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Evaluating the Safety of Trough Versus Area Under the Curve (AUC)-Based Dosing Method of Vancomycin With Concomitant
Cassandra Karas1, Kyle Manning1, Darrell T Childress1
1East Alabama Medical Center, Opelika, AL, USA.
Abstract:
Background: Vancomycin and piperacillin-tazobactam (VPT) is a common antibiotic combination used in hospitals, and there has been increasing data indicating that the combination is associated with increased rates of acute kidney injury (AKI). It is unclear if the dosing method of vancomycin would mitigate the risk of AKI seen with VPT. Objective: To observe and compare incidence of AKI in patients on VPT when using the trough-based dosing method versus the area-under-the-curve (AUC)-based dosing method. Methods: This was a multi-center, retrospective, observational study at 3 community hospitals. Adults receiving at least 48 hours of VPT were included. Patients with severe renal dysfunction, pregnant patients, prisoners, and patients with central nervous system infections, or malignancy were excluded. The primary outcome was incidence of AKI as defined by the Infectious Disease Society of America (IDSA) criteria. Results: A total of 300 patients were included in the study; 150 patients in both the trough and AUC groups. A total of 23 patients (15%) in the trough group and 17 patients (11%) in the AUC group met the primary outcome (odds ratio [OR]: 0.7058, 95% confidence interval [CI]: [0.3603, 1.3826], P = .3098). Conclusion and Relevance: The incidence of AKI was lower in the AUC group compared with the trough group; however, this was not significant. The results of our study suggest that there is no difference between incidence of AKI when using trough- or AUC-based dosing in those receiving VPT. Because of the small sample size and retrospective nature of the study, more data are needed.
Insights
This study compared vancomycin dosing methods for patients receiving vancomycin and piperacillin-tazobactam (VPT). Results showed no significant difference in acute kidney injury (AKI) rates between trough-based and AUC-based vancomycin dosing.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Vancomycin and piperacillin-tazobactam (VPT) is a frequently used antibiotic combination.
- Increasing evidence links VPT to higher rates of acute kidney injury (AKI).
- The impact of vancomycin dosing strategies on AKI risk with VPT remains unclear.
Purpose of the Study:
- To compare the incidence of AKI in patients treated with VPT.
- To evaluate differences between vancomycin trough-based dosing and area-under-the-curve (AUC)-based dosing.
- To determine if vancomycin dosing method influences AKI risk when combined with piperacillin-tazobactam.
Main Methods:
- A multi-center, retrospective, observational study involving 3 community hospitals.
- Inclusion criteria: adults receiving at least 48 hours of VPT.
- Exclusion criteria: severe renal dysfunction, pregnancy, malignancy, CNS infections, or incarceration.
Main Results:
- 300 patients were analyzed, with 150 in each vancomycin dosing group (trough vs. AUC).
- AKI incidence was 15% (23/150) in the trough group and 11% (17/150) in the AUC group.
- The observed difference in AKI incidence was not statistically significant (OR: 0.7058, P = .3098).
Conclusions:
- The incidence of AKI was not significantly different between trough-based and AUC-based vancomycin dosing when used with VPT.
- Current data suggest no definitive advantage of one dosing method over the other for preventing AKI in this context.
- Further research with larger sample sizes and prospective designs is warranted to confirm these findings.
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