Interprofessional Therapeutic Drug Monitoring of Carbapenems Improves ICU Care and Guideline Adherence in Acute-on-Chronic Liver Failure

URN zum Zitieren dieses Dokuments:: urn:nbn:de:bvb:355-epub-552660
DOI zum Zitieren dieses Dokuments:: 10.5283/epub.55266

Schmid, Stephan

; Koch, ChiarA ; Zimmermann, Katharina ; Buttenschoen, Jonas ; Mehrl, Alexander ; Pavel, Vlad

; Schlosser-Hupf, Sophie ; Fleischmann, Daniel ; Krohn, Alexander ; Schilling, Tobias ; Müller, Martina ; Kratzer, Alexander

Lizenz: Creative Commons Namensnennung 4.0 International
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Veröffentlichungsdatum dieses Volltextes: 21 Dez 2023 13:19

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(1) Background: Acute-on-chronic liver failure (ACLF) is a severe, rapidly progressing
disease in patients with liver cirrhosis. Meropenem is crucial for treating severe infections. Therapeutic
drug monitoring (TDM) offers an effective means to control drug dosages, especially vital for
bactericidal antibiotics like meropenem. We aimed to assess the outcomes of implementing TDM for
meropenem using an innovative interprofessional approach in ACLF patients on a medical intensive
care unit (ICU). (2) Methods: The retrospective study was conducted on a medical ICU. The outcomes
of an interprofessional approach comprising physicians, hospital pharmacists, and staff nurses to
TDM for meropenem in critically ill patients with ACLF were examined in 25 patients. Meropenem
was administered continuously via an infusion pump after the application of an initial loading dose.
TDM was performed weekly using high-performance liquid chromatography (HPLC). Meropenem
serum levels, implementation of the recommendations of the interprofessional team, and meropenem
consumption were analyzed. (3) Results: Initial TDM for meropenem showed a mean meropenem
serum concentration of 20.9 � 9.6 mg/L in the 25 analyzed patients. Of note, in the initial TDM,
only 16.0% of the patients had meropenem serum concentrations within the respective target range,
while 84.0% exceeded this range. Follow-up TDM showed serum concentrations of 15.2 � 5.7 mg/L
(9.0–24.6) in Week 2 and 11.9 � 2.3 mg/L (10.2–13.5) in Week 3. In Week 2, 41.7% of the patients had
meropenem serum concentrations that were within the respective target range, while 58.3% of the
patients were above this range. In Week 3, 50% of the analyzed serum concentrations of meropenem
were within the targeted range, and 50% were above the range. In total, 100% of the advice given
by the interprofessional team regarding meropenem dosing or a change in antibiotic therapy was
implemented. During the intervention period, the meropenem application density was 37.9 recommended
daily doses (RDD)/100 patient days (PD), compared to 42.1 RDD/100 PD in the control
period, representing a 10.0% decrease. (4) Conclusions: Our interprofessional approach to TDM
significantly reduced meropenem dosing, with all the team’s recommendations being implemented.
This method not only improved patient safety but also considerably decreased the application density
of meropenem.

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