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Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases 9/2022

19.08.2022 | Original Article

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

verfasst von: G. Macheda, N. El Helali, G. Péan de Ponfilly, M. Kloeckner, P. Garçon, M. Maillet, V. Tolsma, C. Mory, A. Le Monnier, B. Pilmis

Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases | Ausgabe 9/2022

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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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Metadaten
Titel
Impact of therapeutic drug monitoring of antibiotics in the management of infective endocarditis
verfasst von
G. Macheda
N. El Helali
G. Péan de Ponfilly
M. Kloeckner
P. Garçon
M. Maillet
V. Tolsma
C. Mory
A. Le Monnier
B. Pilmis
Publikationsdatum
19.08.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Clinical Microbiology & Infectious Diseases / Ausgabe 9/2022
Print ISSN: 0934-9723
Elektronische ISSN: 1435-4373
DOI
https://doi.org/10.1007/s10096-022-04475-8

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