Abstract
BackgroundAntibiotic exposure in intensive care patients with sepsis is frequently inadequate and is associated with poorer outcomes. Antibiotic dosing is challenging in the intensive care, as critically ill patients have altered and fluctuating antibiotic pharmacokinetics that make current one-size-fits-all regimens unsatisfactory. Real-time bedside dosing software is not available yet, and therapeutic drug monitoring is typically used for few antibiotic classes and only allows for delayed dosing adaptation. Thus, adequate and timely antibiotic dosing continues to rely largely on the level of pharmacokinetic expertise in the ICU. Therefore, we set out to assess the level of knowledge on antibiotic pharmacokinetics among these intensive care professionals.MethodsIn May 2018, we carried out a cross-sectional study by sending out an online survey on antibiotic dosing to more than 20,000 intensive care professionals. Questions were designed to cover relevant topics in pharmacokinetics related to intensive care antibiotic dosing. The preliminary pass mark was set by members of the examination committee for the European Diploma of Intensive Care using a modified Angoff approach. The final pass mark was corrected for clinical relevance as assessed for each question by international experts on pharmacokinetics.ResultsA total of 1448 respondents completed the survey. Most of the respondents were intensivists (927 respondents, 64%) from 97 countries. Nearly all questions were considered clinically relevant by pharmacokinetic experts. The pass mark corrected for clinical relevance was 52.8 out of 93.7 points. Pass rates were 42.5% for intensivists, 36.1% for fellows, 24.8% for residents, and 5.8% for nurses. Scores without correction for clinical relevance were worse, indicating that respondents perform better on more relevant topics. Correct answers and concise clinical background are provided.ConclusionsClinically relevant pharmacokinetic knowledge on antibiotic dosing among intensive care professionals is insufficient. This should be addressed given the importance of adequate antibiotic exposure in critically ill patients with sepsis. Solutions include improved education, intensified pharmacy support, therapeutic drug monitoring, or the use of real-time bedside dosing software. Questions may provide useful for teaching purposes.
Highlights
Antibiotic exposure in intensive care patients with sepsis is frequently inadequate and is associated with poorer outcomes
Despite the importance of antibiotic dosing, antibiotic exposure is well known to be frequently inadequate in intensive care patients [6,7,8]
In May 2018, we set up a cross-sectional study by sending out a questionnaire testing the level of knowledge on pharmacometric principles governing antibiotic dosing in the critically ill by electronic mail
Summary
Antibiotic exposure in intensive care patients with sepsis is frequently inadequate and is associated with poorer outcomes. Adequate and timely antibiotic dosing continues to rely largely on the level of pharmacokinetic expertise in the ICU. Sepsis management continues to rely on source control, supportive measures, and adequate antibiotic treatment. This includes adequate antibiotic dosing to prevent toxicity and inadequate exposure. Despite the importance of antibiotic dosing, antibiotic exposure is well known to be frequently inadequate in intensive care patients [6,7,8]. The DALI study showed that less than 50% of patients treated for infection with β-lactam antibiotics achieved their preferred pharmacokinetic target [8]. The rationale that underdosing leads to ineffective pathogen eradication seems probable for other antibiotics as well
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