633
KLINICKÁ341804301074588109168189242288347
FARMAKOLOGIE709804301074291138211265312372415474533554598
A13288043010753
FARMACIE1403804301074191138210265316336380
/18298043010732
Klin190680430107446583131
Farmakol2057804301074278105179220258305325
Farm2402804301074178104179
2023;37(3):86-882601804301074386128172186230270290333354368412457486532577
/32238043010731
www.klinickafarmakologie.cz4568804301076513320121425327329234035839843647950254457164568672477179183988990895196610061045
861828026012657116
EDITORIAL341207012655130163222297362395465520
The34136501063071103
importance46036501061569103144180212248289324356
of83236501063869
a917365010637
fast-track97036501062967101133158186222264297333
pharmacology131836501063374114149204245278317348387427465
for179836501062970106
the192036501062971103
proper203836501063368109144176212
management226536501065293134174212243298330371403
of268436501063869
antibiotic276936501063879111129165183223254272306
therapy309136501063071103139181215252
in335936501061556
intensive34313650106155688120162194211250281
care372836501063374110142
units38853650106398098130162
The3409910298132270395
importance78499102986527041254963973085699511011225
of20579910298139220
a23259910298127
fast-track25009910298822073093954685536457688741003
pharmacology3552991029814328340749670182693210671132126914081534
for3401251029882219309
the6971251029888229354
proper109912510298144234371513639729
management1877125102982063324705957338581064118913291414
of334012510298138219
antibiotic3608125102981262653504155576227588459101017
therapy46731251029888229354445569710830
in3401511029866204
intensive5931511029866204289414554656720846967
care160815110298109234323449
units210515110298140280343429533
Dario3401938013777134176206269
Cattaneo1,6311938013766124163205264328386450107419470803611081938013729
Jessica11591938013745103151199229278337
Cusato2151819380137651271752342743371853194708036
1Department3402099078333712092013373129191244280319410465526561
of955209201336192
Infectious1071209201332686118172222261285345406448
Diseases,1543209201337399141196248291346389412
ASST19782092013367122174229
Fatebenefratelli22312092013353101137190253309369424457493546581635661686711
Sacco29652092013354107156204262
University32512092013371131156208262297341366402456
Hospital,37312092013371132175237262298351377399
Milan,41532092013388114139192252274
Italy4451209201332662115140192
2Laboratory3402249078333732242013352106168229265318353412448503
of899224201336192
Clinical1014224201336489114174199248301326
Pharmacology13632242013359118170206297350399457483543605657
and20442242013353113175
Pharmacogenetics,22422242013359118170206297350399457519574635690726751800844867
Department31322242013373129191245280319410465526561
of3717224201336091
Medical38322242013388144206231280333358
Sciences,42142242013354103128182243292346389412
University46492242013371131156209262298342366402457
of5129224201336092
Turin,52442242013355108143169229251
Amedeo3402392013367158214276331392
di755239201336287
Savoia8662392013354107158216242294
Hospital,11832392013372133175237263299352377399
Turin,16062392013354107143168228251
Italy1880239201332662115141192
Introduction3402830014732101143186254325394448493524592661
Multidrug-resistant4803001010972122144174195246276326377406437482518539574605649699729
(MDR)1230300101092697157206231
organisms1483300101094979130173223244280355390
are1894300101094473118
common340314101094191168245296348
in714314101092273
patients814314101095297128149196248278316
in1156314101092273
intensive1255314101092273103149201237259304349
care1631314101094186116163
units18203141010950102124155192
(ICU)34032810109264699157182
(1).54232810109256887104
As666328101095592
a7773281010944
result,840328101093075111160182212231
these1091328101092979125161207
patients1317328101095296125147192243272309
have1645328101095094136181
substantial1845328101093685137340342101093666111161190211255276
mortality6323421010975125155188232253274305350
rates998342101092973103148184
(40–65%),1198342101092569117165215260330353370
particularly1584342101095296125158179220269291334364385428
if340356101092149
they415356101093081128171
have613356101095095138183
a8233561010944
high893356101095172124175
severity1094356101093783127173204226257303
of1423356101095077
illness152735610109214365116162199236
score,1789356101093678128158204223
sepsis340370101093681133169190225
and584370101094494145
septic748370101093682133163185225
shock992370101093686136177219
(2,123037010109267189
3).133937010109466986
Given480384101095982127173225
this732384101093082104140
background,899384101095297139183234265316367419472491
immediate1417384101092199176223277299343374420
and1864384101094496148
appropriate340398101094496149179230282313335379409455
antibiotic821398101094394124146198220271301323364
therapy1211398101093081128158203255298
–15353981010946
defined1607398101095197125149200247300
as1933398101094380
timely340412101093153132180203249
commencement620412101094293172250299351394441520568621652
of1304412101095179
pharmacologic14154121010953106152183262308351402425478532555597
treatment340426101093059105148178253299350379
with736426101096688118168
appropriate921426101094395146176226278308329373402447
spectrum1385426101093687133175207236287362
for1764426101092676106
the1887426101093080125
pathogen(s)340440101095297127178228281327378404439462
–8284401010946
is900440101092157
mandatory9834401010976120171223268298348378425
to1433440101093180
improve1539440101092298150181231275320
the1885440101093081127
clinical34045410109406182131152192236257
outcome612454101094999129168216291336
of964454101094975
ICU1055454101092174131
patients1202454101095194123144189239268305
(4).152245410109266992109
Antibiotic16474541010955104133154205226275305326366
therapy340468101093080126155200251293
for655468101092776106
ICU784468101092174132
patients938468101095196125146192242272309
is1269468101092156
initially134846810109217192122143186208229272
empirical,16424681010945121172194224245286330351370
but3404821010952102133
it499482101092152
is576482101092257
revised659482101093075119141177223276
when9614821010966117164215
the1201482101093081127
results1354482101093075112162183214251
of1631482101095077
the1733482101093081127
microbiological1886482101097697340496101094171121174196246269319372393434479501
tests867496101093076112143181
are1074496101094474120
available.1219496101094487132153175219272294340359
Previously,1604496101094978124168190241291328349393408
results340510101092973107155176204240
were5955101010965108137181
obtained790510101094999128171191240284334
in1139510101092169
48–961223510101094592137182228
hours1466510101094997146174210
after1690510101094368100143172
collection1877510101093987108340524101092165105136157205254
of609524101094874
specimens,698524101093584129170190263308357391409
however,1122524101094998162205247290319333
in1470524101092170
recent1554524101092973113157206234
years,1803524101094185127156191210
a3405381010943
number398538101094998171222267296
of709538101094975
novel799538101094998140183204
technologies1019538101092973113162211260281330380401445480
for1514538101092675104
the1633538101092978123
microbiological1771538101097495134163211340552101095173123145195246267308352374
diagnosis737552101095172115166216266302323358
of1118552101095076
infections121855210109217197143184216237287338373
have1614552101095094136181
been1818552101095198144194
developed,340566101095095138182203253304349401419
providing775566101095180129171192243264313363
results1154566101092973109158179208244
in1414566101092170
a15005661010943
shorter1558566101093585134163196240269
time1843566101092950124169
frame34058010109265598171215
compared570580101094087161210253282326376
with961580101096585114163
conventional1139580101093986135176219268297317365414456477
diagnostic1630580101095070112162210259293323343382
approaches340594101094394145175224268308357403438
(5,79459410109256987
6).89759410109456986
They999594101094495140182
include1197594101092170111132181232277
multiplex14895941010975124145175196247268314356
polymerase186159410109511011233406081010942118163193237272318
chain674608101094089133153203
reaction893608101092974118158190211260310
(PCR),1219608101092673125173198215
matrix-assisted14506081010974118147177198240266310345380401436467511563
laser34062210109216397141170
desorption525622101094994128177206256285305353402
ionization942622101092068117138175219247267315364
time-of-flight1321622101092949122167196246272297323346366416464493
mass18286221010974116150184
spectrometry340636101093584129169200229276350394424452496
(MALDI-TOF850636101092694148190248269298337397440
MS)13046361010971114138
and1456636101094391141
lateral161163610109216391135163206226
flow185263610109254897161
assays340650101094377111154194228
or583650101094877
immuno-chromatographic674650101092194167215264312341383431459507581623651699748777819869918938977
methods.16666501010973118147195243294328346
These340664101094596142178224
technological590664101093075116166217267289339391412453497519
improvements1135664101092196148178228271316391437488518555
opened17156641010950102149199245297
the340678101092979124
era479678101094574118
of612678101094975
„fast-track702678101093258102137167192222251294334376
microbiology”,1093678101097495135164213264285334355405455498531544
a16526781010943
concept1711678101093987137177221272301
firstly34069210109264978114144165207
introduced56269210109217199128177228277317360411
by989692101095092
Mulatero10966921010971121141184213257286335
et1446692101094575
al.153669210109436482
in1634692101092170
20111719692101094690132169
(6).190469210109256992108
He21402861010959106
proposed2273286101095182132185237273320373
the2672286101093081128
following2826286101092677100121172239262313364
definition:3217286101095198125150201222253275325377395
“fast3639286101093261106142174
microbiology2140300101097596137167216268289339361411463506
is2667300101092156
based2744300101095196131177229
on29943001010949100
a31153001010943
premise3179300101095181126202223258304
of3504300101095076
faster3601300101092671106137182212
results,2140314101092974110159180209246265
reducing2421314101092974125174215236285336
the2772314101093080125
time2913314101092950125170
needed3099314101095095141192238289
for3404314101092675105
a35253141010943
result,3584314101092974109158179209228
to2140328101093079
allow224432810109446586137203
earlier2472328101094589119140161207237
and2734328101094494146
optimized29053281010949101132153228249288334386
patient3316328101095196125147192243272
management”.361432810109751191692140342101094497144221269320351388401
There2568342101094598145176223
is2817342101092258
no29023421010951102
universal30313421010950102124169215246284330352
consensus3410342101094191143179227279315366402
on21403561010949100
the2259356101093080125
definition2403356101095197124148198219249270320371
of2793356101094975
‘fast’,288735610109194792127158180193
but30993561010951101131
it3249356101092252
is3320356101092156
reasonable3395356101092975118154204254298349371417
to2140370101093080
describe2245370101095298134175205227279326
it2597370101092152
as2674370101094480
obtaining27803701010950102133177199249271321373
the3179370101093080126
result3331370101093076112162184214
within3571370101096789119170191242
a21403841010943
working22023841010967116146189211261312
day2533384101095195136
shift2688384101093686107134167
(i.287438410109254665
e.2950384101094564
830333841010946
h).309838410109507390
Pharmacologic21404090014767135196239342403457524556624694726780
issues2947409001473181131199262312
of21404230014768107
antibiotics22744230014761130172202273305373415446500552
in28534230014731100
ICU29804230014732104183
patients31904230014771132174205268337379430
Beyond2280440101095098142193246299
microbiology,26064401010978100142173225279302353377429482527543
successful3176440101093788131172219256293322375397
treatment360044010109316210915518621404541010975121171201
of2365454101094976
severe2464454101093682125169199245
infections273245410109217198143185217238288338374
in3129454101092171
ICU3224454101092275132
is3380454101092156
based3460454101095195131177229
on37124541010950100
a21404681010943
proper2204468101095181130182229258
antimicrobial2483468101094393123144219240281310360412433477498
stewardship3001468101093667112178222251302338388409460
program3481468101095282131182212256331
(7).2140482101092673100118
This2284482101094699120157
includes2467482101092273116138189241288325
the2819482101093082129
selection2975482101093683106153196229251302354
of3356482101095077
the3460482101093082129
most36154821010977129165197
appropriate2140496101094395147177226278308330373403447
antibiotic2610496101094393122144195217266296317358
agent(s),2990496101094495140191220246280303320
ensuring3332496101094596131180210232282333
the3687496101093080125
adequate2140510101094496143196246291321367
exposure,2533510101094589142194230281311357376
whilst29355101010967119140162198230
taking3191510101093075119142193245
into3462510101092172102152
consideration36415101010940901422140524101093656108153183227256277327377
both25335241010951102132182
pathophysiologic2731524101095195124174224276326367403424474496545597618658
changes3405524101094090134184234280316
of3737524101094975
ICU2140538101092174132
patients2288538101095196125146192242272309
and2613538101094393144
physicochemical27745381010951101143179200240289330380426501523563607629
properties3419538101095181130182228258291312358393
of2140552101094976
the2234552101093080126
antimicrobial2378552101094393123144219240281311360412433477498
agent(s)2894552101094495140191220246280303
administered3215552101094395170191241262298328373403448500
to3733552101093079
reach2140566101092973116156205
optimal2360566101094999129149223266286
pharmacokinetic/pharmacodynamic266256610109501001421712462883283764184404895345635846236567047547968259009429821030108111232140580101095094169190231
(PK/PD)2390580101092573121156205264288
targets2697580101093074103154200230267
(8–10).2983580101092670118159201226243
Indeed,2280594101092274127174222276297
a26065941010943
basic2678594101095298135158200
understanding29075941010950102155203234273306352404457480532585
of3521594101094977
PK3627594101094898
is3754594101092158
important2140608101092199153206239273320373404
for2574608101092779111
clinicians271560810109406487140163206229275327365
when31096081010967120169221
prescribing3360608101095284132170213245269323346399452
drugs.2140622101095081132183220240
This2399622101094496118155
is2572622101092157
particularly2648622101095196127160182224274297341372395439
true3105622101093061111158
for3282622101092676107
antibiotics3408622101094394124147199221272303325367405
since2140636101093658110152198
under-dosing23586361010949101154201233260315366403426478530
may29076361010975121164
result3090636101092976114165188219
in3329636101092173
treatment3421636101093061108153184261308360391
failure,214065010109267092114164194240259
increasing2416650101092171112142188232268289340391
the2824650101092980125
likelihood296765010109214385130153174224274325377
of3362650101094875
the3455650101092979125
development35986501010950961391842140664101092173126203250302333
of2492664101094977
antimicrobial2589664101094394125148224247289320371424448492515
resistance3124664101092976113135172205250302344390
(9).353366410109267197116
The3668664101094497144
achievement2140678101094385135158204248294370417468499
of2657678101094977
optimal27536781010949101132155231275298
antibiotic3070678101094394124146199222272303326367
exposure3456678101094588141193229280310356
is2140692101092158
difficult2218692101095174103134160202254277309
in2547692101092173
clinical264069210109416486138161204250273
practice2933692101095183129171205228271317
because32706921010951100143189240277325
most36156921010975127165197
of3940286101094978
these4043286101092981129167214
drugs4282286101095182134187224
are4531286101094375122
administered4678286101094396173196248271308341387419466520
according5223286101094385127177209262285337389
to3940300101093081
standard4048300101093568114166219264296348
dosing44233001010951103140163215268
regimens.4718300101092976129153230277330367388
They5133300101094598145189
do53493001010951103
not54793001010950102133
take3940314101093076120166
into4128314101092173105155
account4306314101094385127177229281313
pathophysiologic4641314101095197128180232286338381419442493517569622645688
and/or5351314101094395148182230261
iatrogenic3940328101092168100132185239287341364408
factors4378328101092674117152204236276
that4684328101093083129162
are4875328101094577125
likely503032810109214590137162207
to5267328101093182
affect5379328101094473106154198233
the3940342101093082129
PK4095342101094898
in4219342101092172
ICU4317342101092277136
patients.4479342101095197129152199251283321343
This4848342101094497120157
makes50313421010975121165211249
the5306342101092981129
management546134210109751203940356101095095148195273321373404
of4373356101094978
antibiotic4480356101094395126149202226277309332374
therapy4883356101093082129161207260304
extremely5216356101094590124156203280328351396
challenging3940370101094195142166190239293347371425479
in4450370101092175
these4555370101093184133172221
patients48073701010952100133156205259292332
(9,516937010109267493
10).5292370101094793121140
The54633701010946100149
main39403841010977125149203
effects4174384101094677110159204240280
of4485384101095181
altered4596384101094570103151185234290
pathophysiology49173841010952100133187241297351397436460514539593648695
in3940398101092276
ICU4047398101092279141
patients42203981010953101134158207262295335
on45873981010951105
the4724398101093084134
antibiotics4889398101094599132156212236290323348392432
PK53533981010949101
are5486398101094477126
summarized3940412101093687164241286318341382429483
in4445412101092173
Table4541412101094585138162209
1.4773412101094663
Therapeutic39404370014763133195239300371434503545576630
drug45984370014769113181251
monitoring:487643700147102170240270313380424455524593621
analytical39404510014761130191222283329360414476508
aspects44754510014761111182245300345396
Therapeutic4080468101094699147179226280328381413436479
drug4587468101095284136190
monitoring48054681010977130183205238289321344397450
(TDM)5284468101092676139215241
is5554468101092159
the3940482101093080126
clinical408448210109406283134156197241263
practice4365482101095181126167200222263308
of4690482101094977
measuring47844821010975121165201251281303354405
drugs5207482101095080131182218
with5443482101096688119169
the3940496101093081127
aim4087496101094365141
of4247496101095077
optimizing43434961010950103134156232254294316367419
the4781496101093081127
individual4928496101092172124146191213266316361383
dosage53304961010951102138184236282
regimens.3940510101092976128150226273324360381
This4344510101094597119155
approach4522510101094395148179229274316367
is4912510101092157
usually4992510101095086136181203225269
adopted5284510101094396146199230276329
in3940524101092174
patients4042524101095298130153200253284323
treated4393524101093062109155186233287
with4708524101096891123175
narrow4911524101095197128160212280
therapeutic5219524101093183131162208262310363394053810109305395
index4063538101092274127174219
drugs,4310538101095283135188225246
such4584538101093687130182
as4794538101094481
the4903538101093082129
aminoglycoside506153810109441211441962483013243694104614985213940552101095197
antibiotics.4064552101094394125147199222272303325367405425
However,45165521010958110177222267312343359
there4901552101093081128159205
is5133552101092157
increasing5217552101092172113144190234271293344395
evidence3940566101094589112164211262304349
of4315566101094976
TDM44175661010945106180
use4623566101094986132
for4781566101092677108
drugs4914566101095181132184221
with5160566101096689120171
a53565661010944
wide5425566101096689141188
therapeutic3940580101093184134167215270320374407431475
index,4454580101092276131180227250
especially4743580101094786141191236260307331355402
in5184580101092276
the5299580101093084134
ICU5472580101092279141
setting.3940594101093684116150172224277298
Nevertheless,42665941010960108153199231265317364388435473510531
in4825594101092173
order4926594101095082135182214
to5168594101093081
consider5277594101094191144181203256304335
TDM39406081010945108182
clinically415060810109406385137159201247270292337
useful,4514608101095087134163215238258
validated4800608101094389111134187232263309362
bioanalytical51906081010952741261722232682913353703923940622101094085108
assays4074622101094380116161204241
with4341622101096689120171
a45386221010943
rapid4607622101093075127150202
turnaround4835622101093080111163207237288339390442
time5303622101093052128175
for5504622101092677108
the3940636101093081127
quantification40916361010951102146197228250277302344389419441492543
of4658636101095077
anti-infective4759636101094495125147177200251278325367400422467513
drugs5296636101095081132184220
in5540636101092172
biological3940650101095173123145196247269310354376
matrices43336501010975119149179201242286323
are4673650101094373118
essential.4809650101094481117163213243265308330350
Historically,5176650101095880116147196227249290334356378421436
the3940664101093081127
analytical4085664101094495139162206240261303348370
approach4474664101094395148179229274316367
for4859664101092677108
TDM49856641010945107180
in5183664101092172
serum5274664101093582113164240
or5532664101095081
plasma3940678101095276121159237282
used4251678101095087135189
gas4469678101095197134
chromatography4631678101094194125176255300332383437468514568621664
or5323678101095182
high5434678101095173126179
performance39406921010953102135166219252331378431475522
liquid449369210109214599152175230
chromatography4753692101094194126179258305337389444476523577631675
(LC)5459692101092671124153
Dario34574070955288112129173
Cattaneo53574070954683107135172215255298
PharmD,85174070954082119143209261273
PhD114274070954083135
Department34575270955292136174197225291331374398
of76175270954264
Infectious8437527095176081120157184201244287317
Diseases,11777527095527099139175205244275289
ASST148475270954785122161
Fatebenefratelli16627527095377095133177218261300322347384409447464481498
Sacco217775270953775111146188
University238275270955093110147186210240257282320
Hospital,272075270955094124168185211248265279
Milan,30167527095638097133176190
Italy3224752709517427996132
dario.cattaneo@unimi.it34576470954480104121164178214252276304341384423467526569612629695712726744769
Cit.42277407095466388103
zkr:43477407095336792108
Klin44727407095405976118
Farmakol46087407095377094160197231274291
Farm49177407095377094160
2023;37(3):86-88509574070953977115154167206243261299318331371411437478518
Článek46147527095466399142182216
přijat48477527095456986103139164
redakcí:502875270952462107144178213230243
24.52897527095397589
7.539575270953946
2023545975270953977114154