Comparison of Vancomycin Area-Under-the-Curve Dosing Versus Trough Target–Based Dosing in Obese and Nonobese Patients With Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia

Covvey, Jordan R.; Erickson, Olivia; Fiumara, D; Mazzei, Kelly; Moszczenski, Zachary; Slipak, Kelly; Nemecek, Branden D.; Zimmerman, David E.; Guarascio, Anthony J.

doi:10.1177/1060028019897100

Cited by 18 publications

(12 citation statements)

References 29 publications

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“…It was also reported that total daily dose of VCM for trough-based dosing (2390.76 ± 1224.59 mg) differed significantly from AUCbased dosing (1985.07 ± 616.18 mg) across the cohort, and these differences were dependent on patients' BMI, although not the short status, but the obese patients showed significant differences of total dose of VCM. 20 These data suggested similar results with our study that the short status looked a significant factor; however, it did not show the significant relation with VCM trough finally. The hematological patients were also not usually obese and did not show high inflammation.…”

Section: Discussionsupporting

confidence: 89%

Analysis of Risk Factors Associated with Reduced Trough Concentrations of Vancomycin in Relation to Renal Function in a Tertiary Hospital in Japan

Kashiwagura

Kamioka

Seki

et al. 2021

IDR

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Background: Low trough concentrations of vancomycin (VCM) are common in patients receiving the drug, because patients are often administered relatively low doses of VCM due to its high potential for renal toxicity. However, the clinical risk factors associated with low VCM trough concentration in relation to renal function are unclear. Methods: Patients at our hospital who received VCM intravenously from January 2018 to December 2020 were analyzed. The patients were divided into two groups based on their renal function: normal and lower renal function, such as estimated glomerular filtration rate (eGFR) ≧60 and <60 mL/min/1.73 m 2 , respectively. In each renal function group, patients' background characteristics, laboratory data and treatments were compared between lower VCM concentration (<10 mg/L) and appropriate VCM concentration (10-20 mg/L) subgroups. Results: Among 101 patients with normal renal function, 47 and 54 patients, respectively, showed lower and appropriate VCM trough concentrations. Elderly age, short stature, and higher C-reactive protein (CRP) level were significantly more common in the lower VCM concentration group compared with appropriate VCM concentration group. Among the 45 patients with renal dysfunction, 20 and 25 patients, respectively, showed lower and appropriate VCM trough concentrations. CRP levels were significantly higher in lower VCM concentration than appropriate VCM concentration subgroups. Multivariate analysis showed that insufficient total VCM doses and higher CRP might have affected the lower VCM trough concentration in patients with normal renal function. Conclusion:The results of this study suggest that higher CRP might be one of the risk factors associated with lower VCM concentration in both normal and low renal function patients. Severely ill and emergency patients might receive a lower VCM dose due to underestimation of the acceptable VCM dose.

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Section: Discussionsupporting

confidence: 89%

Analysis of Risk Factors Associated with Reduced Trough Concentrations of Vancomycin in Relation to Renal Function in a Tertiary Hospital in Japan

Kashiwagura

Kamioka

Seki

et al. 2021

IDR

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“…Studies have found that pharmacokinetic parameters of vancomycin are associated with the renal function, age, weight, combined medications, and other factors (Chu et al, 2016;Covvey et al, 2019;Yahav et al, 2019). Based on the population pharmacokinetic approach, we can screen out variables that influence the parameters of vancomycin pharmacokinetics, and establish formulas describing individual pharmacokinetic parameters.…”

Section: Introductionmentioning

confidence: 99%

Population Pharmacokinetics of Vancomycin in Kidney Transplant Recipients: Model Building and Parameter Optimization

Liu

Jiao

et al. 2020

Front. Pharmacol.

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Background: Depending on the renal function of patients and many other influencing factors, studies on vancomycin pharmacokinetics show significant inter-and intraindividual variability. The present study was conducted using a population pharmacokinetics method to investigate the pharmacokinetic parameters and identified their influencing covariates for intravenous vancomycin in adult kidney transplant recipients. Methods:The drug monitoring data included 56 adult renal transplant recipients who received intravenous vancomycin as prophylactic medication. The analysis was performed by a population approach with NONMEM. Data were collected mainly during the first week after transplantation. Monitoring of vancomycin trough concentration in blood was initiated mainly 3-5 days after the initial administration. Results:The one-compartment open model was optimal and adequately described the data. Body weight (WT) and estimated glomerular filtration rate (GFR) were identified as significant covariates of the pharmacokinetic parameters CL and V of intravenous vancomycin in the kidney transplant patients. The typical values of vancomycin CL and V were 2.08 L h -1 and 63.2 L, respectively. A dosage strategy scheme according to model results was also designed. Conclusion:Both WT and GFR of the kidney transplant patients positively influence the pharmacokinetic parameters CL and V for intravenous vancomycin. Our population

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“…In a study of obese patients receiving vancomycin, switching to an AUC-based approach reduced total daily doses of vancomycin. 18 Although obese patients exhibited a nearly twofold higher rate of AKI compared with non-obese patients, similar rates of nephrotoxicity were observed in troughbased monitoring approach compared with an AUC-based strategy.…”

Section: Trough-based Versus Area-under-the-curve Therapeutic Drug Mo...mentioning

confidence: 79%

Antibiotic Optimization in the Intensive Care Unit

Lizza

Raush

Micek

2022

Semin Respir Crit Care Med

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Effective antimicrobial therapy remains paramount to successful treatment of patients with critical illness, such as pneumonia and sepsis. Unfortunately, critically ill patients often exhibit altered pharmacokinetics and pharmacodynamics (PK/PD) that make this endeavor challenging. Particularly in sepsis, alterations in volume of distribution (Vd) and protein binding lead to unpredictable effects on serum levels of various antimicrobials. Additionally, metabolic pathways and excretion may be significantly impacted due to end-organ failure. These dynamic factors may increase the likelihood of deleterious effects such as treatment failure or toxicity. Meeting these challenging scenarios has led to various strategies meant to improve clinical cure without untoward consequences. Vancomycin and β-lactam antimicrobials are frequently utilized and have been the focus of dose optimization strategies including extended infusion (EI) or continuous infusion (CI). Available data suggests that administration of vancomycin by CI may reduce the risk of nephrotoxicity without increasing the risk of treatment failure, although retrospective data are largely utilized in supporting this method. Other efforts to optimize vancomycin have focused on transitioning from trough-based therapeutic drug monitoring (TDM) to area-under-the-curve: minimum inhibitory concentration (AUC:MIC) ratios. Despite the creation of more user-friendly methods of calculation and data suggesting reduced rates of nephrotoxicity, widespread implementation is limited, in part due to clinician comfort. Use of β-lactams in patients with sepsis is similarly problematic due to observational data demonstrating fluctuations in serum levels in the setting of critical illness. Implementing TDM of agents such as piperacillin-tazobactam, cefepime, and meropenem has been suggested as a method of improving time above MIC (T >MIC). This practice is limited by the lack of access to commercial assays and the failure of rigorous studies to demonstrate improved treatment success. Clinicians should be aware of these challenges and should refine their dosing strategies based on individualized patient factors to reduce treatment failure.

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Comparison of Vancomycin Area-Under-the-Curve Dosing Versus Trough Target–Based Dosing in Obese and Nonobese Patients With Methicillin-Resistant Staphylococcus aureus Bacteremia

Cited by 18 publications

References 29 publications

Analysis of Risk Factors Associated with Reduced Trough Concentrations of Vancomycin in Relation to Renal Function in a Tertiary Hospital in Japan

Analysis of Risk Factors Associated with Reduced Trough Concentrations of Vancomycin in Relation to Renal Function in a Tertiary Hospital in Japan

Population Pharmacokinetics of Vancomycin in Kidney Transplant Recipients: Model Building and Parameter Optimization

Antibiotic Optimization in the Intensive Care Unit

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