U Liebchen1, M Paal2, C Scharf3, I Schroeder3, B Grabein4, J Zander5, C Siebers6, M Zoller3. 1. Department of Anaesthesiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 München, Germany. Electronic address: uwe.liebchen@med.uni-muenchen.de. 2. Institute of Laboratory Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377 München, Germany. 3. Department of Anaesthesiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 München, Germany. 4. Department for Clinical Microbiology and Hospital Hygiene, University Hospital, LMU Munich, Marchioninistr. 15, 81377 München, Germany. 5. Laboratory Dr. Brunner, Luisenstr. 7a, 78464 Konstanz, Germany. 6. Department of Anaesthesiology and Intensive Care, Garmisch-Partenkirchen Medical Center, Auenstr. 6, 82467 Garmisch-Partenkirchen, Germany.
Abstract
PURPOSE: Optimization of antibiotic therapy is still urgently needed in critically ill patients. The aim of the ONTAI survey (online survey on the use of Therapeutic Drug Monitoring of antibiotics in intensive care units) was to evaluate which strategies intensive care physicians in Germany use to improve the quality of antibiotic therapy and what role a Therapeutic Drug Monitoring (TDM) plays. METHODS: Among the members of the German Society for Anaesthesiology and the German Society for Medical Intensive Care Medicine and Emergency Medicine, a national cross-sectional survey was conducted using an online questionnaire. RESULTS: The questionnaire was completely answered by 398 respondents. Without TDM, prolonged infusion was judged to be the most appropriate dosing regimen for beta lactams. A TDM for piperacillin, meropenem and vancomycin was performed in 17, 22 and 75% of respondents, respectively. For all beta lactams, a TDM was requested more often than it was available. There was great uncertainty as to the optimal pharmacokinetic/pharmacodynamic index for beta-lactams. 86% of the respondents who received minimal inhibitory concentrations adapted the therapy accordingly. CONCLUSION: German intensive care physicians are convinced of TDM for dose optimization. However, practical implementation, the determination of MICs and defined target values are still lacking.
PURPOSE: Optimization of antibiotic therapy is still urgently needed in critically illpatients. The aim of the ONTAI survey (online survey on the use of Therapeutic Drug Monitoring of antibiotics in intensive care units) was to evaluate which strategies intensive care physicians in Germany use to improve the quality of antibiotic therapy and what role a Therapeutic Drug Monitoring (TDM) plays. METHODS: Among the members of the German Society for Anaesthesiology and the German Society for Medical Intensive Care Medicine and Emergency Medicine, a national cross-sectional survey was conducted using an online questionnaire. RESULTS: The questionnaire was completely answered by 398 respondents. Without TDM, prolonged infusion was judged to be the most appropriate dosing regimen for beta lactams. A TDM for piperacillin, meropenem and vancomycin was performed in 17, 22 and 75% of respondents, respectively. For all beta lactams, a TDM was requested more often than it was available. There was great uncertainty as to the optimal pharmacokinetic/pharmacodynamic index for beta-lactams. 86% of the respondents who received minimal inhibitory concentrations adapted the therapy accordingly. CONCLUSION: German intensive care physicians are convinced of TDM for dose optimization. However, practical implementation, the determination of MICs and defined target values are still lacking.
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