1. Eur J Clin Microbiol Infect Dis. 2013 Jun;32(6):763-8. doi:
10.1007/s10096-012-1803-7. Epub 2012 Dec 28.

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

Buyle FM, Decruyenaere J, De Waele J, Tulkens PM, Van Audenrode T, Depuydt P,
Claeys G, Robays H, Vogelaers D.

Pharmacy Department, Ghent University Hospital, De Pintelaan, 185, 9000, Ghent,
Belgium, franky.buyle@uzgent.be.

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

PMID: 23271675  [PubMed - in process]