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

Tabah, Alexis, De Waele, Jan, Lipman, Jeffrey, Zahar, Jean Ralph, Cotta, Menino Osbert, Barton, Greg, Timsit, Jean-Francois, & Roberts, Jason A. (2015) The ADMIN-ICU survey: A survey on antimicrobial dosing and monitoring in ICUs. Journal of Antimicrobial Chemotherapy, 70(9), pp. 2671-2677.

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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.

Impact and interest:

12 citations in Scopus
12 citations in Web of Science®
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ID Code: 86585
Item Type: Journal Article
Refereed: Yes
DOI: 10.1093/jac/dkv165
ISSN: 1460-2091
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Nursing not elsewhere classified (111099)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Schools > School of Nursing
Copyright Owner: Copyright 2015 The Author
Deposited On: 18 Aug 2015 00:00
Last Modified: 18 Aug 2015 21:12

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