Experience of Vancomycin Therapeutic Drug Monitoring in Two Multidisciplinary Hospitals in Latvia

Abstract

Background and Objectives: Management of infectious diseases is a huge burden to every healthcare system worldwide. Antimicrobial resistance, including antibacterial resistance, is an increasing problem worldwide; therefore, more new antibiotics are necessary to be discovered. Meanwhile, “old” antibacterial agents are still administered to fight infectious diseases caused by resistant bacteria. One of these antibacterial agents is vancomycin, which is effective in treating serious systemic infections caused by gram-positive bacteria. Thus, it is necessary to perform vancomycin concentration measurements in plasma due to its narrow therapeutic index. Various approaches are implemented for more precise therapy, including therapeutic drug monitoring (TDM) of vancomycin and with a supervision of a clinical pharmacist. The purpose of the study was to investigate if the TDM practice is improved with a local vancomycin TDM protocol applied in a hospital. The results of TDM in two multidisciplinary hospitals, one with a local TDM protocol implemented and applied and the other with no local TDM protocol implemented and applied, were compared. Materials and Methods: A retrospective study was performed in two multidisciplinary hospitals in Latvia. The data were collected for a time period of 4 years (2016–2020) in a hospital without a local TDM protocol and for a time period of 2 years (2018–2020) in a hospital with a local TDM protocol, starting with a period of time when the vancomycin TDM protocol was developed. The data about the patients included in the study were analyzed based on gender, age, body weight, and renal function. Vancomycin therapy was analyzed based on dosing schemes (vancomycin dose and dosing interval), data about loading and maintenance doses, vancomycin concentration, and details about vancomycin concentration (sampling time and concentration level). Results: Differences between the hospitals were found in terms of the initiation of vancomycin administration and concentration sampling. In the hospital with a TDM protocol compared with the hospital without a TDM protocol, more accurate initiation was found, alongside adaption of therapy (97.22% vs. 18.95%, p < 0.001), better performance of administration of a loading dose (22.73% vs. 1.29%, p < 0.01), and reaching of target concentration (55.56% vs. 35.29%, p < 0.01). Concentration sampling in the correct timeframe before the vancomycin dose and vancomycin administration did not show statistically better results in either of the hospitals (4.60% vs. 6.29%, p = 0.786). Conclusions: Better results of adequate adjustments of vancomycin therapy were achieved in the hospital with a TDM protocol. In the long term, sustainable results and regular medical professionals’ training is necessary.

Clinical benefits of therapeutic drug monitoring of vancomycin therapy in patients with postoperative intracerebral hemorrhage: a retrospective cohort study

“…In our study, after vancomycin treatment the proportion of patients in whom WBC and NEUT levels were reduced to normal was higher in the TDM group than in the non-TDM group (P WBC = 0.000, P NEUT = 0.000). This was consistent with the results of Maulina et al ,23 who found that hospitals implementing TDM protocols achieved better treatment outcomes than hospitals without TDM. Our results showed that more patients in the TDM group had a fall in PCT from the peak level of at least 80% than in the non-TDM group (65.2% vs 10.9%, p=0.000).…”

“…Our results showed that more patients in the TDM group had a fall in PCT from the peak level of at least 80% than in the non-TDM group (65.2% vs 10.9%, p=0.000). A retrospective case–control study showed that, in patients with severe infections, vancomycin TDM had a higher overall efficacy rate than non-TDM (95.16% vs 91.94%), with statistically significant PCT in the TDM group (p<0.05) 23. We also conducted an analysis of the reduction in CRP levels by at least >80% from the peak, amd found that more patients reached this threshold in the TDM group than in the non-TDM group (78.3% vs 41.3%, p=0.000).…”

Pharmacist-Managed Therapeutic Drug Monitoring Programs within Australian Hospital and Health Services—A National Survey of Current Practice

“…An effective and successful TDM process requires a multidisciplinary approach to provide an efficient service and ensure clinically meaningful drug concentrations are achieved [ 24 , 25 , 26 , 27 ]. This survey found medical officers were the most common member of the team involved in TDM within Australian hospitals, and were responsible for ordering pathology, as well as reviewing and interpreting the results.…”

Therapeutic drug monitoring of vancomycin in the real-world clinical practice of treating patients with deep suppuration after hip arthroplasty

“…Полученные результаты подтверждают необходимость рутинного проведения ТЛМ ванкомицина с одной стороны для достижения клинического эффекта, связанного с эрадикацией возбудителя, а с другой -для предотвращения высоких концентраций, сопряжённых с проявлением нефротоксичности. В исследовании [10] оценивали результаты внедрения ТЛМ ванкомицина. Исследование проводилось на базе двух многопрофильных больниц Латвии, в одной из которых был реализован и применялся локальный протокол ТЛМ, а в другой -ванкомицин назначался в стандартных режимах дозирования.…”