Antimicrobial Therapeutic Drug Monitoring in critically ill adult patients -an international perspective on access, utilisation, and barriers

Paul Williams; Menino Osbert Cotta; Alexis Tabah; Indy Sandaradura; Salmaan Kanji; Marc H Scheetz; Sahand Imani; Muhammed Elhadi; Sònia Luque Pardos; Natalie Schellack; Cristina Sanches; Jean Francois Timsit; Jiao Xie; Andras Farkas; Kathryn Wilks; Jason A Roberts

doi:10.1016/j.ijantimicag.2024.107192

Antimicrobial Therapeutic Drug Monitoring in critically ill adult patients -an international perspective on access, utilisation, and barriers

Int J Antimicrob Agents. 2024 May 9:107192. doi: 10.1016/j.ijantimicag.2024.107192. Online ahead of print.

Authors

Paul Williams¹, Menino Osbert Cotta², Alexis Tabah³, Indy Sandaradura⁴, Salmaan Kanji⁵, Marc H Scheetz⁶, Sahand Imani⁷, Muhammed Elhadi⁸, Sònia Luque Pardos⁹, Natalie Schellack¹⁰, Cristina Sanches¹¹, Jean Francois Timsit¹², Jiao Xie¹³, Andras Farkas¹⁴, Kathryn Wilks¹⁵, Jason A Roberts¹⁶

Affiliations

¹ University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Pharmacy Department, Sunshine Coast University Hospital, Birtinya, Queensland, Australia. Electronic address: p.g.williams@uq.edu.au.
² University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
³ University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland.
⁴ Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia; Institute for Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, New South Wales, Australia.
⁵ The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁶ Pharmacometric Center of Excellence, Departments of Pharmacy Practice and Pharmacology, College of Pharmacy, Midwestern University, Downers Grove, IL, USA.
⁷ Nepean Blue Mountains Local Health District, Nepean Hospital, Sydney, New South Wales, Australia.
⁸ Faculty of Medicine, University of Tripoli, Tripoli, Libya.
⁹ Pharmacy Department, Parc de Salut Mar, Barcelona, Spain; Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER of Pharmacy, Saint Clare's Infectious Diseases (CIBERINFEC CB21/13/0002) Institute of Health Carlos III, Madrid, Spain.
¹⁰ Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
¹¹ Campus Centro Oeste Dona Lindu, Federal University of Sao João del Rei, Divinópolis, Minas Gerais, Brasil.
¹² Assistance Publique Hôpitaux de Paris - Bichat hospital Medical and infectious diseases ICU (MI2), F75018, Paris France; IAME U 1137 université Paris-Cité Site Bichat; F75018, Paris France.
¹³ Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
¹⁴ Optimum Dosing Strategies, Bloomingdale, NJ, USA; Department of Pharmacy, Saint Clare's Health, Denville, New Jersey, USA.
¹⁵ Infectious Diseases Department, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
¹⁶ University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Departments of Intensive Care Medicine and Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes France.

PMID: 38734215
DOI: 10.1016/j.ijantimicag.2024.107192

Abstract

Background: Therapeutic drug monitoring (TDM) is an effective method for individualizing antimicrobial therapy in critically ill patients. The 2021 ADMIN-ICU survey studied a wide range of intensive care unit (ICU) clinicians worldwide to gain their perspectives on antimicrobial TDM. This paper reports the responses from this survey relating to TDM access, utilisation, barriers, and clinical value.

Methods: An online survey consisted of multiple-choice questions and 5-point Likert scales. The survey examined respondent's access to minimum inhibitory concentration (MIC) results, drug assays and dosing software, as well as barriers to TDM.

Results: The survey included 538 clinicians from 409 hospitals in 45 countries, with 71% physicians and 29% pharmacists. Despite most respondents having access to assays, 21% and 26% of respondents lacked access to vancomycin and aminoglycosides, respectively. In lower-income countries, almost 40% reported no access. Delayed drug assay turnaround time was the most significant barrier to TDM, particularly in lower-income countries. Routine access to MIC results was unavailable for 41% of respondents, with 25% of lower-income country respondents having no access to MIC or susceptibility reports.

Conclusions: This global survey indicated that consistent TDM usage is hindered by assay access in some sites, and timeliness of assay results in others. Addressing barriers to TDM, particularly in low-income countries, should be a priority to ensure equitable access to affordable TDM.

Keywords: antimicrobial; barriers; intensive care units; survey; therapeutic drug monitoring.