J Korean Med Sci. 2023;38(14):e101.

Evaluation of Vancomycin TDM Strategies: Prediction and Prevention of Kidney Injuries Based on Vancomycin TDM Results.

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제1저자 김병욱 · 교신저자 송경호, 윤성혜

PMID 37038640 PMC10086380 DOI 10.3346/jkms.2023.38.e101 IF 3.2 감염내과

소속 (7)

Department of Clinical Pharmacology and Therapeutics, Seoul National University Hospital, Seoul National University College of Medicine Seoul, Korea.
Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Clinical Pharmacology and Therapeutics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. khsongmd@gmail.com.
Department of Clinical Pharmacology and Therapeutics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. nymph223@snu.ac.kr.

Abstract

The current guidelines for therapeutic drug monitoring (TDM) of vancomycin suggest a target 24-hour area under the curve (AUC_0-24) of 400 to 600 mg*h/L for serious methicillin-resistant Staphylococcus aureus infections. In this study, the predictabilities of acute kidney injury (AKI) of various TDM target parameters, target levels, and sampling methods were evaluated in patients who underwent TDM from January 2020 to December 2020. The AUC_0-24 and trough values were calculated by both one- and two-point sampling methods, and were evaluated for the predictability of AKI. Among the AUC_0-24 cutoff comparisons, the threshold value of 500 mg*h/L in the two sampling methods was statistically significant (P = 0.042) when evaluated for the predictability of AKI. Analysis by an receiver operating characteristic curve estimated an AUC_0-24 cutoff value of 563.45 mg*h/L as a predictor of AKI, and was proposed as the upper limit of TDM target.

Keywords

Acute Kidney InjuryPharmacokineticsTherapeutic Drug MonitoringVancomycin

Figures

**Fig. 1** Vancomycin daily AUC_0-24 and the ratio of creatinine change to baseline calculated by one- and two-point estimation. Each plot was stratified by AUC_0-24 levels of (**A, B**) 500, (**C, D**) 600, and (**E, F**) 700 mg∙h/L. The P values represent Mann–Whitney U test results. AUC_0-24 = area under the curve over 24 hours.

**Fig. 2** ROC curve for estimation of (**A, B**) AUC_0-24 and (**C, D**) trough cutoff values for AKI prediction. The AUC shown in the figure represents the area under the ROC curve. ROC = receiver operating characteristic, AUC_0-24 = area under the curve over 24 hours, AKI = acute kidney injury.

그림 출처: PubMed Central 공개 논문 (PMC10086380)

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

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