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.
引用
收藏
页码:923 / 928
页数:6
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