f6409b84ec4cd8f77a84b9716e8396c0 pmc_9959361.pdf f6afa8eafc5b416a22b7b15593e2a9fc8a1b7989 pmc_9959361.pdf 14c43090bebafc0d6d2388c45351a16f676459b1226e85fb0d7ceaa28dd817cd pmc_9959361.pdf Title: Therapeutic Drug Monitoring of Vancomycin Concentrations for the Management of Bone and Joint Infections: An Urgent Need Subject: Vancomycin is used for the treatment of bone and joint infections (BJI), but scarce information is available about its pharmacokinetic/pharmacodynamic (PK/PD) characteristics. We aimed to identify the risk factors associated with the non-achievement of an optimal PK/PD target in the first therapeutic drug monitoring (TDM). Methods: A retrospective study was conducted in a tertiary hospital from January 2020 to January 2022. Patients with BJI and TDM of vancomycin on day 2 of treatment were included. Initial vancomycin fixed doses (1 g every 8 h or 12 h) was decided by the responsible doctors. According to TDM results, dosage adjustments were performed. An AUC24h/MIC < 400 mg h/L, between 400 and 600 mg h/L and >600 mg h/L, were defined as suboptimal, optimal and supratherapeutic, respectively. Patients were grouped into these three categories. Demographic, clinical and PK characteristics were compared between groups. Nephrotoxicity at the end of treatment was assessed. Results: A total of 94 patients were included: 22 (23.4%), 42 (44.7%) and 30 (31.9%) presented an infratherapeutic, optimal and supratherapeutic PK/PD targets, respectively. A younger age and initial vancomycin dose <40 mg/kg/day were predictive factors for achieving a suboptimal PK/PD target, while older age, higher serum-creatinine and dose >40 mg/kg/day were associated with overexposure. The nephrotoxicity rate was 22.7%. More than 50% of patients did not achieve an optimal PK/PD. Considering age, baseline serum-creatinine and body weight, TDM is required to readily achieve an optimal and safe exposure. Keywords: bone and joint infections; vancomycin; therapeutic drug monitoring; pharmacokinetics; nephrotoxicity; dosage regimens Author: Laura Rio-No, Luisa Sorli, Alba Arderiu-Formenti, Marta De Antonio, Lucas Martorell, Isaac Subirana, Lluis Puig, Albert Alier, Joan Gómez-Junyent, Daniel Pérez-Prieto and Sonia Luque Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Feb 13 07:55:53 2023 CET ModDate: Mon Feb 13 08:01:41 2023 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 10 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 446971 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- HJOMHV+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 QKZKVH+VnURWPalladioL Type 1 Custom yes yes no 15 0 GSSKCT+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 OUZAFR+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 ATCLOL+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 EEQVUF+CMSY10 Type 1 Builtin yes yes no 32 0 ZMZZBL+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 50 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 73 0 OVNEXW+EURM10 Type 1 Builtin yes yes no 80 0 PCPNIK+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 91 0 PCPNIL+PalatinoLinotype CID TrueType Identity-H yes yes yes 94 0 PCPNIM+PalatinoLinotype TrueType WinAnsi yes yes no 100 0 PCPNIO+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 103 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-07-12 02:30:17 CEST RepresentationInformation: pmc_9959361.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-03-09 02:14:08 CET Size: 446971 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 232 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Children: Item: Title: Study Design and Population Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Dosage Recommendations Based on TDM Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Clinical Outcomes Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Children: Item: Title: Clinical Evolution Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Nephrotoxicity at the End of Treatment Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: TDM-Based Vancomycin Dosage Recommendations Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Info: Title: Therapeutic Drug Monitoring of Vancomycin Concentrations for the Management of Bone and Joint Infections: An Urgent Need Author: Laura Rio-No, Luisa Sorli, Alba Arderiu-Formenti, Marta De Antonio, Lucas Martorell, Isaac Subirana, Lluis Puig, Albert Alier, Joan Gómez-Junyent, Daniel Pérez-Prieto and Sonia Luque Subject: Vancomycin is used for the treatment of bone and joint infections (BJI), but scarce information is available about its pharmacokinetic/pharmacodynamic (PK/PD) characteristics. We aimed to identify the risk factors associated with the non-achievement of an optimal PK/PD target in the first therapeutic drug monitoring (TDM). Methods: A retrospective study was conducted in a tertiary hospital from January 2020 to January 2022. Patients with BJI and TDM of vancomycin on day 2 of treatment were included. Initial vancomycin fixed doses (1 g every 8 h or 12 h) was decided by the responsible doctors. According to TDM results, dosage adjustments were performed. An AUC24h/MIC < 400 mg h/L, between 400 and 600 mg h/L and >600 mg h/L, were defined as suboptimal, optimal and supratherapeutic, respectively. Patients were grouped into these three categories. Demographic, clinical and PK characteristics were compared between groups. Nephrotoxicity at the end of treatment was assessed. Results: A total of 94 patients were included: 22 (23.4%), 42 (44.7%) and 30 (31.9%) presented an infratherapeutic, optimal and supratherapeutic PK/PD targets, respectively. A younger age and initial vancomycin dose <40 mg/kg/day were predictive factors for achieving a suboptimal PK/PD target, while older age, higher serum-creatinine and dose >40 mg/kg/day were associated with overexposure. The nephrotoxicity rate was 22.7%. More than 50% of patients did not achieve an optimal PK/PD. Considering age, baseline serum-creatinine and body weight, TDM is required to readily achieve an optimal and safe exposure. 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