Predictive performance of reported vancomycin population pharmacokinetic model in patients with different renal function status, especially those with augmented renal clearance

Yu, Yanxia; Lü, Jian; Lu, Haodi; Li, Lan; Li, Jingjing; Shi, Lu; Duan, Lufen; Zhuang, Zhiwei; Xue, Song; Shen, Yi; Tang, Lian

doi:10.1136/ejhpharm-2020-002477

Cited by 12 publications

(16 citation statements)

References 25 publications

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“…Similarly, augmented renal function is common in critical care settings, leading to increased vancomycin elimination. [7][8][9][10][11] Conversely, in sepsis, 12 edema, and fluid overload, an increase in volume of distribution and/or the presence of acute kidney injury result in a decrease in clearance of vancomycin. 13 Furthermore, the use of mechanical support systems, such as renal replacement therapies 14,15 and cardiopulmonary bypass, 16 are also known to influence drug disposition.…”

Section: If and How To Perform Tdm (Preanalytical I)mentioning

confidence: 99%

Optimal Practice for Vancomycin Therapeutic Drug Monitoring: Position Statement From the Anti-infectives Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology

Reuter

Stocker

Alffenaar

et al. 2022

Therapeutic Drug Monitoring

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Individualization of vancomycin dosing based on therapeutic drug monitoring (TDM) data is known to improve patient outcomes compared with fixed or empirical dosing strategies. There is increasing evidence to support area-under-the-curve (AUC 24 )-guided TDM to inform vancomycin dosing decisions for patients receiving therapy for more than 48 hours. It is acknowl-edged that there may be institutional barriers to the implementation of AUC 24 -guided dosing, and additional effort is required to enable the transition from trough-based to AUC 24 -based strategies. Adequate documentation of sampling, correct storage and transport, accurate laboratory analysis, and pertinent data reporting are required to ensure appropriate interpretation of TDM data to guide vancomycin dosing recommendations. Ultimately, TDM data in the clinical context of the patient and their response to treatment should guide vancomycin therapy. Endorsed by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology, the IATDMCT Anti-Infectives Committee, provides recommendations with respect to best clinical practice for vancomycin TDM.

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Section: If and How To Perform Tdm (Preanalytical I)mentioning

confidence: 99%

Optimal Practice for Vancomycin Therapeutic Drug Monitoring: Position Statement From the Anti-infectives Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology

Reuter

Stocker

Alffenaar

et al. 2022

Therapeutic Drug Monitoring

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“…Por otro lado, un valor de MAPE de 28.16% también pudo considerarse como clínicamente adecuado 24 . Asimismo, el R 2 también mostró, considerando un ámbito clínico, una buena correlación entre los valores de valle predichos y observados 25 . En resumen, en el marco de la atención clínica, los valores de RMSE, MAPE, y R 2 reflejaron una buena relación entre concentraciones predichas y observadas.…”

Section: Discussionunclassified

evaluación de desempeño del servicio de dosificación de precisión para vancomicina en un hospital pediátrico de nivel terciario

Guido

Licciardone

Riva

et al. 2022

Rev Fac Cien Med Univ Nac Cordoba

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Introducción: La dosificación de precisión a través del monitoreo de vancomicina basado en sus concentraciones plasmáticas (vancocinemia) es una práctica recomendada en el tratamiento de infecciones pediátricas de alta complejidad para aumentar la probabilidad de lograr una farmacoterapia segura y eficaz. Objetivo: Evaluar retrospectivamente las actividades y el desempeño relacionado a la optimización farmacoterapéutica basada en las vancocinemias (período 2007-2020) de un hospital pediátrico terciario. Métodos: Se analizaron las vancocinemias de pacientes pediátricos, estimándose indicadores de calidad asistencial y verificaciones analíticas, así como también aspectos relacionados a docencia e investigación. Se evaluó el desempeño predictivo de las concentraciones de vancomicina cuando se ajustaron los regímenes terapéuticos con un programa de optimización farmacocinética (BestDose v1.126) considerando el coeficiente de determinación (R2), el error porcentual absoluto medio (MAPE) y la raíz del error cuadrático medio (RMSE). Resultados: Se analizaron 13269 vancocinemias. El 70% fueron valles y el 81% pertenecieron a pacientes de Unidades de Cuidados Intensivos. El 40% de los valles se encontró dentro del margen terapéutico al ajustarse sin programa informático. Se realizaron 347 intervenciones farmacoterapéuticas, el 97% de las cuales fueron aceptadas por el médico tratante; el 75% de los valles posteriores al ajuste entraron en el margen terapéutico, valor significativamente mayor respecto al 40% de cuando el abordaje fue empírico (p=0.03). Los valores asociados al desempeño predictivo, (n subgrupo de pacientes = 91) fueron: R2=0.61, MAPE=28.16% y RMSE=3.3, mostrándose todos adecuados. Conclusión: Las actividades de monitoreo y farmacocinética clínica de vancomicina mostraron un buen rendimiento clínico.

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“…Vancomycin clearance by the kidney is accelerated in ARC patients owing to an elevated creatinine clearance rate, resulting in reduced effectiveness ( Bakke et al, 2017 ; Bilbao-Meseguer et al, 2018 ; Izumisawa et al, 2019 ; Chu et al, 2020 ; Zhao et al, 2021 ; Scully et al, 2022 ; Yu et al, 2022 ). ARC risk is significantly increased by febrile neutropenia or neurosurgery, and clearance of VCM is augmented, resulting in subtherapeutic levels ( Hirai et al, 2016 ; Kim et al, 2016 ).…”

Section: Antibacterial Therapy In Arc Patientsmentioning

confidence: 99%

Individualized antibiotic dosage regimens for patients with augmented renal clearance

Shi

Zhuang

et al. 2023

Front. Pharmacol.

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Objectives: Augmented renal clearance (ARC) is a state of enhanced renal function commonly observed in 30%–65% of critically ill patients despite normal serum creatinine levels. Using unadjusted standard dosing regimens of renally eliminated drugs in ARC patients often leads to subtherapeutic concentrations, poor clinical outcomes, and the emergence of multidrug-resistant bacteria. We summarized pharmaceutical, pharmacokinetic, and pharmacodynamic research on the definition, underlying mechanisms, and risk factors of ARC to guide individualized dosing of antibiotics and various strategies for optimizing outcomes.Methods: We searched for articles between 2010 and 2022 in the MEDLINE database about ARC patients and antibiotics and further provided individualized antibiotic dosage regimens for patients with ARC.Results: 25 antibiotic dosage regimens for patients with ARC and various strategies for optimization of outcomes, such as extended infusion time, continuous infusion, increased dosage, and combination regimens, were summarized according to previous research.Conclusion: ARC patients, especially critically ill patients, need to make individualized adjustments to antibiotics, including dose, frequency, and method of administration. Further comprehensive research is required to determine ARC staging, expand the range of recommended antibiotics, and establish individualized dosing guidelines for ARC patients.

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Predictive performance of reported vancomycin population pharmacokinetic model in patients with different renal function status, especially those with augmented renal clearance

Cited by 12 publications

References 25 publications

Optimal Practice for Vancomycin Therapeutic Drug Monitoring: Position Statement From the Anti-infectives Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology

Optimal Practice for Vancomycin Therapeutic Drug Monitoring: Position Statement From the Anti-infectives Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology

evaluación de desempeño del servicio de dosificación de precisión para vancomicina en un hospital pediátrico de nivel terciario

Individualized antibiotic dosage regimens for patients with augmented renal clearance

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