Assessment of the practical impact of adjusting beta-lactam dosages based on therapeutic drug monitoring in critically ill adult patients: a systematic review and meta-analysis of randomized clinical trials and observational studies

被引：1
作者：
Gulyás E. [1 ,2 ,3 ]
Horváth I.L. [1 ,2 ]
Engh M.A. [1 ,4 ]
Bunduc S. [1 ,5 ,6 ]
Dembrovszky F. [4 ,7 ,8 ]
Fehérvári P. [1 ,9 ]
Bánvölgyi A. [1 ,10 ]
Csupor D. [1 ,4 ,11 ]
Hegyi P. [1 ,4 ,8 ,12 ]
Karvaly G.B. [1 ,3 ]
机构：
[1] Centre for Translational Medicine, Semmelweis University, Budapest
[2] University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest
[3] Department of Laboratory Medicine, Semmelweis University, 4 Nagyvarad ter, Budapest
[4] Institute for Translational Medicine, Medical School, University of Pécs, Pécs
[5] Carol Davila University of Medicine and Pharmacy, Bucharest
[6] Fundeni Clinical Institute, Bucharest
[7] First Department of Medicine, University of Pécs, Pécs
[8] János Szentágothai Research Center, University of Pécs, Pécs
[9] Department of Biostatistics, University of Veterinary Medicine, Budapest
[10] Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest
[11] Department of Clinical Pharmacy, University of Szeged, Szeged
[12] Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest
来源：
Scientific Reports | / 14卷 / 1期
关键词：
Beta-lactam; Critically ill; ICU; Meta-analysis; Therapeutic drug monitoring;
D O I：
10.1038/s41598-024-58200-w
中图分类号：
学科分类号：
摘要：
An estimated 70% of critically ill patients receive antibiotics, most frequently beta-lactams. The pharmacokinetic properties of these substances in this patient population are poorly predictable. Therapeutic drug monitoring (TDM) is helpful in making personalized decisions in this field, but its overall impact as a clinical decision-supporting tool is debated. We aimed to evaluate the clinical implications of adjusting beta-lactam dosages based on TDM in the critically ill population by performing a systematic review and meta-analysis of available investigations. Randomized controlled trials and observational studies were retrieved by searching three major databases. The intervention group received TDM-guided beta-lactam treatment, that is, at least one dose reconsideration based on the result of the measurement of drug concentrations, while TDM-unadjusted dosing was employed in the comparison group. The outcomes were evaluated using forest plots with random-effects modeling and subgroup analysis. Eight eligible studies were identified, including 1044 patients in total. TDM-guided beta-lactam treatment was associated with improved clinical cure from infection [odds ratio (OR): 2.22 (95% confidence interval (CI): 1.78–2.76)] and microbiological eradication [OR: 1.72 (CI: 1.05–2.80)], as well as a lower probability of treatment failure [OR: 0.47 (CI: 0.36–0.62)], but the heterogeneity of studies was remarkably high, especially in terms of mortality (70%). The risk of bias was moderate. While the TDM-guided administration of beta-lactams to critically ill patients has a favorable impact, standardized study designs and larger sample sizes are required for developing evidence-based protocols in this field. © The Author(s) 2024.
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