Msdi Abdulwhab Shremo, Ravari Alireza Fakhri, Abdul-Mutakabbir Jacinda C, Tan Karen K
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, 77204, USA.
Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, USA.
Infect Dis Ther. 2025 Mar;14(3):615-626. doi: 10.1007/s40121-025-01115-4. Epub 2025 Feb 17.
This study compared the calculated vancomycin area under the curve (AUC) using trapezoidal and non-trapezoidal first-order pharmacokinetic equations.
This retrospective observational study included adult patients with documented MRSA bacteremia who received ≥ 48 h of intravenous vancomycin and had two consecutive serum levels after the first dose. AUC was calculated using trapezoidal and non-trapezoidal equations. Correlation and agreement between methods were assessed using Pearson's correlation coefficient (r) and Bland-Altman plots. Significant predictors (p < 0.05) from simple linear regression were included in a multiple linear regression model to evaluate their impact on AUC for both methods.
Fifty-two patients were included. The median age was 63 years (interquartile range [IQR]: 50-73), and the median vancomycin clearance was 4 l/h (IQR: 2-6). Median vancomycin AUC was 399 mg∙h/l (IQR: 257-674) for the trapezoidal method and 572 mg∙h/l (IQR: 466-807) for the non-trapezoidal method. There was a strong correlation between the methods (r = 0.87 [95% CI, 0.79-1]; P < 0.01), but Bland-Altman analysis showed poor agreement, with a bias of - 198 mg∙h/l and 95% limits of agreement from - 482 to 86 mg∙h/l. In multiple linear regression, total daily dose and vancomycin clearance were independent predictors of AUC for both methods, with a stronger impact on non-trapezoidal AUC (adjusted R = 0.70) than trapezoidal AUC (adjusted R = 0.59).
Trapezoidal and non-trapezoidal equations are not interchangeable for estimating vancomycin AUC. The trapezoidal method consistently results in lower AUC estimates than the non-trapezoidal method.
本研究比较了使用梯形和非梯形一级药代动力学方程计算的万古霉素曲线下面积（AUC）。
这项回顾性观察性研究纳入了有记录的耐甲氧西林金黄色葡萄球菌（MRSA）菌血症成年患者，这些患者接受了≥48小时的静脉万古霉素治疗，且在首剂给药后有连续两次血清浓度。使用梯形和非梯形方程计算AUC。采用Pearson相关系数（r）和Bland-Altman图评估两种方法之间的相关性和一致性。简单线性回归中具有显著意义的预测因素（p<0.05）被纳入多元线性回归模型，以评估它们对两种方法的AUC的影响。
共纳入52例患者。中位年龄为63岁（四分位间距[IQR]：50 - 73），万古霉素清除率中位数为4升/小时（IQR：2 - 6）。梯形法计算的万古霉素AUC中位数为399毫克∙小时/升（IQR：257 - 674），非梯形法为572毫克∙小时/升（IQR：466 - 807）。两种方法之间存在强相关性（r = 0.87 [95% CI，0.79 - 1]；P < 0.01），但Bland-Altman分析显示一致性较差，偏差为 - 198毫克∙小时/升，一致性界限为 - 482至86毫克∙小时/升。在多元线性回归中，每日总剂量和万古霉素清除率是两种方法AUC的独立预测因素，对非梯形AUC（调整后R = 0.70）的影响比对梯形AUC（调整后R = 0.59）更强。
梯形和非梯形方程在估算万古霉素AUC时不可互换。梯形法得出的AUC估算值始终低于非梯形法。
