Antimicrobial therapeutic drug monitoring in critically ill adult patients - An international perspective on access, utilisation, and barriers.

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

Risk factors for bloodstream infections caused by extended-spectrum ß-lactamase-producing Escherichia coli and Klebsiella pneumoniae.

UNLABELLED: The objective of this study was to identify risk factors for bacteremia by extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Retrospective case-control study performed in a 450-bed acute care academic tertiary hospital in Barcelona, Spain. Cases included 53 patients with ESBL-producing E. coli or K. pneumoniae bacteremia, and 159 controls with non-ESBL-producing E. coli or K. pneumoniae bacteremia. Controls were matched in a 3:1 ratio to case patients according to species of infecting organism, age, and severity of illness in the 24-48 h before blood sample collection for culture calculated by the Simplified Acute Physiology Score (SAPS II) system. Previous antimicrobials were more frequently administered to cases than to controls (56.5% vs 17%, p < 0.001). Binary logistic regression showed that the number (> 2) of different families of antimicrobials received within 90 days before bloodstream infection was the only predictor of ESBL-producing E. coli or K. pneumoniae in blood culture (OR = 2.29, 95% CI 1.35-3.88, p = 0.002). CONCLUSION: Previous use of different families of antimicrobials (more than two) in patients with bloodstream infection caused by E. coli or K. pneumoniae increased the risk for ESBL-producing strains.

Risk factors for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae

The objective of this study was to identify risk factors for bacteremia by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Retrospective case-control study performed in a 450-bed acute care academic tertiary hospital in Barcelona, Spain. Cases included 53 patients with ESBL-producing E. coli or K. pneumoniae bacteremia, and 159 controls with non-ESBL-producing E. coli or K. pneumoniae bacteremia. Controls were matched in a 3:1 ratio to case patients according to species of infecting organism, age, and severity of illness in the 24-48h before blood sample collection for culture calculated by the Simplified Acute Physiology Score (SAPS II) system. Previous antimicrobials were more frequently administered to cases than to controls (56.5 percent vs 17 percent, p < 0.001). Binary logistic regression showed that the number (> 2) of different families of antimicrobials received within 90 days before bloodstream infection was the only predictor of ESBL-producing E. coli or K. pneumoniae in blood culture (OR = 2.29, 95 percent CI 1.35-3.88, p = 0.002). Conclusion: Previous use of different families of antimicrobials (more than two) in patients with bloodstream infection caused by E. coli or K. pneumoniae increased the risk for ESBL-producing strains.

Características farmacocinéticas diferenciales de micafungina. Experiencia en poblaciones especiales / Differential pharmacokinetic characteristics of micafungin. Experience in special populations

Resumen En la actualidad se dispone de 3 equinocandinas para el tratamiento de infecciones fúngicas. Micafungina ha representado la última incorporación a este grupo de antifúngicos. A pesar de presentar un mecanismo de acción similar, esta molécula tiene algunas características farmacocinéticas distintas a las del resto del grupo. Hoy en día se dispone de amplia información acerca del comportamiento farmacocinético de micafungina procedente, fundamentalmente, de los pacientes incluidos en los ensayos clínicos. Sin embargo, el conocimiento de la farmacocinética de esta equinocandina en poblaciones especiales es mucho más limitado. El objetivo de la presente revisión es analizar la información disponible sobre la farmacocinética de micafungina en pediatría, pacientes ancianos, insuficiencia renal, insuficiencia hepática y en pacientes trasplantados (AU)

Currently, three echinocandins are available for the treatment of fungal infections. Micafungin is the latestdrug to be incorporated into this group of antifungal agents. Although the mechanism of action ofmicafungin is similar to that of other echinocandins, this molecule has certain pharmacokineticcharacteristics that distinguish it from other drugs in this group. Nowadays, there is wide information onthe pharmacokinetic behavior of micafungin, mainly from patients included in clinical trials. However,there is far less knowledge of the pharmacokinetics of this echinocandin in special populations. The aim ofthe current review was to analyze the available information on the pharmacokinetics of micafungin inpediatric patients, the elderly, patients with renal insufficiency or liver failure, and transplant recipient