Individualized Vancomycin Dosing with Therapeutic Drug Monitoring and Pharmacokinetic Consultation Service: A Large-Scale Retrospective Observational Study

Kim, Sangmi; Lee, Hyunseung; Hwang, Narae; Kim, Kyunga; Park, Hyung-Doo; Lee, Soo-Youn

doi:10.2147/dddt.s285488

Cited by 7 publications

(4 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11,[55][56][57] No study has reported a significant decrease in incidence. In some instances, this may be related to the therapeutic targets used by the different Services, with 2 studies focusing on attainment of trough concentrations, 58,59 which are inferior to AUC for guiding vancomycin dosing. While patient characteristics between pre-and postimplementation cohorts were not entirely the same, with more patients in the former group having had hypertension, been admitted to ICU, or administered concomitant sulfamethoxazole-trimethroprim, none of these were significant risk factors for VAN in the multivariate GEE model, thus would not have impacted the observed decrease in VAN incidence.…”

Section: Discussionmentioning

confidence: 99%

The Influence of a Therapeutic Drug Monitoring Service on Vancomycin‐Associated Nephrotoxicity

Yang,

Brett,

Sordo

et al. 2023

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Vancomycin's widespread use as the mainstay antibiotic against methicillin‐resistant Staphylococcus aureus infections is complicated by its narrow therapeutic index. Therapeutic drug monitoring (TDM) using area‐under the concentration curve (AUC)‐guided dosing is recommended to optimise therapy and prevent vancomycin‐associated nephrotoxicity (VAN). In 2018, a consultative TDM Advisory Service (the Service) was piloted at an Australian hospital to enable AUC‐guided vancomycin dosing. This study sought to compare the incidence of VAN pre‐ and post‐Service implementation. A 4‐year retrospective observational study of intravenous vancomycin therapy (>48 hours) in adults (≥18 years), spanning 3‐years pre‐ and 1‐year post‐implementation of the Service was undertaken. Nephrotoxicity was defined as an increase in serum creatinine concentrations of ≥26.5 μmol/L or ≥50% from baseline, on ≥2 consecutive days. Univariate analysis was performed to compare patients pre‐ and post‐implementation, and with and without VAN. Independent factors associated with VAN were identified using a multivariate model. In total, 971 courses of vancomycin therapy, administered to 781 patients, were included; 764 courses (603 patients) pre‐implementation and 207 courses (163 patients) post‐implementation. The incidence of VAN decreased by 5% post‐Service implementation [15% pre‐implementation vs 10% post‐implementation; p = 0.075). Independent factors associated with VAN were sepsis, heart failure, solid organ transplant, concomitant piperacillin‐tazobactam, and average vancomycin AUC during therapy. In conclusion, there was a non‐significant trend towards a reduced incidence of VAN after the Service. Larger, prospective studies are needed to confirm the efficacy of the Service.This article is protected by copyright. All rights reserved

show abstract

Section: Discussionmentioning

confidence: 99%

The Influence of a Therapeutic Drug Monitoring Service on Vancomycin‐Associated Nephrotoxicity

Yang,

Brett,

Sordo

et al. 2023

The Journal of Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Studies have shown that vancomycin TDM is necessary in elderly patients, children, critically ill patients with sepsis and those with renal impairment 12–14. In these studies, TDM significantly increased the rate of clinical efficacy and decreased the rate of nephrotoxicity in patients treated with vancomycin.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

ObjectiveThe objective of this study was to investigate the clinical efficacy and safety of conducting therapeutic drug monitoring (TDM) of vancomycin in patients with postoperative intracerebral haemorrhage.MethodsWe conducted a retrospective analysis of 435 patients who experienced postoperative cerebral haemorrhage and were treated with vancomycin in the Department of Neurosurgery of Inner Mongolia Autonomous Region People’s Hospital from January 2017 to December 2021. Patients were then matched using the propensity score matching method in a ratio of 1:1. Ninety-two pairs of cases were successfully matched, and the data before and after performing vancomycin TDM were analysed.ResultsAfter PSM, the baseline data of the two groups were balanced. There were no significant differences in the 14-day mortality and length of hospital stay (p>0.05) between the two groups. Compared with the non-TDM group, the TDM group had a higher proportion of patients with normal white blood cells (83.7% vs 56.5%, p=0.000), neutrophil count (57.6% vs 25.0%, p=0.000) and attaining desirable reductions of 80% in procalcitonin (65.2% vs 10.9%, p=0.000) and C-reactive protein (78.3% vs 41.3%, p=0.000) levels. At US$15.82 per additional TDM, TDM significantly promoted patient outcomes, as seen in improvements in the proportion of patients attaining desirable levels of white blood cells, neutrophil count, procalcitonin and C-reactive protein.ConclusionsVancomycin TDM is a safe and effective approach for the treatment of patients with postoperative intracerebral haemorrhage. The empirical use of TDM of vancomycin significantly improved normal values of white blood cells and neutrophil count, achieved desirable reductions of 80% in procalcitonin and C-reactive protein, and reduced nephrotoxicity in patients with postoperative intracerebral haemorrhage.

show abstract

“…Through consulting related literature, it is shown that individualized drug delivery may acquire the more effective and reasonable dose. 2 Vancomycin dosing in orthopaedics is a complex and multifactorial challenge in which orthopaedists, microbiologists, and clinical pharmacologists should all be involved to weigh the risks of prescribing vancomycin, determine the dose, and evaluate the effect.…”

mentioning

confidence: 99%

“…Through consulting related literature, it is shown that individualized drug delivery may acquire the more effective and reasonable dose. 2…”

mentioning

confidence: 99%

Letter to the Editor on “Vancomycin Powder Use in Fractures at High Risk of Surgical Site Infection”

Lou¹,

Zhao²,

Zhang³

2021

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

We read with great interest the article "Vancomycin Powder Use in Fractures at High Risk of Surgical Site Infection" by Rabah Qadir et al. 1 In addition to appreciating the author's efforts, we also pointed out some questions that we consider will contribute to the validity of this research. 1. Deep infection after treatment of high-energy fractures is a devastating complication. The initial data found by this study suggest that vancomycin powder might play a role in lowering the rate of surgical site infection after fracture fixation surgery. Dr Rabah Qadir provides a new antiinfection treatment idea for trauma orthopaedics. 2. Vancomycin is frequently used to treat staphylococcal infections resistant to beta-lactam antibiotics with the mode of administration being intravenous injection. However, the topical application of vancomycin in this study seems to be beyond the scope of the instructions. It is worth thinking about whether this method of use will cause the abuse of antibiotics or the appearance of unknown side effects or not? The author believes this method needs to be used cautiously. 3. Excessive exposure to vancomycin will increase the risk of nephrotoxicity. Regardless of the method of use, the author believes that the occurrence of complications should be described in detail while paying attention to the effect of the drug.

show abstract

Individualized Vancomycin Dosing with Therapeutic Drug Monitoring and Pharmacokinetic Consultation Service: A Large-Scale Retrospective Observational Study

Cited by 7 publications

References 66 publications

The Influence of a Therapeutic Drug Monitoring Service on Vancomycin‐Associated Nephrotoxicity

The Influence of a Therapeutic Drug Monitoring Service on Vancomycin‐Associated Nephrotoxicity

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

Letter to the Editor on “Vancomycin Powder Use in Fractures at High Risk of Surgical Site Infection”

Contact Info

Product

Resources

About