Abstract
Introduction
Selective decontamination of the digestive tract (SDD) is a strategy in mechanically ventilated patients to reduce mortality. Treatment consists of enterally administered non-absorbable antibiotics, i.e., tobramycin. However, most intensive care unit (ICU) patients with SDD appear to have detectable tobramycin serum concentrations. The Rijnstate Hospital implemented a protocol for therapeutic drug monitoring (TDM) of tobramycin in patients at risk. The aim of this study was to evaluate the necessity of TDM in these patients and to optimize the current protocol.
Methods
This retrospective observational study included ICU patients with SDD treatment for ≥ 7 days and renal failure. These patients were considered eligible for monitoring of tobramycin. Tobramycin serum concentrations, relevant laboratory parameters (i.e., renal function, lactate), and patient data were extracted from the National Intensive Care Evaluation database and the hospital electronic patient data system.
Results
In 23 subjects, a total of 43 tobramycin serum concentrations was determined. The median tobramycin serum concentration was 0.33 (IQR 0.17–0.49) mg/L of which 12 (27.9%) samples had concentrations < 0.2 mg/L, 30 (69.8%) had concentrations 0.2–1.0 mg/L and 1 (2.3%) had a toxic concentration > 1.0 mg/L. In 3 (7.0%) cases, an intervention was conducted based on the tobramycin serum concentration.
Conclusion
The majority (83.7%) of samples had detectable tobramycin serum concentrations. Monitoring of tobramycin serum concentrations can be considered necessary in patients at risk. However, the current protocol should be optimized to intercept patients more precise.
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Authors and Affiliations
Contributions
J.E. Möhlmann PharmD. Collected the data, analyzed the results and wrote the paper.
M. van Luin PharmD PhD. Second supervisor. Contributed to paper with text and comments. Co-inventor of the analyzed TDM protocol.
E.M. Mascini MD PhD. Contributed to the paper with text and comments. Co-inventor of the analyzed TDM protocol.
H.J. van Leeuwen MD PhD. Contributed to the paper with text and comments. Co-inventor of the analyzed TDM protocol. Provided guidance during internship at the department of Intensive Care.
M.R. de Maat PharmD PhD. First supervisor. Contributed to the papier with text and comments. Co-inventor of the analyzed TDM protocol.
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The authors declare that they have no conflict of interest.
Ethical approval for research involving human participants, informed consent
This study was approved by the local medical ethical review board of the Rijnstate Hospital. Requirement of informed consent was waived for this retrospective study since determination of tobramycin serum concentrations was part of routine care in selected patients within the SDD regimen.
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Data availability
The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Möhlmann, J.E., van Luin, M., Mascini, E.M. et al. Monitoring of tobramycin serum concentrations in selected critically ill patients receiving selective decontamination of the digestive tract: a retrospective evaluation. Eur J Clin Pharmacol 75, 831–836 (2019). https://doi.org/10.1007/s00228-019-02644-x
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DOI: https://doi.org/10.1007/s00228-019-02644-x