Rates of Acute Kidney Injury Utilizing Area Under the Concentration-Time Curve Versus Trough-Based Vancomycin Dosing...

Area of Science:

• Pharmacology and Therapeutics
• Infectious Diseases
• Nephrology

Background:

• Vancomycin is a critical antibiotic for treating methicillin-resistant Staphylococcus aureus (MRSA) infections.
• Current dosing guidelines are shifting towards area under the concentration-time curve (AUC) from trough-based strategies to minimize vancomycin-associated acute kidney injury (AKI).
• Limited data exist regarding the safety and efficacy of AUC-based vancomycin dosing in obese patient populations.

Purpose of the Study:

• To evaluate the safety and efficacy of AUC-based vancomycin dosing compared to trough-based dosing in obese patients with severe MRSA infections.
• To assess the incidence of AKI in this specific patient cohort under different dosing strategies.

Main Methods:

• A single-center retrospective cohort study was conducted from January 1, 2014, to December 31, 2022.
• Included were adult patients (≥18 years) with obesity receiving vancomycin for severe MRSA infections for at least 72 hours.
• The primary outcome was the incidence of AKI, defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria.

Main Results:

• The study included 398 patients: 230 in the trough group and 168 in the AUC group.
• AKI rates were significantly lower in the AUC group (11.3%) compared to the trough group (25.2%) (P < .001).
• AUC-based dosing was associated with reduced AKI risk (OR, 0.47 [95% CI, .25-.88]) for cumulative doses below the median and higher initial target attainment (50.0% vs 23.9%, P < .001).

Conclusions:

• AUC-based vancomycin dosing is associated with lower rates of AKI in obese patients with severe MRSA infections compared to trough-based dosing.
• This dosing strategy may improve therapeutic efficacy by increasing initial target attainment.