Therapeutic Drug Monitoring of Vancomycin Concentrations for the Management of Bone and Joint Infections : An Urgent Need
Rio-No, Laura (Parc de Salut MAR de Barcelona)
Sorlí, Luisa (Universitat Pompeu Fabra. Facultat de Ciències de la Salut i de la Vida)
Arderiu-Formentí, Alba (Parc de Salut MAR de Barcelona)
de Antonio Ferrer, Marta (Parc de Salut MAR de Barcelona)
Martorell, Lucas (Universitat Autònoma de Barcelona. Facultat de Medicina)
Subirana, Isaac (Institut Hospital del Mar d'Investigacions Mèdiques)
Puig-Verdié, Lluís (Parc de Salut MAR de Barcelona)
Alier, Albert (Parc de Salut MAR de Barcelona)
Gómez-Junyent, Joan (Parc de Salut MAR de Barcelona)
Pérez-Prieto, Daniel (Parc de Salut MAR de Barcelona)
Luque, Sonia (Parc de Salut MAR de Barcelona)
Universitat Autònoma de Barcelona

Date:	2023
Abstract:	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 AUC/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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Bone and joint infections ; Vancomycin ; Therapeutic drug monitoring ; Pharmacokinetics ; Nephrotoxicity ; Dosage regimens
Published in:	Tropical medicine and infectious disease, Vol. 8 (february 2023) , ISSN 2414-6366

DOI: 10.3390/tropicalmed8020113
PMID: 36828529

10 p, 436.5 KB

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