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J Antimicrob Chemother. 2015 Sep;70(9):2671-7. doi: 10.1093/jac/dkv165. Epub 2015 Jul 13.

The ADMIN-ICU survey: a survey on antimicrobial dosing and monitoring in ICUs.

Author information

1
Intensive Care Unit, The Royal Brisbane and Women's Hospital, Brisbane, Australia Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Brisbane, Australia alextabah@gmail.com.
2
Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.
3
Intensive Care Unit, The Royal Brisbane and Women's Hospital, Brisbane, Australia Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Brisbane, Australia Faculty of Health, Queensland University of Technology, Brisbane, Australia.
4
Unité de Prévention et de Lutte contre les Infections Nosocomiales, CHU Angers - Université D'Angers, Angers, France.
5
Intensive Care Unit, The Royal Brisbane and Women's Hospital, Brisbane, Australia Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
6
Pharmacy Department, St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, UK School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK.
7
APHP - Hopital Bichat - Reanimation Medicale et des maladies infectieuses, F-75018 Paris, France UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, control and care; Inserm/Univ Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France.

Abstract

OBJECTIVES:

There is little evidence and few guidelines to inform the most appropriate dosing and monitoring for antimicrobials in the ICU. We aimed to survey current practices around the world.

METHODS:

An online structured questionnaire was developed and sent by e-mail to obtain information on local antimicrobial prescribing practices for glycopeptides, piperacillin/tazobactam, carbapenems, aminoglycosides and colistin.

RESULTS:

A total of 402 professionals from 328 hospitals in 53 countries responded, of whom 78% were specialists in intensive care medicine (41% intensive care, 30% anaesthesiology, 14% internal medicine) and 12% were pharmacists. Vancomycin was used as a continuous infusion in 31% of units at a median (IQR) daily dose of 25 (25-30) mg/kg. Piperacillin/tazobactam was used as an extended infusion by 22% and as a continuous infusion by 7%. An extended infusion of carbapenem (meropenem or imipenem) was used by 27% and a continuous infusion by 5%. Colistin was used at a daily dose of 7.5 (3.9-9) million IU (MIU)/day, predominantly as a short infusion. The most commonly used aminoglycosides were gentamicin (55%) followed by amikacin (40%), with administration as a single daily dose reported in 94% of the cases. Gentamicin was used at a daily dose of 5 (5-6) mg/day and amikacin at a daily dose of 15 (15-20) mg/day. Therapeutic drug monitoring of vancomycin, piperacillin/tazobactam and meropenem was used by 74%, 1% and 2% of the respondents, respectively. Peak aminoglycoside concentrations were sampled daily by 28% and trough concentrations in all patients by 61% of the respondents.

CONCLUSIONS:

We found wide variability in reported practices for antibiotic dosing and monitoring. Research is required to develop evidence-based guidelines to standardize practices.

PMID:
26169558
DOI:
10.1093/jac/dkv165
[Indexed for MEDLINE]

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