Antimicrobial stewardship, therapeutic drug monitoring and infection management in the ICU: results from the international A- TEAMICU survey

Authors
Lanckohr, Christian 
Boeing, Christian 
De Waele, Jan J 
de Lange, Dylan W 
Schouten, Jeroen 

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Article
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Abstract

BACKGROUND: Severe infections and multidrug-resistant pathogens are common in critically ill patients. Antimicrobial stewardship (AMS) and therapeutic drug monitoring (TDM) are contemporary tools to optimize the use of antimicrobials. The A-TEAMICU survey was initiated to gain contemporary insights into dissemination and structure of AMS programs and TDM practices in intensive care units. METHODS: This study involved online survey of members of ESICM and six national professional intensive care societies. RESULTS: Data of 812 respondents from mostly European high- and middle-income countries were available for analysis. 63% had AMS rounds available in their ICU, where 78% performed rounds weekly or more often. While 82% had local guidelines for treatment of infections, only 70% had cumulative antimicrobial susceptibility reports and 56% monitored the quantity of antimicrobials administered. A restriction of antimicrobials was reported by 62%. TDM of antimicrobial agents was used in 61% of ICUs, mostly glycopeptides (89%), aminoglycosides (77%), carbapenems (32%), penicillins (30%), azole antifungals (27%), cephalosporins (17%), and linezolid (16%). 76% of respondents used prolonged/continuous infusion of antimicrobials. The availability of an AMS had a significant association with the use of TDM. CONCLUSIONS: Many respondents of the survey have AMS in their ICUs. TDM of antimicrobials and optimized administration of antibiotics are broadly used among respondents. The availability of antimicrobial susceptibility reports and a surveillance of antimicrobial use should be actively sought by intensivists where unavailable. Results of this survey may inform further research and educational activities.

Publication Date
2021-08-26
Online Publication Date
2021-08-26
Acceptance Date
2021-08-05
Keywords
Antibiotic, Antimicrobial stewardship, Critical care, Multiresistant bacteria, Therapeutic drug monitoring
Journal Title
Annals of Intensive Care
Journal ISSN
2110-5820
2110-5820
Volume Title
11
Publisher
Springer
Sponsorship
MRC (MR/V006118/1)
Wellcome Trust (205214/Z/16/Z)
MRC Clinician Scientist Fellowship (MR/V006118/1)