The ANTIBIOPERF study: a nationwide cross-sectional survey about ă practices for beta-lactam administration and therapeutic drug monitoring ă among critically ill patients in France
Résumé
Our objective was to assess current practices about the administration ă (intermittent, extended, or continuous infusions) and therapeutic drug ă monitoring (TDM) of beta-lactam antibiotics and vancomycin in France. We ă conducted a nationwide cross-sectional survey in May August 2015, using ă an online questionnaire, sent as an e-mail link to infectious disease ă specialists and intensive care specialists through national mailing ă lists. We used clinical vignettes of critically ill patients to assess ă physicians' practices about administration and TDM practices for ă amoxicillin, cloxacillin, piperacillin/tazobactam, cefotaxime, ă ceftazidime, cefepime, meropenem and vancomycin. In all, 507 physicians ă participated (507/1200, response rate 42%). TDM was rarely available ă for beta-lactams (from 16.5% (81/490) for cloxacillin to 30% (145/490) ă for ceftazidime), whereas vancomycin TDM was available in 97% (477/490) ă of the cases. In the clinical vignettes, ceftazidime and ă piperacillin/tazobactam were the beta-lactams administered most ă frequently by extended or continuous infusions (76% (336/440) and 57% ă (252/444), respectively). Gaps in knowledge about the duration of ă stability of intravenous beta-lactams were common (correct answers ă ranged from 8% (35/432) for cloxacillin to 33% (146/438) for ă ceftazidime). Most physicians (77%, 339/442) were convinced of the ă value of extended or continuous infusions for beta-lactams in critically ă ill patients, but 48% (211/442) did not have access to practical ă guidelines. Our survey found that most infectious disease and intensive ă care specialists are favourable to optimized administration of ă beta-lactams in critically ill patients. But the lack of guidelines and ă limited TDM availability for beta-lactams in hospitals are potential ă barriers to its implementation. (C) 2016 European Society of Clinical ă Microbiology and Infectious Diseases. Published by Elsevier Ltd. All ă rights reserved.