Model-informed AUC-guided dosing for parenteral vancomycin in critically ill patients: impact on target attainment and renal safety - a pre-post intervention study.

BACKGROUND

Parenteral vancomycin is essential for the treatment of certain gram-positive infections but is associated with acute kidney injury (AKI). The 2020 IDSA guideline recommends AUC24-based dosing for MRSA to increase treatment safety. Due to the low MRSA prevalence at the University Hospital of Würzburg (UKW), this study investigated the impact of model-informed precision dosing (MIPD) of vancomycin on AKI incidence and target attainment in MRSA and non-MRSA infections.

METHODS

This pre-post intervention study compared a retrospective group (January 1, 2019 - June 30, 2021) with a prospective group (October 17, 2022 - December 31, 2023), including critically ill patients from intensive and intermediate care units. The prospective group received AUC24-based MIPD using Bayesian pharmacometric modeling performed by a clinical pharmacist. The primary outcome was the incidence of AKI. Secondary outcomes included vancomycin therapeutic target attainment and the proportions of therapies within, below, and above the therapeutic range.

RESULTS

AKI occurred in 27.8% of the retrospective group and 14.0% of the prospective group (p = 0.04). The AUC-based group achieved therapeutic targets more frequently (70.2% vs. 55.1%, p = 0.049) and had fewer supratherapeutic levels (8.8% vs. 24.5%, p = 0.01).

CONCLUSIONS

AUC24-based MIPD for vancomycin improved therapeutic target attainment and was associated with a lower observed incidence of AKI. These findings support further evaluation of AUC-guided dosing for both MRSA and non-MRSA infections.