Abstract：
There is little evidence of antimicrobial elimination via therapeutic plasma exchange (TPE) and no guidelines for antimicrobial optimal dosing in patients undergoing TPE. We aimed to assess current practices and knowledge regarding antimicrobial management during TPE. A structured online survey was conducted from May to November 2023, and physicians were invited to participate through national scientific platforms and professional societies. One hundred five participants completed the survey, of whom 61% were infectious disease physicians, with 68.6% having more than 10 years of experience. That the TPE procedure could significantly affect plasma concentrations of antimicrobial agents was reported by 74.3% of the respondents. Among the physicians, 42.9% suggest antimicrobial dose adjustment, and 38.1% recommend temporarily discontinuing antimicrobial drug administration during TPE. Therapeutic drug monitoring was recommended by 33.3% of the respondents for certain antimicrobials, mainly glycopeptides and aminoglycosides, in patients undergoing concurrent TPE. Furthermore, 59.3% of physicians sometimes consult with another healthcare professional for treatment management, most commonly a pharmacist or a clinical pharmacist and an infectious diseases specialist. The core questions regarding potential drug-, procedure-, and patient-related antimicrobial elimination factors via TPE were responded to accurately by less than half of the physicians. It was clear that they had a lack of clinical practices and knowledge regarding antimicrobial management during TPE. To ensure the therapeutic efficacy of antimicrobials and avoid treatment failure, physicians should improve their practice strategies and consider antimicrobial elimination factors with TPE in this data-poor setting.
摘要：
几乎没有证据表明通过治疗性血浆置换（TPE）消除抗微生物剂，也没有关于TPE患者抗微生物剂最佳剂量的指南。我们旨在评估TPE期间有关抗菌药物管理的当前实践和知识。2023年5月至11月进行了结构化的在线调查，并通过国家科学平台和专业协会邀请医生参加。一百零五名参与者完成了调查，其中61%是传染病医生，68.6%的人有十年以上的经验。74.3％的受访者报告说，TPE程序可以显着影响抗菌药物的血浆浓度。在医生中，42.9%建议调整抗菌药物剂量，38.1%的人建议在TPE期间暂时停止抗菌药物管理。33.3%的受访者建议对某些抗菌药物进行治疗药物监测,主要是糖肽和氨基糖苷类，同时接受TPE的患者。此外，59.3％的医生有时会咨询其他医疗保健专业人员进行治疗管理，最常见的是药剂师或临床药剂师和传染病专家。关于潜在药物的核心问题-，不到一半的医生通过TPE对与手术和患者相关的抗菌消除因子做出了准确的反应。很明显，缺乏关于TPE期间抗菌管理的临床实践和知识。为了确保抗菌药物的治疗效果，避免治疗失败，医师应改进他们的实践策略,并在这种数据不足的情况下考虑TPE消除抗菌药物的因素.
