Intensivists’ practices and perceptions regarding β-lactam prescribing and monitoring in intensive care units: a cross-sectional survey

BACKGROUND: Prolonged β-lactam infusion and therapeutic drug monitoring (TDM) are recommended to optimize target attainment in critically ill patients, but implementation varies, and Middle Eastern data are scarce. This study assessed intensivists' practices, beliefs, and perceptions regarding β-lactam administration and TDM in intensive care units (ICUs) in Kuwait. METHODS: A cross-sectional study was conducted among intensivists in adult, pediatric, and neonatal ICUs across public hospitals using a validated questionnaire. Descriptive and multivariable regression analyses were performed. RESULTS: Of 348 intensivists invited, 212 responded (61%). Intermittent infusion predominated for cephalosporins (91%), cloxacillin (84%), and piperacillin-tazobactam/meropenem (81%). Piperacillin-tazobactam/meropenem extended infusion was reported by 60%, while continuous infusion was rare (<10%). Loading doses for severe infections were more frequent with intermittent infusion (68%) than extended (39%) or continuous (9%). Experience > 10 years predicted greater use of intermittent infusion and loading doses; neonatal ICU respondents were less likely to use prolonged infusions or loading doses. Beliefs toward prolonged infusion were neutral or uncertain (median 3.0), whereas perceptions of TDM were generally positive (median 4.0), both lower in pediatric ICUs. CONCLUSIONS: Intermittent infusion remains dominant. Practices vary by experience and ICU type, underscoring the need for national protocols, targeted education, and TDM implementation to strengthen stewardship.