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Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults
We aimed to evaluate the predictive performance and predicted doses of a single-model approach or several multi-model approaches compared with the standard therapeutic drug monitoring (TDM)-based vancomycin dosing. We performed a hospital-wide monocentric retrospective study in adult patients treate...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9320266/ https://www.ncbi.nlm.nih.gov/pubmed/35890354 http://dx.doi.org/10.3390/pharmaceutics14071459 |
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author | Gastmans, Heleen Dreesen, Erwin Wicha, Sebastian G. Dia, Nada Spreuwers, Ellen Dompas, Annabel Allegaert, Karel Desmet, Stefanie Lagrou, Katrien Peetermans, Willy E. Debaveye, Yves Spriet, Isabel Gijsen, Matthias |
author_facet | Gastmans, Heleen Dreesen, Erwin Wicha, Sebastian G. Dia, Nada Spreuwers, Ellen Dompas, Annabel Allegaert, Karel Desmet, Stefanie Lagrou, Katrien Peetermans, Willy E. Debaveye, Yves Spriet, Isabel Gijsen, Matthias |
author_sort | Gastmans, Heleen |
collection | PubMed |
description | We aimed to evaluate the predictive performance and predicted doses of a single-model approach or several multi-model approaches compared with the standard therapeutic drug monitoring (TDM)-based vancomycin dosing. We performed a hospital-wide monocentric retrospective study in adult patients treated with either intermittent or continuous vancomycin infusions. Each patient provided two randomly selected pairs of two consecutive vancomycin concentrations. A web-based precision dosing software, TDMx, was used to evaluate the model-based approaches. In total, 154 patients contributed 308 pairs. With standard TDM-based dosing, only 48.1% (148/308) of all of the second concentrations were within the therapeutic range. Across the model-based approaches we investigated, the mean relative bias and relative root mean square error varied from −5.36% to 3.18% and from 24.8% to 28.1%, respectively. The model averaging approach according to the squared prediction errors showed an acceptable bias and was the most precise. According to this approach, the median (interquartile range) differences between the model-predicted and prescribed doses, expressed as mg every 12 h, were 113 [−69; 427] mg, −70 [−208; 120], mg and 40 [−84; 197] mg in the case of subtherapeutic, supratherapeutic, and therapeutic exposure at the second concentration, respectively. These dose differences, along with poor target attainment, suggest a large window of opportunity for the model-based TDM compared with the standard TDM-based vancomycin dosing. Implementation studies of model-based TDM in routine care are warranted. |
format | Online Article Text |
id | pubmed-9320266 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-93202662022-07-27 Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults Gastmans, Heleen Dreesen, Erwin Wicha, Sebastian G. Dia, Nada Spreuwers, Ellen Dompas, Annabel Allegaert, Karel Desmet, Stefanie Lagrou, Katrien Peetermans, Willy E. Debaveye, Yves Spriet, Isabel Gijsen, Matthias Pharmaceutics Article We aimed to evaluate the predictive performance and predicted doses of a single-model approach or several multi-model approaches compared with the standard therapeutic drug monitoring (TDM)-based vancomycin dosing. We performed a hospital-wide monocentric retrospective study in adult patients treated with either intermittent or continuous vancomycin infusions. Each patient provided two randomly selected pairs of two consecutive vancomycin concentrations. A web-based precision dosing software, TDMx, was used to evaluate the model-based approaches. In total, 154 patients contributed 308 pairs. With standard TDM-based dosing, only 48.1% (148/308) of all of the second concentrations were within the therapeutic range. Across the model-based approaches we investigated, the mean relative bias and relative root mean square error varied from −5.36% to 3.18% and from 24.8% to 28.1%, respectively. The model averaging approach according to the squared prediction errors showed an acceptable bias and was the most precise. According to this approach, the median (interquartile range) differences between the model-predicted and prescribed doses, expressed as mg every 12 h, were 113 [−69; 427] mg, −70 [−208; 120], mg and 40 [−84; 197] mg in the case of subtherapeutic, supratherapeutic, and therapeutic exposure at the second concentration, respectively. These dose differences, along with poor target attainment, suggest a large window of opportunity for the model-based TDM compared with the standard TDM-based vancomycin dosing. Implementation studies of model-based TDM in routine care are warranted. MDPI 2022-07-13 /pmc/articles/PMC9320266/ /pubmed/35890354 http://dx.doi.org/10.3390/pharmaceutics14071459 Text en © 2022 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 | Article Gastmans, Heleen Dreesen, Erwin Wicha, Sebastian G. Dia, Nada Spreuwers, Ellen Dompas, Annabel Allegaert, Karel Desmet, Stefanie Lagrou, Katrien Peetermans, Willy E. Debaveye, Yves Spriet, Isabel Gijsen, Matthias Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults |
title | Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults |
title_full | Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults |
title_fullStr | Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults |
title_full_unstemmed | Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults |
title_short | Systematic Comparison of Hospital-Wide Standard and Model-Based Therapeutic Drug Monitoring of Vancomycin in Adults |
title_sort | systematic comparison of hospital-wide standard and model-based therapeutic drug monitoring of vancomycin in adults |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9320266/ https://www.ncbi.nlm.nih.gov/pubmed/35890354 http://dx.doi.org/10.3390/pharmaceutics14071459 |
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