Ondrush Nicole M, Ademovic Rejs, Seabury Robert W, Darko William, Miller Christopher D, Mogle Bryan T
The Mount Sinai Hospital, One Gustave L. Levy Place, New York, USA.
Upstate University Hospital, Syracuse, New York, USA.
J Clin Pharm Ther. 2022 Dec;47(12):2223-2229. doi: 10.1111/jcpt.13795. Epub 2022 Nov 9.
Current vancomycin monitoring guidelines recommend the use of area under the concentration-time curve (AUC ) monitoring in patients with serious Methicillin-Resistant Staphylococcus aureus (MRSA) infections by utilizing either a Bayesian approach or first-order analytic equations. Several open-access websites exist that allow estimation of vancomycin AUC with the use of a single steady-state concentration. It is uncertain how these open-access calculators perform against guideline-recommended methods. The objective was to compare AUC estimates from two online, open-access, single-concentration vancomycin calculators compared with the two-point pharmacokinetic (2PK) method.
AUC estimates were made using the 2PK reference method and the single-concentration vancomycin calculators, ClinCalc and VancoPK. The AUC estimates from the 2PK reference method were compared to the online calculators by assessing bias (median AUC difference) and precision (AUC difference ± 100 mgh/L). Clinical precision was also assessed by characterizing the frequency that the 2PK reference method and the online calculators showed clinical disagreement based on the following AUC categories: (1) AUC < 400 mg*h/L; (2) AUC 400-600 mg*h/L and (3) AUC > 600 mgh/L.
A total of 253 patients were included in the study. The AUC estimates from the ClinCalc and VancoPK single-concentration vancomycin calculators showed some bias and imprecision, though VancoPK appeared to have less. Clinical disagreement versus the 2PK reference method occurred in 31.2% and 19.4% of AUC estimates from the ClinCalc and VancoPK single-concentration vancomycin calculators, suggesting clinical imprecision.
The AUC estimates from single-concentration, online vancomycin calculators showed some bias and imprecision in comparison to the 2PK method. Institutions should validate these online, trough-only calculators relative to a 2PK method in their patient populations prior to adoption as standard-of-care.
当前的万古霉素监测指南建议，对于患有严重耐甲氧西林金黄色葡萄球菌（MRSA）感染的患者，采用贝叶斯方法或一阶分析方程来监测浓度-时间曲线下面积（AUC）。有几个开放获取的网站可通过单一稳态浓度来估算万古霉素的AUC。目前尚不确定这些开放获取的计算器与指南推荐的方法相比效果如何。本研究目的是比较两款在线、开放获取的单浓度万古霉素计算器与两点药代动力学（2PK）方法所得的AUC估算值。
使用2PK参考方法以及单浓度万古霉素计算器ClinCalc和VancoPK进行AUC估算。通过评估偏差（AUC中位数差异）和精密度（AUC差异±100mgh/L），将2PK参考方法所得的AUC估算值与在线计算器的结果进行比较。还根据以下AUC类别，通过描述2PK参考方法和在线计算器出现临床分歧的频率来评估临床精密度：（1）AUC＜400mgh/L；（2）AUC 400 - 600mgh/L；（3）AUC＞600mgh/L。
本研究共纳入253例患者。ClinCalc和VancoPK单浓度万古霉素计算器所得的AUC估算值存在一定偏差和不精密度，不过VancoPK似乎偏差较小。ClinCalc和VancoPK单浓度万古霉素计算器所得的AUC估算值中，分别有31.2%和19.4%与2PK参考方法存在临床分歧，提示临床不精密度。
与2PK方法相比，单浓度在线万古霉素计算器所得的AUC估算值存在一定偏差和不精密度。在将这些仅基于谷浓度的在线计算器作为标准治疗方法采用之前，医疗机构应在其患者群体中相对于2PK方法对其进行验证。
