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Carbapenem Therapeutic Drug Monitoring in Critically Ill Adult Patients and Clinical Outcomes: A Systematic Review with Meta-Analysis

Drug monitoring is one strategy of antibiotic stewardship to face antimicrobial resistance. This strategy could have a determinant role in critically ill patients treated with carbapenems to overcome pharmacokinetic variability, reduce the risk of subtherapeutic dosage or toxicity, and reduce the ri...

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Autores principales: Lechtig-Wasserman, Sharon, Liebisch-Rey, Hans, Diaz-Pinilla, Nicolas, Blanco, Jhosep, Fuentes-Barreiro, Yuli-Viviana, Bustos, Rosa-Helena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916352/
https://www.ncbi.nlm.nih.gov/pubmed/33578672
http://dx.doi.org/10.3390/antibiotics10020177
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author Lechtig-Wasserman, Sharon
Liebisch-Rey, Hans
Diaz-Pinilla, Nicolas
Blanco, Jhosep
Fuentes-Barreiro, Yuli-Viviana
Bustos, Rosa-Helena
author_facet Lechtig-Wasserman, Sharon
Liebisch-Rey, Hans
Diaz-Pinilla, Nicolas
Blanco, Jhosep
Fuentes-Barreiro, Yuli-Viviana
Bustos, Rosa-Helena
author_sort Lechtig-Wasserman, Sharon
collection PubMed
description Drug monitoring is one strategy of antibiotic stewardship to face antimicrobial resistance. This strategy could have a determinant role in critically ill patients treated with carbapenems to overcome pharmacokinetic variability, reduce the risk of subtherapeutic dosage or toxicity, and reduce the risks inherent to treatment. However, the effectiveness of therapeutic drug monitoring (TDM) is unknown. This paper aims to identify TDM effectiveness in critically ill patients treated with carbapenems. English and ClinicalTrials.gov databases were searched to identify relevant studies evaluating carbapenem TDM. Randomized controlled trials (RCTs) and comparative cohort studies were selected for inclusion if they compared carbapenem TDM to standard care in adult critically ill or sepsis/septic shock patients. The primary outcome was mortality. Secondary outcomes included morbidity, clinical cure, microbiological eradication, antimicrobial resistance, drug-related side effects, and achievement of target plasma concentrations. Overall, performing carbapenem TDM was not associated with a decrease in mortality. However, it could be evidence for a relationship with clinical cure as well as target attainment. Some studies found favorable outcomes related to clinical and microbiological responses, such as lower procalcitonin levels at the end of the monitored therapy compared to standard care. For the primary and secondary outcomes analyzed, strong evidence was not identified, which could be due to the size, risk of bias, and design of selected studies.
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spelling pubmed-79163522021-03-01 Carbapenem Therapeutic Drug Monitoring in Critically Ill Adult Patients and Clinical Outcomes: A Systematic Review with Meta-Analysis Lechtig-Wasserman, Sharon Liebisch-Rey, Hans Diaz-Pinilla, Nicolas Blanco, Jhosep Fuentes-Barreiro, Yuli-Viviana Bustos, Rosa-Helena Antibiotics (Basel) Review Drug monitoring is one strategy of antibiotic stewardship to face antimicrobial resistance. This strategy could have a determinant role in critically ill patients treated with carbapenems to overcome pharmacokinetic variability, reduce the risk of subtherapeutic dosage or toxicity, and reduce the risks inherent to treatment. However, the effectiveness of therapeutic drug monitoring (TDM) is unknown. This paper aims to identify TDM effectiveness in critically ill patients treated with carbapenems. English and ClinicalTrials.gov databases were searched to identify relevant studies evaluating carbapenem TDM. Randomized controlled trials (RCTs) and comparative cohort studies were selected for inclusion if they compared carbapenem TDM to standard care in adult critically ill or sepsis/septic shock patients. The primary outcome was mortality. Secondary outcomes included morbidity, clinical cure, microbiological eradication, antimicrobial resistance, drug-related side effects, and achievement of target plasma concentrations. Overall, performing carbapenem TDM was not associated with a decrease in mortality. However, it could be evidence for a relationship with clinical cure as well as target attainment. Some studies found favorable outcomes related to clinical and microbiological responses, such as lower procalcitonin levels at the end of the monitored therapy compared to standard care. For the primary and secondary outcomes analyzed, strong evidence was not identified, which could be due to the size, risk of bias, and design of selected studies. MDPI 2021-02-10 /pmc/articles/PMC7916352/ /pubmed/33578672 http://dx.doi.org/10.3390/antibiotics10020177 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Lechtig-Wasserman, Sharon
Liebisch-Rey, Hans
Diaz-Pinilla, Nicolas
Blanco, Jhosep
Fuentes-Barreiro, Yuli-Viviana
Bustos, Rosa-Helena
Carbapenem Therapeutic Drug Monitoring in Critically Ill Adult Patients and Clinical Outcomes: A Systematic Review with Meta-Analysis
title Carbapenem Therapeutic Drug Monitoring in Critically Ill Adult Patients and Clinical Outcomes: A Systematic Review with Meta-Analysis
title_full Carbapenem Therapeutic Drug Monitoring in Critically Ill Adult Patients and Clinical Outcomes: A Systematic Review with Meta-Analysis
title_fullStr Carbapenem Therapeutic Drug Monitoring in Critically Ill Adult Patients and Clinical Outcomes: A Systematic Review with Meta-Analysis
title_full_unstemmed Carbapenem Therapeutic Drug Monitoring in Critically Ill Adult Patients and Clinical Outcomes: A Systematic Review with Meta-Analysis
title_short Carbapenem Therapeutic Drug Monitoring in Critically Ill Adult Patients and Clinical Outcomes: A Systematic Review with Meta-Analysis
title_sort carbapenem therapeutic drug monitoring in critically ill adult patients and clinical outcomes: a systematic review with meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916352/
https://www.ncbi.nlm.nih.gov/pubmed/33578672
http://dx.doi.org/10.3390/antibiotics10020177
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