title: The ANTIBIOPERF study: a nationwide cross-sectional survey about practices for β-lactam administration and therapeutic drug monitoring among critically ill patients in France.
abstract: Our objective was to assess current practices about the administration (intermittent, extended, or continuous infusions) and therapeutic drug monitoring (TDM) of β-lactam antibiotics and vancomycin in France. We conducted a nationwide cross-sectional survey in May-August 2015, using an online questionnaire, sent as an e-mail link to infectious disease specialists and intensive care specialists through national mailing lists. We used clinical vignettes of critically ill patients to assess physicians' practices about administration and TDM practices for amoxicillin, cloxacillin, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, meropenem and vancomycin. In all, 507 physicians participated (507/1200, response rate 42%). TDM was rarely available for β-lactams (from 16.5% (81/490) for cloxacillin to 30% (145/490) for ceftazidime), whereas vancomycin TDM was available in 97% (477/490) of the cases. In the clinical vignettes, ceftazidime and piperacillin/tazobactam were the β-lactams administered most frequently by extended or continuous infusions (76% (336/440) and 57% (252/444), respectively). Gaps in knowledge about the duration of stability of intravenous β-lactams were common (correct answers ranged from 8% (35/432) for cloxacillin to 33% (146/438) for ceftazidime). Most physicians (77%, 339/442) were convinced of the value of extended or continuous infusions for β-lactams in critically ill patients, but 48% (211/442) did not have access to practical guidelines. Our survey found that most infectious disease and intensive care specialists are favourable to optimized administration of β-lactams in critically ill patients. But the lack of guidelines and limited TDM availability for β-lactams in hospitals are potential barriers to its implementation.
authors.affiliation: CHU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France; Université de Lorraine, Nancy, France.
authors.forename: A
authors.initials: A
authors.lastname: Charmillon
authors.affiliation: Université de Lorraine, Nancy, France; CHU de Nancy, Service de Réanimation Médicale Brabois, Nancy, France.
authors.forename: E
authors.initials: E
authors.lastname: Novy
authors.affiliation: CHU de Nancy, Inserm, CIC-1433 Epidémiologie Clinique, Nancy, France; Université de Lorraine, EA 4360 APEMAC, Nancy, France.
authors.forename: N
authors.initials: N
authors.lastname: Agrinier
authors.affiliation: Université de Marseille, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'anesthésie et de Réanimation, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Leone
authors.affiliation: CHU de Nancy, Service de Réanimation Médicale Brabois, Nancy, France; Université de Lorraine, Inserm U1116, Nancy, France.
authors.forename: A
authors.initials: A
authors.lastname: Kimmoun
authors.affiliation: CHU de Nancy, Service de Réanimation Médicale Brabois, Nancy, France; Université de Lorraine, Inserm U1116, Nancy, France.
authors.forename: B
authors.initials: B
authors.lastname: Levy
authors.affiliation: CHU de Nancy, Pharmacie de Brabois, Nancy, France; Université de Lorraine, SRSMC, UMR 7565, Nancy, France.
authors.forename: B
authors.initials: B
authors.lastname: Demoré
authors.affiliation: CHU de Nice, Service de réanimation médicale, Nice, France; Université de Nice Sophia Antipolis, INSERM 1065 team 3 'Metabolic Control of cell death' C3M Nice, Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Dellamonica
authors.affiliation: CHU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France; Université de Lorraine, EA 4360 APEMAC, Nancy, France; Antibiolor, Nancy, France. Electronic address: celine.pulcini@univ-lorraine.fr.
authors.forename: C
authors.initials: C
authors.lastname: Pulcini
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D016638:Critical Illness; D003430:Cross-Sectional Studies; D016903:Drug Monitoring / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011361:Professional Competence; D011795:Surveys and Questionnaires; D014640:Vancomycin / Q000008:administration & dosage; D047090:beta-Lactams / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D014640:Vancomycin
keywords: Antibiotic stewardship; Intensive care; Intravenous infusions; Pharmacodynamics; Pharmacokinetics; Questionnaire