Bellamy Ashton, Covington Elizabeth W
McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA.
Harrison College of Pharmacy, Auburn University, Auburn, AL, USA.
J Pharm Technol. 2023 Aug;39(4):183-190. doi: 10.1177/87551225231182542. Epub 2023 Jun 27.
Two methods of area under the curve (AUC) dosing are recommended in vancomycin consensus guidelines: first-order calculations utilizing 2 vancomycin concentrations or a Bayesian approach. It is unknown if there is a difference in acute kidney injury (AKI) between the 2 dosing strategies for patients receiving concomitant piperacillin-tazobactam and vancomycin (VPT). The objective of this study was to compare incidence of AKI in patients being administered VPT with first-order calculations versus model-informed precision dosing (MIPD)/Bayesian dosing. This was a single-center, retrospective, observational study at a community hospital. Patients who received VPT therapy for at least 48 hours were included. The primary outcome was overall incidence of AKI. Secondary outcomes included percentage target attainment with initial regimen, average serum creatinine increase, time to AKI, usable vancomycin levels, and need for temporary dialysis or intensive care unit admission. There were 100 patients included (50 in the first-order group and 50 in the MIPD/Bayesian group). The overall incidence of AKI was lower in the MIPD/Bayesian group (12% vs 28%, = 0.046). There was no difference in average serum creatinine increase, time to AKI, need for temporary dialysis, or intensive care unit admission. Patients in the MIPD/Bayesian group had a higher percentage of target attainment (46% vs 18%, = 0.003) and usable vancomycin levels (98% vs 60%, < 0.001). In patients receiving VPT, model-informed precision dosing with Bayesian modeling resulted in a lower rate of AKI, higher target attainment, and more usable vancomycin levels compared with first-order AUC dosing. The small sample and retrospective nature of this study reinforces the need for additional data.
万古霉素共识指南推荐了两种曲线下面积（AUC）给药方法：利用2个万古霉素浓度的一级计算法或贝叶斯方法。对于同时接受哌拉西林 - 他唑巴坦和万古霉素（VPT）治疗的患者，这两种给药策略在急性肾损伤（AKI）方面是否存在差异尚不清楚。本研究的目的是比较采用一级计算法与模型指导的精准给药（MIPD）/贝叶斯给药法的VPT患者中AKI的发生率。这是一项在社区医院进行的单中心、回顾性观察研究。纳入接受VPT治疗至少48小时的患者。主要结局是AKI的总体发生率。次要结局包括初始治疗方案的目标达成率、血清肌酐平均升高值、发生AKI的时间、可用的万古霉素水平，以及临时透析或入住重症监护病房的需求。共纳入100例患者（一级计算法组50例，MIPD/贝叶斯组50例）。MIPD/贝叶斯组的AKI总体发生率较低（12%对28%，P = 0.046）。血清肌酐平均升高值、发生AKI的时间、临时透析需求或入住重症监护病房方面无差异。MIPD/贝叶斯组患者的目标达成率更高（46%对18%，P = 0.003），可用的万古霉素水平更高（98%对60%，P < 0.001）。在接受VPT治疗的患者中，与一级AUC给药法相比，采用贝叶斯模型的模型指导精准给药导致AKI发生率更低、目标达成率更高，且可用的万古霉素水平更高。本研究样本量小且具有回顾性，这凸显了获取更多数据的必要性。
