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A survey of beta-lactam antibiotics and vancomycin dosing strategies in intensive care units and general wards in Belgian hospitals

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Extended and continuous infusions with beta-lactam antibiotics have been suggested as a means of pharmacokinetic and pharmacodynamic optimisation of antimicrobial therapy. Vancomycin is also frequently administered in continuous infusion, although more for practical reasons. A survey was undertaken to investigate the recommendations by the local antibiotic management teams (AMTs) in Belgian acute hospitals concerning the administration (intermittent, extended or continuous infusion) and therapeutic drug monitoring of four beta-lactam antibiotics (ceftazidime, cefepime, piperacillin–tazobactam, meropenem) and vancomycin for adult patients with a normal kidney function. A structured questionnaire survey comprising three domains was developed and approved by the members of the Belgian Antibiotic Policy Coordination Committee (BAPCOC). The questionnaire was sent by e-mail to the official AMT correspondents of 105 Belgian hospitals, followed by two reminders. The response rate was 32 %, with 94 %, 59 %, 100 %, 100 % and 100 % of the participating Belgian hospitals using ceftazidime, cefepime, piperacillin–tazobactam, meropenem and vancomycin, respectively. Comparing intensive care unit (ICU) with non-ICU wards showed a higher implementation of extended or continuous infusions for ceftazidime (81 % vs. 41 %), cefepime (35 % vs. 10 %), piperacillin–tazobactam (38 % vs. 12 %), meropenem (68 % vs. 35 %) and vancomycin (79 % vs. 44 %) on the ICU wards. A majority of the hospitals recommended a loading dose prior to the first dose. For vancomycin, the loading dose and the trough target concentration were too low based on the current literature. This survey shows that extended and continuous infusions with beta-lactams and vancomycin are widely implemented in Belgian hospitals.

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Notes

  1. The Belgian law provides that an AMT must be operating in each Belgian hospital where infectious diseases treatments are undertaken. AMTs have a mandatory role in the setting of hospital formularia and must intervene in the setting of local guidelines and analysis of local epidemiology.

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Acknowledgements

We thank the members of the Hospital Medicine Working Group of the Belgian Antibiotic Policy Coordination Committee (BAPCOC) for revising the content of the questionnaire and for providing the e-mail addresses of the official contact persons of the antibiotic management teams (AMTs) in Belgian hospitals.

We thank our colleagues from the AMTs in the participating hospitals for completing the questionnaire.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Pharmacy Department, Ghent University Hospital, De Pintelaan, 185, 9000, Ghent, Belgium

    F. M. Buyle & H. Robays

  2. Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan, 185, 9000, Ghent, Belgium

    J. Decruyenaere, J. De Waele & P. Depuydt

  3. Cellular and Molecular Pharmacology and Centre for Clinical Pharmacy, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium

    P. M. Tulkens

  4. Faculty of Pharmaceutical Sciences, Ghent University, Harelbekestraat, 72, 9000, Ghent, Belgium

    T. Van Audenrode

  5. Department of Microbiology, Ghent University Hospital, De Pintelaan, 185, 9000, Ghent, Belgium

    G. Claeys

  6. Department of General Internal Medicine, Infectious Diseases and Psychosomatic Medicine, Ghent University Hospital, De Pintelaan, 185, 9000, Ghent, Belgium

    D. Vogelaers

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  1. F. M. Buyle
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  2. J. Decruyenaere
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  3. J. De Waele
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  6. P. Depuydt
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  7. G. Claeys
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  8. H. Robays
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  9. D. Vogelaers
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Correspondence to F. M. Buyle.

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Buyle, F.M., Decruyenaere, J., De Waele, J. et al. A survey of beta-lactam antibiotics and vancomycin dosing strategies in intensive care units and general wards in Belgian hospitals. Eur J Clin Microbiol Infect Dis 32, 763–768 (2013). https://doi.org/10.1007/s10096-012-1803-7

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  • DOI: https://doi.org/10.1007/s10096-012-1803-7

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