Keil Elizabeth, Wrenn Rebekah H, Deri Connor R, Slaton Cara N, Shroba Jenny, Parish Alice, Erkanli Alaattin, Spivey Justin
Department of Pharmacy, Duke University Hospital, Durham, NC, USA.
Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA.
Ann Pharmacother. 2023 Aug;57(8):940-947. doi: 10.1177/10600280221138867. Epub 2022 Dec 1.
Vancomycin area-under-the-curve (AUC) monitoring is associated with reduced nephrotoxicity but may increase cost and workload for personnel compared to trough monitoring.
The purpose of this study was to compare the accuracy of vancomycin AUC calculated by open-access, online, trough-only calculators to AUCs calculated by the trapezoidal method (TM) using peak and trough concentrations.
This retrospective, multi-center study included adults ≥18 years old with stable renal function who received vancomycin with steady-state peak and trough concentrations. Areas under the curve calculated by TM were compared to AUCs calculated by 3 online calculators using trough-only options for calculation: ClinCalc, VancoVanco, and VancoPK. The primary outcome was actual difference in AUC between TM and the online calculators. Secondary outcomes were percent difference in AUC and clinical alignment in dose adjustments between methods.
Seventy patients were included for analysis. There was a statistically significant difference in AUC between TM and ClinCalc (median actual difference: -52, < 0.001) and VancoVanco (median actual difference: 95, < 0.001), whereas there was no significant difference between TM and VancoPK (median actual difference: -0.8, = 0.827). Discordant dose adjustments were indicated when comparing ClinCalc, VancoVanco, and VancoPK to TM in 28%, 36%, and 12% of cases, respectively.
The AUC calculator most closely aligned with TM was VancoPK, whereas other included calculators were statistically different. Owing to the cost and complexity of obtaining multiple levels, our findings support using a single steady-state trough using VancoPK as an alternative to TM for calculation of vancomycin AUC.
万古霉素曲线下面积（AUC）监测与肾毒性降低相关，但与谷浓度监测相比，可能会增加成本和人员工作量。
本研究的目的是比较通过开放获取的在线仅谷浓度计算器计算的万古霉素AUC与使用峰浓度和谷浓度通过梯形法（TM）计算的AUC的准确性。
这项回顾性多中心研究纳入了年龄≥18岁、肾功能稳定且接受万古霉素治疗并具有稳态峰浓度和谷浓度的成年人。将通过TM计算的曲线下面积与使用仅谷浓度选项进行计算的3个在线计算器（ClinCalc、VancoVanco和VancoPK）计算的AUC进行比较。主要结局是TM与在线计算器之间AUC的实际差异。次要结局是AUC的百分比差异以及两种方法在剂量调整方面的临床一致性。
70例患者纳入分析。TM与ClinCalc（中位实际差异：-52，P<0.001）和VancoVanco（中位实际差异：95，P<0.001）之间的AUC存在统计学显著差异，而TM与VancoPK之间无显著差异（中位实际差异：-0.8，P = 0.827）。将ClinCalc、VancoVanco和VancoPK与TM进行比较时，分别在28%、36%和12%的病例中显示出不一致的剂量调整。
与TM最接近的AUC计算器是VancoPK，而其他纳入的计算器在统计学上存在差异。由于获取多个浓度水平的成本和复杂性，我们的研究结果支持使用单一稳态谷浓度并使用VancoPK作为TM的替代方法来计算万古霉素AUC。
