The equity gap in precision dosing: a cross-sectional analysis of hospital-wide antimicrobial therapeutic drug monitoring implementation
Abstract
BACKGROUND: Therapeutic Drug Monitoring (TDM) is pivotal for optimizing antimicrobial efficacy and managing drug-resistant infections. However, its real-world implementation patterns, particularly the heterogeneity in initial hospital-wide application within large Chinese general hospitals, have not been systematically evaluated.
METHODS: This retrospective study was conducted in a representative Chinese tertiary hospital to assess its hospital-wide antimicrobial TDM program launched in June 2024. The analysis included 2,316 plasma drug concentration measurements from 1,928 inpatients between October and December 2024, primarily evaluated based on trough concentrations.
RESULTS: The study revealed significant inter-departmental heterogeneity in TDM implementation. Utilization was high in intensive care units (e.g., EICU: 91.95%) and infection-related departments, but critically low in non-intensive care settings (e.g., Pediatrics: 0%). Overall, only 50.3% of drug concentrations were within the therapeutic range, with time-dependent antimicrobials (e.g., piperacillin attainment: 31.47%) performing significantly worse than concentration-dependent agents (e.g., moxifloxacin attainment: 86.09%). Subtherapeutic concentrations were predominantly clustered in hematology patients, while supratherapeutic concentrations were concentrated in ICUs. The study also demonstrated the inadequacy of a trough concentration-based monitoring strategy for addressing the complex pharmacokinetics…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
Read the paper
Related studies
- Synthesis, In Vitro and In Silico Molecular Docking Studies of Novel Phthalimide–Pyrimidine Hybrid Analogues to Thalidomide as Potent Antitubercular Agents
- Exploring the inhibitory performance of expired moxifloxacin and norfloxacin on copper corrosion in saline environment
- Molecular investigation of antimicrobial peptides against Helicobacter pylori proteins using a peptide-protein docking approach
- Screening of novel narrow-spectrum benzofuroxan derivatives for the treatment of multidrug-resistant tuberculosis through in silico, in vitro, and in vivo approaches
- Synthesis, Characterization, Anticancer, Antioxidant, and In Silico Evaluation of Semicarbazides and Thiosemicarbazides
- Fast and accurate prediction of drug induced proarrhythmic risk with sex specific cardiac emulators
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.