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

• Published in: International journal of antimicrobial agents 2024-08, Vol.64 (2), p.107192, Article 107192
• Main Authors: Williams, Paul, Cotta, Menino Osbert, Tabah, Alexis, Sandaradura, Indy, Kanji, Salmaan, Scheetz, Marc H., Imani, Sahand, Elhadi, Muhammed, Pardos, Sònia Luque, Schellack, Natalie, Sanches, Cristina, Timsit, Jean Francois, Xie, Jiao, Farkas, Andras, Wilks, Kathryn, Roberts, Jason A., Brinkmann, Alexander, Ramanan, Mahesh, Koulenti, Despoina, Gurjar, Mohan, Sulaiman, Helmi, Shrestha, Gentle S., Cortegiani, Andrea, Crespo, Monica, Ling, Lowell, Abidi, Khalid, Schellongowski, Peter
• Format: Article
• Language: English
• Subjects: Antimicrobial; Barriers; Intensive care units; Life Sciences; Survey; Therapeutic drug monitoring
• ISSN: 0924-8579; 1872-7913; 1872-7913; 0924-8579
• DOI: 10.1016/j.ijantimicag.2024.107192

•Therapeutic drug monitoring use is limited to a narrow number of antimicrobials.•Delayed drug assay results are a significant barrier to therapeutic drug monitoring.•Minimum inhibitory concentration are results unavailable for 41% of respondents.•Equitable access to therapeutic drug monitoring should be a global priority. 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. 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. 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. 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. [Display omitted]