Effect of augmented renal clearance on the therapeutic drug monitoring of vancomycin in patients after neurosurgery

Abstract

Objective To study the effect of augmented renal clearance (ARC) on vancomycin therapeutic drug monitoring in patients undergoing neurosurgery. Methods A retrospective observational analysis was conducted in a neurosurgery department from January 2019 to June 2019. Patients undergoing vancomycin therapeutic drug monitoring were assigned to the normal renal function or ARC group. The baseline characteristics, vancomycin therapeutic drug monitoring data, and prognosis were compared and analyzed. Results In total, 104 patients were enrolled, including 78 and 26 patients in the normal renal function and ARC groups, respectively. There were significant differences in age, weight, creatinine clearance, the vancomycin treatment duration, the total dose, the trough concentration, and the trough concentration achievement rate between the two groups. Prognosis did not differ between the two groups. The trough concentration achievement rate in the ARC group was only 19.23%. Conclusion For young, obese, or otherwise healthy patients undergoing neurosurgery, attention should be paid to the possibility of ARC and the need for individualized dose adjustment based on the results of therapeutic drug monitoring.

Therapeutic drug monitoring of vancomycin in neurosurgery patients, from trough concentration to area under the curve: a retrospective single center cohort study in a tertiary hospital

“… 9 Regarding the dosing strategy for vancomycin in neurosurgery patients, its augmented clearance rate should be considered, and TDM should be performed as needed. Similar to a previous report, 10 in our study, approximately one-third (32.2%) of patients exhibited ARC. Therefore, the attainment rate of vancomycin TDM in this cohort was only 46.5%.…”

Population Pharmacokinetic Modeling and Dose Optimization of Vancomycin in Chinese Patients with Augmented Renal Clearance

“…Although different models have been implemented regarding vancomycin pharmacokinetics, little is known about the behavior in patients with ARC [17]. In observational cohort studies, a lower blood concentration has been described in patients with ARC [18,19]. Our model suggested between 1.3 and 2.1 times higher clearance in patients with ARC than in patients with normal kidney function.…”

Augmented Renal Clearance in Severe Infections—An Important Consideration in Vancomycin Dosing: A Narrative Review

“…When the CrCl was 130 ml/min, the estimated CL V was 9.37 L/h, which was relatively high, suggesting that ARC patients need to increase the dose. Chen et al (2020) reported that for infective patients after neurosurgery treated with vancomycin, Cmin was lower in the ARC group compared to the normal renal function group despite receiving a higher dose (6.45 mg/L vs. 10.72 mg/L; p < 0.001). The rate of achieving target Cmin was 41.03% in the normal renal function group compared to only 19.23% in the ARC group.…”

“…Moreover, observational studies have found that the incidence of ARC is higher in neurological diseases like traumatic brain injury (TBI) ( Dias et al, 2015 ; Udy et al, 2017a ), intracerebral hemorrhage (ICH) ( Morbitzer et al, 2019 ), and subarachnoid hemorrhage (SAH), which are 83.0–88.0%, 50.0%, and 94.0–100.0%, respectively. For CNS infections, ARC has an incidence of 25.0–47.0% in patients with bacterial meningitis (BM), ventriculitis, or neurosurgery ( Lautrette et al, 2012 ; Blassmann et al, 2019 ; Chen et al, 2020 ). ARC patients are more likely to be younger ( De Waele et al, 2015 ), and it can occur transiently or persist during hospitalization ( Udy et al, 2014 ; De Waele et al, 2015 ).…”