1
|
Ishigo T, Matsumoto K, Yoshida H, Tanaka H, Ibe Y, Fujii S, Fukudo M, Fujihara H, Yamaguchi F, Ebihara F, Maruyama T, Hamada Y, Samura M, Nagumoi F, Komatsu T, Tomizawa A, Takuma A, Chiba H, Nishi Y, Enoki Y, Taguchi K, Suzuki A. Relationship between nephrotoxicity and area under the concentration-time curve of vancomycin in critically ill patients: a multicenter retrospective study. Microbiol Spectr 2024; 12:e0373923. [PMID: 38775483 PMCID: PMC11324017 DOI: 10.1128/spectrum.03739-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/07/2024] [Indexed: 07/03/2024] Open
Abstract
We aimed to assess the frequency of acute kidney injury (AKI) in different areas under the concentration-time curve (AUC) values of vancomycin (VAN) using a two-point blood collection method, allowing for accurate AUC assessment in critically ill patients. This multicenter retrospective observational study was conducted in eight hospitals. We retrospectively analyzed the data of patients who had received VAN in an intensive care unit (ICU) between January 2020 and December 2022. The primary outcome was the incidence of AKI. Patients were classified into three groups according to the AUC24-48h at the initial therapeutic drug monitoring (TDM) as follows: <500, 500-600, and ≥600 µg·h/mL. The AUC24-48h values were calculated using the Bayesian estimation software Practical AUC-guided TDM. Among 146 patients [median age (interquartile range), 67 (56-78) years; 39% women], the AUC24-48h <500 µg·h/mL had an AKI rate of 6.5% (7/107), the AUC24-48h 500-600 µg·h/mL had an AKI rate of 28.0% (7/25), and the AUC24-48h ≥600 µg·h/mL had an AKI rate of 42.9% (6/14). In multivariate Cox proportional hazard analysis, the AUC24-48h 500-600 µg·h/mL [hazard ratio 5.4, 95% confidence interval (CI) 1.64-17.63] and the AUC24-48h ≥600 μg·h/mL (hazard ratio 7.0, 95% CI 2.31-21.18) significantly correlated with a higher incidence of AKI compared with the AUC24-48h <500 μg·h/mL. In conclusion, we identified an association between AUC on day 2 and the risk of AKI in ICU patients, suggesting that not only AUCs above 600 µg·h/mL but also those between 500 and 600 µg·h/mL pose a risk for AKI. IMPORTANCE Vancomycin (VAN) is a glycopeptide antibiotic and one of the most commonly used antibiotics for severe infections caused by methicillin-resistant Staphylococcus aureus. However, higher VAN concentrations have been associated with an increased risk of acute kidney injury (AKI). Herein, we aimed to assess the frequency of AKI in different areas under the concentration-time curve (AUC) values of VAN using a two-point blood collection method, allowing for accurate AUC assessment in critically ill patients. We identified an association between AUC on day 2 and the risk of AKI in intensive care unit patients, suggesting that not only AUCs above 600 µg·h/mL but also those between 500 and 600 µg·h/mL pose a risk for AKI. Therefore, individualized dosing is feasible, with pharmacists being able to optimize VAN doses to attain appropriate targets.
Collapse
Affiliation(s)
- Tomoyuki Ishigo
- Department of
Pharmacy, Sapporo Medical University
Hospital, Sapporo,
Japan
| | - Kazuaki Matsumoto
- Division of
Pharmacodynamics, Keio University Faculty of
Pharmacy, Tokyo,
Japan
| | - Hiroaki Yoshida
- Department of
Pharmacy, Kyorin University Hospital,
Mitaka, Japan
| | - Hiroaki Tanaka
- Department of
Pharmacy, Kyorin University Hospital,
Mitaka, Japan
| | - Yuta Ibe
- Department of
Pharmacy, Sapporo Medical University
Hospital, Sapporo,
Japan
| | - Satoshi Fujii
- Department of
Pharmacy, Sapporo Medical University
Hospital, Sapporo,
Japan
| | - Masahide Fukudo
- Department of
Pharmacy, Sapporo Medical University
Hospital, Sapporo,
Japan
| | - Hisato Fujihara
- Department of
Pharmacy, Showa University Fujigaoka
Hospital, Yokohama,
Japan
- Department of Hospital
Pharmaceutics, School of Pharmacy, Showa
University, Tokyo,
Japan
| | - Fumihiro Yamaguchi
- Department of
Respiratory Medicine, Showa University Fujigaoka
Hospital, Yokohama,
Japan
| | - Fumiya Ebihara
- Department of
Pharmacy, Tokyo Women’s Medical University
Hospital, Tokyo,
Japan
| | - Takumi Maruyama
- Department of
Pharmacy, Tokyo Women’s Medical University
Hospital, Tokyo,
Japan
| | - Yukihiro Hamada
- Department of
Pharmacy, Tokyo Women’s Medical University
Hospital, Tokyo,
Japan
- Department of
Pharmacy, Kochi Medical School
Hospital, Kochi,
Japan
| | - Masaru Samura
- Division of
Pharmacodynamics, Keio University Faculty of
Pharmacy, Tokyo,
Japan
- Department of
Pharmacy, Yokohama General Hospital,
Yokohama, Japan
| | - Fumio Nagumoi
- Department of
Pharmacy, Yokohama General Hospital,
Yokohama, Japan
| | - Toshiaki Komatsu
- Department of
Pharmacy, Kitasato University Hospital,
Sagamihara, Japan
| | - Atsushi Tomizawa
- Department of
Pharmacy, Kitasato University Hospital,
Sagamihara, Japan
| | - Akitoshi Takuma
- Department of Hospital
Pharmaceutics, School of Pharmacy, Showa
University, Tokyo,
Japan
- Department of
Pharmacy, Showa University Northern Yokohama
Hospital, Yokohama,
Japan
| | - Hiroaki Chiba
- Department of
Pharmacy, Tohoku Kosai Hospital,
Sendai, Japan
| | - Yoshifumi Nishi
- Center for
Pharmacist Education, School of Pharmacy, Nihon
University, Funabashi,
Japan
| | - Yuki Enoki
- Division of
Pharmacodynamics, Keio University Faculty of
Pharmacy, Tokyo,
Japan
| | - Kazuaki Taguchi
- Division of
Pharmacodynamics, Keio University Faculty of
Pharmacy, Tokyo,
Japan
| | - Ayako Suzuki
- Department of
Pharmacy, Showa University Fujigaoka
Hospital, Yokohama,
Japan
| |
Collapse
|
2
|
Islam I. Vancomycin AUC-Based Dosing Practices in a Non-Teaching Community Hospital and Associated Outcomes: A One-Year Survey of Uniform Targets for Infections with or without MRSA. PHARMACY 2024; 12:15. [PMID: 38251409 PMCID: PMC10801466 DOI: 10.3390/pharmacy12010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Intravenous (IV) vancomycin area under the curve (AUC)-based dosing is used uniformly for Gram-positive organisms in non-teaching community hospitals. However, evidence for using vancomycin AUC-based dosing for non-methicillin-resistant Staphylococcus aureus (non-MRSA) and less serious infections is limited in the literature. A gap in the literature also exists with respect to comparisons between the outcomes that can be derived using the regimens suggested by Bayesian programs and target doses of the AUC of 400-499 and 500-600. METHODS A retrospective review of all patients hospitalized in a non-teaching community hospital who used AUC-based vancomycin was performed over a 1-year period. RESULTS Only 17.6% of the included patients had confirmed MRSA. The values for the overall early response rate, 30-day all-cause mortality, and rate of acute kidney injury (AKI) were 50.3%, 11.3%, and 3.8%, respectively, in this population. In regression analysis, compared to non-MRSA infections, a significantly higher rate of early response was seen in patients with MRSA (unadjusted OR = 2.68, 95% CI [1.06-6.76] p = 0.04). Patients in the AUC 400-499 group had a non-significant higher incidence of 30 d mortality and new AKI compared to patients in the AUC 500-600 group. In our Kaplan-Meier survival analysis, there was no statistically significant difference between the comparison groups. CONCLUSIONS Early response was lower in patients with non-MRSA compared to patients with MRSA despite achieving the AUC target. There was no apparent difference in clinical outcomes between the higher and lower AUC groups. Further large-scale research is needed to confirm these findings.
Collapse
Affiliation(s)
- Iftekharul Islam
- Department of Pharmacy, MedStar Montgomery Medical Center, Olney, MD 20832, USA
| |
Collapse
|