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Impact of therapeutic drug monitoring of antibiotics in the management of infective endocarditis

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Abstract

Treatment of infective endocarditis (IE) is based on high doses of antibiotics with a prolonged duration. Therapeutic drug monitoring (TDM) allows antibiotic prescription optimization and leads to a personalized medicine, but no study evaluates its interest in the management of IE. We conducted a retrospective, bicentric, descriptive study, from January 2007 to December 2019. We included patients cared for IE, defined according to Duke’s criteria, for whom a TDM was requested. Clinical and microbiological data were collected after patients’ charts review. We considered a trough or steady-state concentration target of 20 to 50 mg/L. We included 322 IE episodes, corresponding to 306 patients, with 78.6% (253/326) were considered definite according to Duke’s criteria. Native valves were involved in 60.5% (185/306) with aortic valve in 46.6% (150/322) and mitral in 36.3% (117/322). Echocardiography was positive in 76.7% (247/322) of cases. After TDM, a dosage modification was performed in 51.5% (166/322) (decrease in 84.3% (140/166)). After initial dosage, 46.3% (82/177) and 92.8% (52/56) were considered overdosed, when amoxicillin and cloxacillin were used, respectively. The length of hospital stay was higher for patient overdosed (25 days versus 20 days (p = 0.04)), and altered creatinine clearance was associated with overdosage (p = 0.01). Our study suggests that the use of current guidelines probably leads to unnecessarily high concentrations in most patients. TDM benefits predominate in patients with altered renal function, but probably limit adverse effects related to overdosing in most patients.

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Funding

This study was carried out as part of our routine work.

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Authors and Affiliations

  1. Service de Maladies Infectieuses Et Tropicales, Centre Hospitalier Annecy Genevois, Annecy, France

    G. Macheda, M. Maillet & V. Tolsma

  2. Plateforme de Dosage Des Anti-Infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France

    N. El Helali & C. Mory

  3. Institut Micalis UMR 1319, Université Paris-Saclay, INRAeChâtenay Malabry, AgroParisTech, France

    G. Péan de Ponfilly, A. Le Monnier & B. Pilmis

  4. Service de Microbiologie Clinique, GH Paris Saint-Joseph, 75014, Paris, France

    G. Péan de Ponfilly & A. Le Monnier

  5. Laboratoire de Bactériologie, Département des Agents infectieux, CHU Saint Louis-Lariboisière-Fernand Widal, APHP, 75010, Paris, France

    G. Péan de Ponfilly & A. Le Monnier

  6. Service de Cardiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France

    M. Kloeckner & P. Garçon

  7. Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France

    B. Pilmis

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  1. G. Macheda
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  6. M. Maillet
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  7. V. Tolsma
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Correspondence to B. Pilmis.

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Macheda, G., El Helali, N., Péan de Ponfilly, G. et al. Impact of therapeutic drug monitoring of antibiotics in the management of infective endocarditis. Eur J Clin Microbiol Infect Dis 41, 1183–1190 (2022). https://doi.org/10.1007/s10096-022-04475-8

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