Observational studyCritical care (London, England)2022
Expert clinical pharmacological advice may make an antimicrobial TDM program for emerging candidates more clinically useful in tailoring therapy of critically ill patients.
Observational study in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
45 citing papers in PubMed, 2 syntheses or guidelines pooled it, 95 citations in OpenAlex.
- Impact of attaining aggressive vs. conservative PK/PD target on the clinical efficacy of beta-lactams for the treatment of Gram-negative infections in the critically ill patients: a systematic review and meta-analysis.Critical care (London, England) · 2024Pooled it
- Pooled it
- Article
- Personalizing beta-lactams therapy in critical patients undergoing RRT: moving a further step forward?Intensive care medicine · 2026Article
- Voriconazole pseudotoxicity: a case report highlighting the importance of sampling timing in TDM interpretation by clinical pharmacists.Frontiers in medicine · 2026Article
- Next-generation hybrid bioanalytical platforms and clinical integration of TDM technologies for precision monitoring to optimize last-resort antibiotic therapy.Frontiers in pharmacology · 2026Review
- New Antibiotics Against Multidrug-Resistant Gram-Negative Bacteria in Lung Transplantation: Clinical Evidence, Safety, and PK/PD Properties.Transplant international : official journal of the European Society for Organ Transplantation · 2026Review
- Raising the Bar of PK/PD Target Attainment of Beta-Lactams in Daily Clinical Practice: An Effective Strategy to Overcome Resistance Development to Novel Beta-Lactams?Infectious disease reports · 2025Article
- Validation of a predictive risk score of aggressive PK/PD target non-attainment with continuous infusion piperacillin/tazobactam or meropenem in critically ill patients having documented Gram-negative infections.Journal of anesthesia, analgesia and critical care · 2025Article
- Diagnosis and management of invasive candidiasis in critically ill patients: SIAARTI multidisciplinary statement.Journal of anesthesia, analgesia and critical care · 2025Review
- Utility of a TDM-Guided Expert Clinical Pharmacological Advice Program for Optimizing the Use of Novel Beta-Lactam/Beta-Lactamase Inhibitor Combinations and Cefiderocol in a Tertiary University Hospital: An Interim Analysis.Therapeutic drug monitoring · 2025Article
- TDM-Based Approach for Properly Managing Intravenous Isavuconazole Treatment in a Complex Case Mix of Critically Ill Patients.Antibiotics (Basel, Switzerland) · 2025Article
- Antibiotic Therapy Duration for Multidrug-Resistant Gram-Negative Bacterial Infections: An Evidence-Based Review.International journal of molecular sciences · 2025Review
- A pre-post quasi-experimental study of antimicrobial stewardship exploring the impact of a multidisciplinary approach aimed at attaining an aggressive joint pharmacokinetic/pharmacodynamic target with ceftazidime/avibactam on treatment outcome of KPC-producingAntimicrobial agents and chemotherapy · 2025Article
- Effective Management of a Skin and Soft Tissue Infection Caused by Community-Acquired MRSA Through Triple-Targeted Therapy Along with Aggressive Source Control: A Case Report.Infectious disease reports · 2025Article
- Therapeutic Drug Monitoring of Antimicrobial Drugs in Children with Cancer: A New Tool for Personalized Medicine.Paediatric drugs · 2025Review
- Therapeutic Drug Monitoring-Guided Linezolid Therapy for the Treatment of Multiple Staphylococcal Brain Abscesses in a 3-Month-Old Infant.Pathogens (Basel, Switzerland) · 2024Article
- Cefiderocol in Combating Carbapenem-ResistantBiomedicines · 2024Review
- Biliary pharmacokinetic/pharmacodynamic analysis of continuous infusion meropenem/vaborbactam in a case series of orthotopic liver transplant recipients.The Journal of antimicrobial chemotherapy · 2024Article
- Adverse events during intravenous fosfomycin therapy in a real-life scenario. Risk factors and the potential role of therapeutic drug monitoring.BMC infectious diseases · 2024Article
Corrections and comments
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Authors and funding
13 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTherapeutic drug monitoring (TDM) may represent an invaluable tool for optimizing antimicrobial therapy in septic patients, but extensive use is burdened by barriers. The aim of this study was to assess the impact of a newly established expert clinical pharmacological advice (ECPA) program in improving the clinical usefulness of an already existing TDM program for emerging candidates in tailoring antimicrobial therapy among critically ill patients.
methodsThis retrospective observational study included an organizational phase (OP) and an assessment phase (AP). During the OP (January-June 2021), specific actions were organized by MD clinical pharmacologists together with bioanalytical experts, clinical engineers, and ICU clinicians. During the AP (July-December 2021), the impact of these actions in optimizing antimicrobial treatment of the critically ill patients was assessed. Four indicators of performance of the TDM-guided real-time ECPA program were identified [total TDM-guided ECPAs July-December 2021/total TDM results July-December 2020; total ECPA dosing adjustments/total delivered ECPAs both at first assessment and overall; and turnaround time (TAT) of ECPAs, defined as optimal (< 12 h), quasi-optimal (12-24 h), acceptable (24-48 h), suboptimal (> 48 h)].
resultsThe OP allowed to implement new organizational procedures, to create a dedicated pathway in the intranet system, to offer educational webinars on clinical pharmacology of antimicrobials, and to establish a multidisciplinary team at the morning bedside ICU meeting. In the AP, a total of 640 ECPAs were provided for optimizing 261 courses of antimicrobial therapy in 166 critically ill patients. ECPAs concerned mainly piperacillin-tazobactam (41.8%) and meropenem (24.9%), and also other antimicrobials had ≥ 10 ECPAs (ceftazidime, ciprofloxacin, fluconazole, ganciclovir, levofloxacin, and linezolid). Overall, the pre-post-increase in TDM activity was of 13.3-fold. TDM-guided dosing adjustments were recommended at first assessment in 61.7% of ECPAs (10.7% increases and 51.0% decreases), and overall in 45.0% of ECPAs (10.0% increases and 35.0% decreases). The overall median TAT was optimal (7.7 h) and that of each single agent was always optimal or quasi-optimal.
conclusionsMultidisciplinary approach and timely expert interpretation of TDM results by MD Clinical Pharmacologists could represent cornerstones in improving the cost-effectiveness of an antimicrobial TDM program for emerging TDM candidates.
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