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Evaluation of Real-World Vancomycin Dosing and Attainment of Therapeutic Drug Monitoring Targets
In 2020, the Infectious Diseases Society of America (IDSA) recommended a change in vancomycin therapeutic drug monitoring from trough-based to AUC/MIC-based to optimize vancomycin’s efficacy and reduce nephrotoxicity. Many hospitals have not implemented this change due to barriers such as the cost o...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10302851/ https://www.ncbi.nlm.nih.gov/pubmed/37368421 http://dx.doi.org/10.3390/pharmacy11030095 |
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author | Bradley, Nicole Ng, Kimberly |
author_facet | Bradley, Nicole Ng, Kimberly |
author_sort | Bradley, Nicole |
collection | PubMed |
description | In 2020, the Infectious Diseases Society of America (IDSA) recommended a change in vancomycin therapeutic drug monitoring from trough-based to AUC/MIC-based to optimize vancomycin’s efficacy and reduce nephrotoxicity. Many hospitals have not implemented this change due to barriers such as the cost of AUC/MIC software and lack of provider familiarity. The purpose of this study was to determine the rate of AUC/MIC ratio target attainment using current trough-based vancomycin dosing practices at a city hospital. The rates of acute kidney injury (AKI) were also evaluated. Vancomycin orders were reviewed retrospectively to determine the expected AUC/MIC ratios using first-order pharmacokinetic equations over a 7-month period. Orders were excluded if they were written for a one-time dose, for individuals less than 18 years of age, or for those on hemodialysis. A total of 305 vancomycin orders were included in this review. Overall, 27.9% (85/305) of vancomycin orders attained the AUC/MIC ratio target of 400–600 mg·h/L as recommended by the guidelines. Nearly 35% (106/305) achieved AUC/MIC ratios below 400 mg·h/L and 37.4% (114/305) achieved AUC/MIC ratios above 600 mg·h/L. Orders for obese patients were significantly more likely to have below the target AUC/MIC ratios (68% vs. 23.9%, X(2) 48.48, p < 0.00001) and non-obese patients were significantly more likely to have above the target AUC/MIC ratios (45.7% vs. 12%, X(2) 27.36, p < 0.00001). The overall rate of acute kidney injury observed was 2.6%. Most vancomycin orders did not attain therapeutic drug monitoring targets, reflecting the ongoing clinical challenge of optimizing vancomycin doses and implementing new guideline recommendations. |
format | Online Article Text |
id | pubmed-10302851 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-103028512023-06-29 Evaluation of Real-World Vancomycin Dosing and Attainment of Therapeutic Drug Monitoring Targets Bradley, Nicole Ng, Kimberly Pharmacy (Basel) Brief Report In 2020, the Infectious Diseases Society of America (IDSA) recommended a change in vancomycin therapeutic drug monitoring from trough-based to AUC/MIC-based to optimize vancomycin’s efficacy and reduce nephrotoxicity. Many hospitals have not implemented this change due to barriers such as the cost of AUC/MIC software and lack of provider familiarity. The purpose of this study was to determine the rate of AUC/MIC ratio target attainment using current trough-based vancomycin dosing practices at a city hospital. The rates of acute kidney injury (AKI) were also evaluated. Vancomycin orders were reviewed retrospectively to determine the expected AUC/MIC ratios using first-order pharmacokinetic equations over a 7-month period. Orders were excluded if they were written for a one-time dose, for individuals less than 18 years of age, or for those on hemodialysis. A total of 305 vancomycin orders were included in this review. Overall, 27.9% (85/305) of vancomycin orders attained the AUC/MIC ratio target of 400–600 mg·h/L as recommended by the guidelines. Nearly 35% (106/305) achieved AUC/MIC ratios below 400 mg·h/L and 37.4% (114/305) achieved AUC/MIC ratios above 600 mg·h/L. Orders for obese patients were significantly more likely to have below the target AUC/MIC ratios (68% vs. 23.9%, X(2) 48.48, p < 0.00001) and non-obese patients were significantly more likely to have above the target AUC/MIC ratios (45.7% vs. 12%, X(2) 27.36, p < 0.00001). The overall rate of acute kidney injury observed was 2.6%. Most vancomycin orders did not attain therapeutic drug monitoring targets, reflecting the ongoing clinical challenge of optimizing vancomycin doses and implementing new guideline recommendations. MDPI 2023-06-06 /pmc/articles/PMC10302851/ /pubmed/37368421 http://dx.doi.org/10.3390/pharmacy11030095 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Brief Report Bradley, Nicole Ng, Kimberly Evaluation of Real-World Vancomycin Dosing and Attainment of Therapeutic Drug Monitoring Targets |
title | Evaluation of Real-World Vancomycin Dosing and Attainment of Therapeutic Drug Monitoring Targets |
title_full | Evaluation of Real-World Vancomycin Dosing and Attainment of Therapeutic Drug Monitoring Targets |
title_fullStr | Evaluation of Real-World Vancomycin Dosing and Attainment of Therapeutic Drug Monitoring Targets |
title_full_unstemmed | Evaluation of Real-World Vancomycin Dosing and Attainment of Therapeutic Drug Monitoring Targets |
title_short | Evaluation of Real-World Vancomycin Dosing and Attainment of Therapeutic Drug Monitoring Targets |
title_sort | evaluation of real-world vancomycin dosing and attainment of therapeutic drug monitoring targets |
topic | Brief Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10302851/ https://www.ncbi.nlm.nih.gov/pubmed/37368421 http://dx.doi.org/10.3390/pharmacy11030095 |
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