Evaluation of a Multi-disciplinary Medical Model in Vancomycin Treatment in Chinese Adult Patients: A Randomized Controlled Trial

Abstract

Background Acute kidney injury (AKI) is a common adverse drug reaction of vancomycin which is associated with increased mortality and morbidity. To investigate the roles of a multi-disciplinary medical model in preventing vancomycin-induced AKI (VI-AKI) through a standardized clinical path. Methods This study was a single center open-label randomized clinical trial which included adult pneumonia patients using vancomycin in Peking University First Hospital. In the intervention group (multi-disciplinary medical model), a standardized clinical path was conducted as (1) pharmacists-driven PopPK formula-based vancomycin regimen. (2) pharmacists-driven TDM monitor. (3) physicians-driven SCr monitor. (4) nephrologists-driven multi-disciplinary kidney protection. Pharmacists or nephrologists did not intervene patients; treatment in the control group (routine medical model). The primary outcome was the incidence of VI-AKI. Results145 patients including 72 in the intervention arm and 73 in the control arm, aged 69.0 (60.0-79.0) years with male in 74.5%, were included in the outcome analysis. The incidence of AKI was 23.6% (17/72) in the intervention arm and 34.2% (25/73) in the control arm (P=0.16). Among the 57 patients in the intervention arm who accepted PopPK based vancomycin regimen, AKI incidence was significantly decreased compared to patients in the control arm (15.8% vs. 34.2%, P=0.02). Conclusions Intervention with a multi-disciplinary medical model through standardized clinical path has the potential to reduce the incidence of VI-AKI. Multicenter and large sample size studies are warranted. This trial is registered with chictr.org (number ChiCTR1900021115, http://www.chictr.org.cn/edit.aspx?pid=35376&htm=4) on 29th Jan 2019 by retrospective registration.