Gu, Qingze;
Jones, Nicola;
Drennan, Philip;
Peto, Tim EA;
Walker, Ann;
Eyre, David W;
(2022)
Assessment of an institutional guideline for vancomycin dosing and identification of predictive factors associated with dose and drug trough levels.
Journal of Infection
, 85
(4)
pp. 382-389.
10.1016/j.jinf.2022.06.029.
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Abstract
Summary Objectives To evaluate the effectiveness of an antimicrobial guideline for vancomycin prescribing deployed using electronic prescribing aid and web/phone-based app. To define factors associated with guideline compliance and drug levels, and to investigate if antimicrobial dosing recommendations can be refined using routinely collected electronic healthcare record data. Methods We used data from Oxford University Hospitals between 01-January-2016 and 01-June-2021 and multivariable regression models to investigate factors associated with dosing compliance, drug levels and acute kidney injury (AKI). Results 3767 patients received intravenous vancomycin for ≥24 h. Compliance with recommended loading and initial maintenance doses reached 84% and 70% respectively; 72% of subsequent maintenance doses were correctly adjusted. However, only 26% first and 32% subsequent levels reached the target range, and for patients with ongoing vancomycin treatment, 55–63% achieved target levels at 5 days. Drug levels were independently higher in older patients. Incidence of AKI was low (5.7%). Model estimates were used to propose updated age, weight and eGFR specific guidelines. Conclusion Despite good compliance with guidelines for vancomycin dosing, the proportion of drug levels achieving the target range remained suboptimal. Routinely collected electronic data can be used at scale to inform pharmacokinetic studies and could improve vancomycin dosing.
| Type: | Article |
|---|---|
| Title: | Assessment of an institutional guideline for vancomycin dosing and identification of predictive factors associated with dose and drug trough levels |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.jinf.2022.06.029 |
| Publisher version: | https://doi.org/10.1016/j.jinf.2022.06.029 |
| Language: | English |
| Additional information: | This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
| Keywords: | Vancomycin, Guidelines, Electronic patient records, Therapeutic drug monitoring, Trough concentration, Nephrotoxicity |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10150939 |
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