title: Impact of the introduction of real-time therapeutic drug monitoring on empirical doses of carbapenems in critically ill burn patients.
abstract: OBJECTIVE
  Adequate empirical antibiotic dose selection for critically ill burn patients is difficult due to extreme variability in drug pharmacokinetics. Therapeutic drug monitoring (TDM) may aid antibiotic prescription and implementation of initial empirical antimicrobial dosage recommendations. This study evaluated how gradual TDM introduction altered empirical dosages of meropenem and imipenem/cilastatin in our burn ICU.
  
  
  METHODS
  Imipenem/cilastatin and meropenem use and daily empirical dosage at a five-bed burn ICU were analyzed retrospectively. Data for all burn admissions between 2001 and 2011 were extracted from the hospital's computerized information system. For each patient receiving a carbapenem, episodes of infection were reviewed and scored according to predefined criteria. Carbapenem trough serum levels were characterized. Prior to May 2007, TDM was available only by special request. Real-time carbapenem TDM was introduced in June 2007; it was initially available weekly and has been available 4 days a week since 2010.
  
  
  RESULTS
  Of 365 patients, 229 (63%) received antibiotics (109 received carbapenems). Of 23 TDM determinations for imipenem/cilastatin, none exceeded the predefined upper limit and 11 (47.8%) were insufficient; the number of TDM requests was correlated with daily dose (r=0.7). Similar numbers of inappropriate meropenem trough levels (30.4%) were below and above the upper limit. Real-time TDM introduction increased the empirical dose of imipenem/cilastatin, but not meropenem.
  
  
  CONCLUSIONS
  Real-time carbapenem TDM availability significantly altered the empirical daily dosage of imipenem/cilastatin at our burn ICU. Further studies are needed to evaluate the individual impact of TDM-based antibiotic adjustment on infection outcomes in these patients.
authors: Service of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
authors: Anne
authors: A
authors: Fournier
authors: Service of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors: Philippe
authors: P
authors: Eggimann
authors: Service of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors: Jean-Luc
authors: JL
authors: Pagani
authors: Service of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors: Jean-Pierre
authors: JP
authors: Revelly
authors: Service of Biomedicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors: Laurent A
authors: LA
authors: Decosterd
authors: Service of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors: Oscar
authors: O
authors: Marchetti
authors: Service of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors: André
authors: A
authors: Pannatier
authors: Service of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
authors: Pierre
authors: P
authors: Voirol
authors: Service of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Electronic address: yok-ai.que@chuv.ch.
authors: Yok-Ai
authors: YA
authors: Que
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D001830:Body Surface Area; D002053:Burn Units; D002056:Burns / Q000150:complications / Q000473:pathology / Q000628:therapy*; D015780:Carbapenems / Q000008:administration & dosage / Q000097:blood; D015377:Cilastatin / Q000008:administration & dosage* / Q000097:blood; D000077728:Cilastatin, Imipenem Drug Combination; D015331:Cohort Studies; D003199:Computer Systems; D016638:Critical Illness; D004338:Drug Combinations; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage* / Q000097:blood; D007902:Length of Stay; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D012189:Retrospective Studies; D013845:Thienamycins / Q000008:administration & dosage* / Q000097:blood; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D004338:Drug Combinations; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination; D000077731:Meropenem
keywords: Burn; Carbapenems; Critical care; Infection; Therapeutic drug monitoring