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1097. A Comparison of Area-Under Curve (AUC)-Guided vs Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-analysis

BACKGROUND: Trough levels have been used for Vancomycin (VAN) therapeutic drug monitoring (TDM) historically due to its practicality. A paradigm shift towards the use of area under curve (AUC)-guided dosing TDM has been made due to availability of advanced pharmacokinetics software, variability betw...

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Autores principales: Lim, Ashley Shiyuan, Seng, Jun Jie Benjamin, Ng, Tao Tao Magdeline, Chng, Hui Ting, Han, Zhe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8644319/
http://dx.doi.org/10.1093/ofid/ofab466.1291
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author Lim, Ashley Shiyuan
Seng, Jun Jie Benjamin
Ng, Tao Tao Magdeline
Chng, Hui Ting
Han, Zhe
author_facet Lim, Ashley Shiyuan
Seng, Jun Jie Benjamin
Ng, Tao Tao Magdeline
Chng, Hui Ting
Han, Zhe
author_sort Lim, Ashley Shiyuan
collection PubMed
description BACKGROUND: Trough levels have been used for Vancomycin (VAN) therapeutic drug monitoring (TDM) historically due to its practicality. A paradigm shift towards the use of area under curve (AUC)-guided dosing TDM has been made due to availability of advanced pharmacokinetics software, variability between trough levels and AUC values and the potential for reducing toxicity. This review aims to evaluate the impact of AUC-guided vs trough-guided vancomycin TDM on nephrotoxicity-related outcomes. METHODS: A systematic review was conducted using PubMed®, Embase®, Web of Science®, CINAHL®, Google scholar and Cochrane library® up till 1st January 2021 and was reported according to the PRISMA checklist. Studies which evaluated AUC-guided or trough-guided VAN TDM and vancomycin-associated nephrotoxicity were included. Random effects models were used to compare differences in nephrotoxicity between trough level or AUC based vancomycin TDM due to expected heterogeneity in study designs. PRISMA Flowchart [Image: see text] PRISMA flow chart depicting the selection process of studies included in the meta-analysis RESULTS: Of 1191 records retrieved, 57 studies were included. Majority of studies included adult and elderly patients (n=47, 82.5%). The pooled prevalence of nephrotoxicity was lower using the AUC-guided TDM [6.2%, 95% confidence interval (CI): 2.9 – 9.5%] compared to trough-guided TDM [17.0%; 95% CI: 14.7 – 19.2%]. The risk of nephrotoxicity was lower with the AUC-guided approach as compared with the trough-guided approach [OR: 0.53, 95% CI: 0.32–0.89]. AUC thresholds correlated with risk of nephrotoxicity only for the first 96 hours of therapy. A frequency analysis of significant multivariable factors showed that concomitant use of nephrotoxins, VAN trough levels and duration of VAN therapy were most commonly associated with nephrotoxicity. Forest plot comparing the risk of nephrotoxicity of AUC-guided vs trough-guided [Image: see text] Forest plot comparing the risk of nephrotoxicity of AUC-guided vs trough-guided Pooled nephrotoxicity rates from AUC-guided monitoring [Image: see text] Pooled nephrotoxicity rates from AUC-guided monitoring Pooled nephrotoxicity rates from trough-guided monitoring [Image: see text] Pooled nephrotoxicity rates from trough-guided monitoring CONCLUSION: The AUC-guided approach appeared to have lower risk of nephrotoxicity which supports the updated American Society of Health-System Pharmacists recommendations. More studies should be performed to evaluate the optimal derivation of AUC and clinical utility of repeated measurements of vancomycin AUC and trough levels. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-86443192021-12-06 1097. A Comparison of Area-Under Curve (AUC)-Guided vs Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-analysis Lim, Ashley Shiyuan Seng, Jun Jie Benjamin Ng, Tao Tao Magdeline Chng, Hui Ting Han, Zhe Open Forum Infect Dis Poster Abstracts BACKGROUND: Trough levels have been used for Vancomycin (VAN) therapeutic drug monitoring (TDM) historically due to its practicality. A paradigm shift towards the use of area under curve (AUC)-guided dosing TDM has been made due to availability of advanced pharmacokinetics software, variability between trough levels and AUC values and the potential for reducing toxicity. This review aims to evaluate the impact of AUC-guided vs trough-guided vancomycin TDM on nephrotoxicity-related outcomes. METHODS: A systematic review was conducted using PubMed®, Embase®, Web of Science®, CINAHL®, Google scholar and Cochrane library® up till 1st January 2021 and was reported according to the PRISMA checklist. Studies which evaluated AUC-guided or trough-guided VAN TDM and vancomycin-associated nephrotoxicity were included. Random effects models were used to compare differences in nephrotoxicity between trough level or AUC based vancomycin TDM due to expected heterogeneity in study designs. PRISMA Flowchart [Image: see text] PRISMA flow chart depicting the selection process of studies included in the meta-analysis RESULTS: Of 1191 records retrieved, 57 studies were included. Majority of studies included adult and elderly patients (n=47, 82.5%). The pooled prevalence of nephrotoxicity was lower using the AUC-guided TDM [6.2%, 95% confidence interval (CI): 2.9 – 9.5%] compared to trough-guided TDM [17.0%; 95% CI: 14.7 – 19.2%]. The risk of nephrotoxicity was lower with the AUC-guided approach as compared with the trough-guided approach [OR: 0.53, 95% CI: 0.32–0.89]. AUC thresholds correlated with risk of nephrotoxicity only for the first 96 hours of therapy. A frequency analysis of significant multivariable factors showed that concomitant use of nephrotoxins, VAN trough levels and duration of VAN therapy were most commonly associated with nephrotoxicity. Forest plot comparing the risk of nephrotoxicity of AUC-guided vs trough-guided [Image: see text] Forest plot comparing the risk of nephrotoxicity of AUC-guided vs trough-guided Pooled nephrotoxicity rates from AUC-guided monitoring [Image: see text] Pooled nephrotoxicity rates from AUC-guided monitoring Pooled nephrotoxicity rates from trough-guided monitoring [Image: see text] Pooled nephrotoxicity rates from trough-guided monitoring CONCLUSION: The AUC-guided approach appeared to have lower risk of nephrotoxicity which supports the updated American Society of Health-System Pharmacists recommendations. More studies should be performed to evaluate the optimal derivation of AUC and clinical utility of repeated measurements of vancomycin AUC and trough levels. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2021-12-04 /pmc/articles/PMC8644319/ http://dx.doi.org/10.1093/ofid/ofab466.1291 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Poster Abstracts
Lim, Ashley Shiyuan
Seng, Jun Jie Benjamin
Ng, Tao Tao Magdeline
Chng, Hui Ting
Han, Zhe
1097. A Comparison of Area-Under Curve (AUC)-Guided vs Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-analysis
title 1097. A Comparison of Area-Under Curve (AUC)-Guided vs Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-analysis
title_full 1097. A Comparison of Area-Under Curve (AUC)-Guided vs Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-analysis
title_fullStr 1097. A Comparison of Area-Under Curve (AUC)-Guided vs Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-analysis
title_full_unstemmed 1097. A Comparison of Area-Under Curve (AUC)-Guided vs Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-analysis
title_short 1097. A Comparison of Area-Under Curve (AUC)-Guided vs Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-analysis
title_sort 1097. a comparison of area-under curve (auc)-guided vs trough-guided monitoring of vancomycin and its impact on nephrotoxicity: a systematic review and meta-analysis
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8644319/
http://dx.doi.org/10.1093/ofid/ofab466.1291
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