol, Madison, WI 53706 USA
来源：
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY | 2019年 / 63卷 / 10期
关键词：
antifungal; pharmacodynamics; therapeutic drug monitoring; timing; triazole; INFECTIOUS-DISEASES-SOCIETY; CLINICAL-PRACTICE GUIDELINES; INVASIVE FUNGAL-INFECTIONS; BLOOD-STREAM; 2016; UPDATE; VORICONAZOLE; MANAGEMENT; POSACONAZOLE; EFFICACY; SAFETY;
D O I：
10.1128/AAC.01245-19
中图分类号：
Q93 [微生物学];
学科分类号：
071005 ; 100705 ;
摘要：
Therapeutic drug monitoring (TDM) is an established strategy to optimize antifungal therapy with certain triazoles. While established relationships exist between concentration and safety or efficacy, the impact of TDM timing on outcomes is unknown. We report clinical outcomes, including antifungal exposure and mortality, in patients receiving institutional versus reference laboratory TDM. The availability of in-house triazole assays reduced the time to drug concentration result (12 versus 68 h; P < 0.001) and time to achieve therapeutic serum concentrations (10 versus 31 days; P < 0.001). Subtherapeutic concentrations were associated with higher patient mortality (32% versus 13.3%; P = 0.036).
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