The admin-ICU survey

Published Date: 19th July 2016

Publication Authors: Barton G

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INTRODUCTION

Antibiotic choice and dosing is one of the cornerstones of infection management in intensive care. Recent research demonstrates variability in antimicrobial pharmacokinetics in the critically ill. There is little evidence to which is the most appropriate dosing, administration and monitoring strategy.

OBJECTIVES

To determine current practices in antimicrobial dosing, administration and monitoring strategies around the world.

METHODS

An online structured questionnaire was developed by the ESICM infection section to obtain information on local practices. Dosing was considered for a 35 year old male weighing 80 kg with normal kidney function. Participation was voluntary. The survey was sent by email to the members of the ESICM, ANZICS and local research networks.

RESULTS

402 professionals from 328 hospitals in 252 cities and 53 countries responded. 78 % were specialists in intensive care, 11.9 % pharmacists and 7 % doctors in training. 82.6 % were primarily responsible for the choice of antimicrobials. A pharmacist was available daily in 42 %, once a week in 9.7 %, only over the phone in 20.6 % and never in 27.6 % of the ICUs. Vancomycin was the glycopeptide of choice for 88.8 %, and was used as a continuous infusion by 31.3 %. Median [IQR] daily dose 25 [18.75-30] mg/kg. Therapeutic drug monitoring (TDM) was used for all the patients by 73.6 % and everyday in 40.4 %. Piperacillin/tazobactam was used as a short fractionated infusion by 70 %, an extended infusion by 21.9 %, a continuous infusion by 7 %. Median daily dose was 15.75 [13.5-18] g. TDM was used by 7.2 %. Meropenem was the most commonly used carbapenem (80.6 %), followed by imipenem (18.7 %). An extended infusion was used by 26.8 % and a continuous infusion by 4.5 %. Median daily dose of meropenem was 3 [3-3] g/day. TDM was used by 6.3 %. Colimycin was used less than once a month by 20.6 %, more than once a month by 12.2 % and more than weekly by 13.2 % at a median daily dose of 8 [4.3-9] MU/day. A short infusion was used by 80.9 %. The most common aminoglycoside used was gentamycin (54.1 %), followed by amikacin (39.6 %) and tobramycin (4.7 %). Median daily dose was 15 [15-20] mg for amikacin and 5 [4-6] mg for gentamycin. A single daily dose was used by 91.9 %. Peak concentrations were sampled everyday by 21.1 %, only in unstable or renally impaired patients in 36.8 % and less frequently by 42.1 %. Through concentrations were sampled in all patients by 60.2 %, in cases of renal failure by 16.4 % and infrequently or never by 20.4 %. If trough level was above the target 52.7 % would resample and do not re-administer before it was below that target and 43.8 % would reduce the next daily dose.

CONCLUSIONS

We found an important variability in reported practices for dosing, administering and using therapeutic drug monitoring for some of the most commonly used antimicrobials. Research is required to define the most adequate strategies and allow for the development of guidelines to standardize practices.

Tabah, A; Barton, G et al. (2014).  The admin-ICU survey: A survey on antimicrobials dosing and monitoring strategies in intensive care units . Intensive Care Medicine. 40 (Supplement 1), S131

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