Rationality of Time-Dependent Antimicrobial Use in Intensive Care Units in China: A Nationwide Cross-Sectional Survey.
Rationality of Time-Dependent Antimicrobial Use in Intensive Care Units in China: A Nationwide Cross-Sectional Survey.
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DOI：
10.3389/fmed.2021.584813
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发表时间：
2021
影响因子：
3.9
通讯作者：
Chen D
中科院分区：
文献类型：
--
作者：
Liu J;Zhang S;Huang S;Chen Y;Zhang L;Du H;Wang T;Liu Y;Xu Y;Chen D
背景：推荐延长/持续输注和治疗药物监测(TDM)，以优化重症监护病房(ICU)患者的药物暴露，尽管这些措施的实际应用仍不确定。我们调查了中国在ICU中输注和监测常用的时间依赖性抗菌药的当前做法。方法：从2019年12月至2020年1月，对中国地区的强化治疗人员进行时间依赖性抗菌药物输注及监测各方面的在线问卷调查。临床医生的回答与他们的职称相匹配，使用Sankey图表。进行单因素和多因素Logistic回归分析，寻找与TDM相关的因素。结果：中国所在的31个省级行政区共3687名ICU专科医生进行了问卷调查。据报道，医院有抗生素管理(ABS)小组，有3243名(88.0%)强化治疗人员，其中1308名(35.5%)是ABS小组成员。虽然大多数强化治疗人员(3490人，94.7%)熟悉长时间/持续输液的概念，但近一半(1634人，44.3%)的人经常间歇使用β-内酰胺类抗生素。近三分之二的受访者报告称，他们的医院无法进行TDM。多因素Logistic回归分析显示，在医院层面，对药物样本时机和监测治疗效果的态度的了解，以及药物的谷峰浓度影响着是否进行TDM的决定。结论：我们发现，从给药到TDM，严重感染患者常用的几种时间依赖性抗生素的处方实践有很大的差异。需要进一步的研究来有效地评估促进一致处方行为的策略。
Background: Extended/continuous infusion and therapeutic drug monitoring (TDM) of time-dependent antimicrobials are recommended for optimizing drug exposure for patients in intensive care units (ICUs), although practical application of these measures remains uncertain. We surveyed current practices in infusion and monitoring of commonly prescribed time-dependent antimicrobials in ICUs across China. Methods: From December 2019 to January 2020, we sent online questionnaires about various aspects of infusion and monitoring of time-dependent antimicrobials to intensivists across China. Responses from clinicians were matched with their professional titles using the Sankey diagram. Univariate and multivariate logistic regression analyses were performed to find factors associated with TDM. Results: A total of 3,687 ICU specialists from 31 provincial administrative regions of China responded to our questionnaires. Antibiotic stewardship (ABS) teams were available in hospitals as reported by 3,243 (88.0%) intensivists, including 1,308 (35.5%) who were ABS team members. Although most intensivists (3,490, 94.7%) were acquainted with the concept of prolonged/continuous infusion, nearly half of them (1,634, 44.3%) commonly administered β-lactam antibiotics intermittently. Nearly two-thirds of the respondents reported that their hospitals could not perform TDM. Our multivariable logistic regression analysis revealed that at the hospital level, knowledge of drug sample timing and attitude toward monitoring treatment effects, and drug trough or peak concentration influenced the decision to conduct TDM. Conclusions: We found great variability in prescribing practices, from drug administration to TDM, for several time-dependent antibiotics commonly used for patients with severe infections. Further studies are necessary to effectively evaluate strategies to promote consistent prescribing behavior.
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DOI：
10.1016/j.ijantimicag.2016.02.017
发表时间：
2016-06-01
影响因子：
10.8
作者：
Cotta, Menino O.;Dulhunty, Joel M.;Lipman, Jeffrey
通讯作者：
Lipman, Jeffrey
DOI：
10.1016/s1473-3099(15)00077-8
发表时间：
2015-11
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Das J;Kwan A;Daniels B;Satyanarayana S;Subbaraman R;Bergkvist S;Das RK;Das V;Pai M
通讯作者：
Pai M
影响因子：
11.8
作者：
Liu, Catherine;Bayer, Arnold;Chambers, Henry F.
通讯作者：
Chambers, Henry F.
影响因子：
4.9
作者：
Neely, Michael N.;Kato, Lauren;Minejima, Emi
通讯作者：
Minejima, Emi
影响因子：
56.3
作者：
Roberts, Jason A.;Abdul-Aziz, Mohd H.;Lipman, Jeffrey;Mouton, Johan W.;Vinks, Alexander A.;Felton, Timothy W.;Hope, William W.;Farkas, Andras;Neely, Michael N.;Schentag, Jerome J.;Drusano, George;Frey, Otto R.;Theuretzbacher, Ursula;Kuti, Joseph L.
通讯作者：
Kuti, Joseph L.