Vancomycin therapeutic monitoring by measured trough concentration versus Bayesian‐derived area under the curve in critically ill patients with cancer

Abusara, Aseel; Abdelrahman, Deema H.; Habash, Khader; Al‐Shaer, Mohammad H.; Lê, Jennifer; Nazer, Lama

doi:10.1002/prp2.912

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…In our study, this could translate to increased urinary elimination of unbound vancomycin, resulting in lower plasma levels and consequently decreased AUC. These results are consistent with those of other studies in both pediatric and critically ill adult cohorts in which the association between augmented renal clearance and failure to reach the AUC target was documented [20,21].…”

Section: Discussionsupporting

confidence: 92%

Real-Life Vancomycin Therapeutic Drug Monitoring in Coagulase-Negative Staphylococcal Bacteremia in Neonatal and Pediatric Intensive Care Unit: Are We Underestimating Augmented Renal Clearance?

Sette,

Mariani,

Grasselli

et al. 2023

Antibiotics

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Bloodstream infections (BSI) from coagulase-negative-staphylococci (CoNS) are among the most frequent healthcare-related infections. Their treatment involves the use of vancomycin, a molecule whose optimal pharmacokinetic/pharmacodynamic (PK/PD) target for efficacy and safety is an area-under-curve/minimum inhibitory concentration (AUC/MIC) ratio ≥ 400 with AUC < 600. BSIs from CoNS in pediatric and neonatal intensive care unit that occurred at the Gaslini Institute over five years were evaluated to investigate the efficacy of vancomycin therapy in terms of achieving the desired PK/PD target and determining whether any variables interfere with the achievement of this target. AUC/MIC ≥ 400 with AUC < 600 at 48 and 72 h after therapy initiation was achieved in only 21% of the neonatal population and 25% of the pediatric population. In the pediatric population, an inverse correlation emerged between estimated glomerular filtration rate (eGFR) and achieved AUC levels. Median eGFR at 72 h was significantly higher (expression of hyperfiltration) in events with AUC < 400, compared with those with AUC ≥ 400 (p < 0.001). A cut-off value of eGFR in the first 72 h has been identified (145 mL/min/1.73 m2), beyond which it is extremely unlikely to achieve an AUC ≥ 400, and therefore a higher dose or a different antibiotic should be chosen.

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Section: Discussionsupporting

confidence: 92%

Real-Life Vancomycin Therapeutic Drug Monitoring in Coagulase-Negative Staphylococcal Bacteremia in Neonatal and Pediatric Intensive Care Unit: Are We Underestimating Augmented Renal Clearance?

Sette,

Mariani,

Grasselli

et al. 2023

Antibiotics

View full text Add to dashboard Cite

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Vancomycin therapeutic monitoring by measured trough concentration versus Bayesian‐derived area under the curve in critically ill patients with cancer

Abusara

Abdelrahman

Habash

et al. 2022

Pharmacology Res & Perspec

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The updated vancomycin guideline and recent studies suggested that trough concentrations may result in underestimation of the actual area under the curve (AUC), leading to excessive dosing and nephrotoxicity. With limited data available on critically ill cancer patients, this study aimed to compare the two methods in this patient population. This was a 5-year retrospective study on patients treated with vancomycin in the intensive care unit (ICU) of a comprehensive cancer center. The measured trough concentration was compared to Bayesian-derived AUC/minimum-inhibitoryconcentration (MIC), considering MIC as 1. Trough concentrations of 15-20 mg/L and AUC of 400-600 mg h/L were considered the targeted goal. Multivariate analysis was performed to identify factors associated with an AUC below the targeted goal. During the study period, 316 patients were included. The mean age was 54 years ±16 (SD); most patients had solid tumors (75%), and 11% had neutropenia. A targeted goal AUC and trough were recorded in 128 (41%) patients and in 64 (20%) patients, respectively.Of the 128 patients with targeted goal AUC, 31 (24%) had targeted goal trough concentrations and 91 (71%) had trough concentrations below 15 mg/L. Furthermore, among the patients with targeted goal trough concentration (n = 64), 33 (52%) had higher than targeted goal AUC. Augmented renal clearance (ARC), defined as a calculated creatinine-clearance ≥130 ml/min, was associated with an AUC below the targeted goal. In a cohort of critically ill patients with cancer, over two-thirds of the patients with a targeted goal Bayesian AUC/MIC had trough concentrations below the targeted goal. ARC was associated with AUC below the targeted goal.

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Comparison of Trough-Based and Area Under the Curve-Based Therapeutic Drug Monitoring of Vancomycin: An In Silico Study

et al. 2022

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Background: Recent American guideline published in 2020 recommend using 24-h area under the curve (AUC)/minimum inhibitory concentration instead of vancomycin serum concentration (Ctrough) for vancomycin therapeutic drug monitoring (TDM). However, Ctrough-based TDM is widely used in clinical practice. Thus, this retrospective study aimed to compare Ctrough-based and AUC-based TDM. Methods: We evaluated patients' TDM data with at least one vancomycin trough measurement. Patients younger than 18 years, admitted to an intensive care unit, or on renal replacement therapy were excluded. The variables of Ctrough-based and AUC-based TDM were simulated using Mw-Pharm++ (Mediware, Czech Republic) with vancomycin two-compartment model. The therapeutic range was 400-600 mg*h/L and 15-20 mg/L for AUC and Ctrough, respectively. We evaluated the correlation between Ctrough and AUC, the attainment rate of AUC target range, and changes in vancomycin dose and Ctrough when AUC-based TDM is applied. Results: One hundred and four patients were enrolled. Ctrough and AUC correlated moderately (R=0.707, P <0.001). Among 31 patients with Ctrough of 15-20 mg/L, the AUC of only 18 patients was within the target range (18/31, 58.1%). In addition, most patients with Ctrough of 10-15 mg/L had the AUC within the target range (57/66, 86.4%). The respective vancomycin dose and Ctrough were expected to be significantly lower in AUC-based TDM simulation than those in Ctrough-based TDM simulation Conclusions: Ctrough of 15-20 mg/L for vancomycin monitoring is not appropriate for attaining AUC target range. Targeting either AUC or lower Ctrough is recommended for vancomycin TDM.

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Vancomycin therapeutic monitoring by measured trough concentration versus Bayesian‐derived area under the curve in critically ill patients with cancer

Cited by 3 publications

References 34 publications

Real-Life Vancomycin Therapeutic Drug Monitoring in Coagulase-Negative Staphylococcal Bacteremia in Neonatal and Pediatric Intensive Care Unit: Are We Underestimating Augmented Renal Clearance?

Real-Life Vancomycin Therapeutic Drug Monitoring in Coagulase-Negative Staphylococcal Bacteremia in Neonatal and Pediatric Intensive Care Unit: Are We Underestimating Augmented Renal Clearance?

Vancomycin therapeutic monitoring by measured trough concentration versus Bayesian‐derived area under the curve in critically ill patients with cancer

Comparison of Trough-Based and Area Under the Curve-Based Therapeutic Drug Monitoring of Vancomycin: An In Silico Study

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