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Comparison of single trough-based area under the concentration-time curve versus trough concentration for the incidence of vancomycin-associated nephrotoxicity
被引:8
|作者:
Niwa, Takashi
[1
]
Yasue, Moeka
[1
]
Harada, Saki
[1
]
Yamada, Yuto
[1
]
Otsubo, Manami
[1
]
Yamada, Michi
[1
]
Matsuoka, Serika
[1
]
Yamamoto, Taishi
[1
]
Mizusaki, Yurika
[1
]
Suzuki, Akio
[1
]
机构:
[1] Gifu Univ Hosp, Dept Pharm, 1-1 Yanagido, Gifu 5011194, Japan
关键词:
Vancomycin;
Serum concentration;
Area under the concentration-time curve;
Trough concentration;
Nephrotoxicity;
RESISTANT STAPHYLOCOCCUS-AUREUS;
INFECTIOUS-DISEASES SOCIETY;
HEALTH-SYSTEM PHARMACISTS;
AMERICAN SOCIETY;
GUIDELINES;
BACTEREMIA;
PROFILE;
D O I:
10.1016/j.jiac.2022.03.019
中图分类号:
R51 [传染病];
学科分类号:
100401 ;
摘要:
Introduction: While the revised 2020 consensus guideline recommends the use of area under the concentration-time curve (AUC)-guided vancomycin monitoring, collecting multiple vancomycin serum samples to calculate the AUC may cause clinical complications. The aim of the present retrospective study was to evaluate whether AUC-guided vancomycin monitoring, in which AUC was calculated based on a single trough concentration, is a better predictor of nephrotoxicity than trough-guided monitoring in patients receiving vancomycin therapy. Methods: A single-center, retrospective cohort study was conducted at the 614-bed Gifu University Hospital in Japan. Patients who received intravenous vancomycin for a documented or suspected infection and had their serum vancomycin trough concentration monitored between October 1, 2016 and September 30, 2020 were enrolled in the present study. Results: Multivariate Cox proportional hazard analysis indicated that AUC (>600 mu g center dot h/mL) was a significant risk factor for the incidence of acute kidney injury (AKI), while trough concentration (>15 mu g/mL) was not. Moreover, the AUC (>600 mu g center dot h/mL) showed higher specificity and similar sensitivity to the trough concentration (>15 mu g/mL). Kaplan-Meier plots of the cumulative incidence of the AKI-free rate in patients indicated that the onset of AKI was significantly longer in patients with AUC <600 mu g center dot h/mL than in patients with AUC >600 mu g center dot h/ mL (HR, 16.1; 95% CI, 6.3-41.2; p < 0.001). Conclusion: AUC based on a single trough concentration was a better predictor of nephrotoxicity than trough concentration.
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页码:923 / 928
页数:6
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