Abstract:
BACKGROUND: Therapeutic drug monitoring (TDM) is an effective method for individualising antimicrobial therapy in critically ill patients. The 2021 ADMIN-intensive care unit survey studied a wide range
of intensive care unit clinicians worldwide to gain their perspectives on antimicrobial TDM. This article
reports the responses from this survey relating to TDM access, utilisation, and barriers.
METHODS: An online survey consisted of multiple-choice questions and 5-point Likert scales. The survey
examined respondent’s access to minimum inhibitory concentration (MIC) results, drug assays, and dosing
software, as well as barriers to TDM.
RESULTS: The survey included 538 clinicians from 409 hospitals in 45 countries, with 71% physicians and
29% pharmacists. Despite most respondents having access to assays, 21% and 26% of respondents lacked
access to vancomycin and aminoglycosides, respectively. In lower-income countries, almost 40% reported
no access. Delayed drug assay turnaround time was the most significant barrier to TDM, particularly in
lower-income countries. Routine access to MIC results was unavailable for 41% of respondents, with 25%
of lower-income country respondents having no access to MIC or susceptibility reports.
CONCLUSIONS: This global survey indicated that consistent TDM usage is hindered by assay access in some
sites and the timeliness of assay results in others. Addressing barriers to TDM, particularly in low-income
countries, should be a priority to ensure equitable access to affordable TDM.
