Implementing a pharmacist-managed personalized medicine dosing protocol for beta-lactam antibiotics in critically ill patients: a prospective observational pilot study.

Aim 1: Describe beta-lactam target attainment (% T>MIC) for current standard of care beta-lactam dosing in critically ill septic patients. Hypothesis 1: Current standard dosing strategies of beta-lactam antibiotics are not optimized based on patient-specific factors of clearance. Aim 2: Develop and validate a pharmacist-led dosing protocol utilizing a therapeutic drug monitoring program (TDM) for beta-lactam antibiotics (cefepime, meropenem, aztreonam and piperacillin-tazobactam) in critically ill septic patients. Hypothesis 2: A pharmacist-led personalized medicine dosing protocol utilizing TDM of beta-lactam antibiotics will increase the number of dosage adjustments based on TDM levels, increase pharmacokinetic/pharmacodynamics (PK/PD) target attainment and reduce toxicity in critically ill patients with sepsis. Aim 3: Develop and validate novel prediction models for development of nephrotoxic acute kidney injury (AKI) in critically ill septic patients. Hypothesis 3: Novel prediction models incorporating biomarkers of tubular injury will increase early detection of antibiotic-related nephrotoxic AKI with clinical prediction scores in critically ill septic patients.