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Purpose <p>Guidelines recommend a target AUC<sub>24</sub>/MIC of 400–600 for vancomycin dosing in serious MRSA infections. However, various challenges hinder the implementation of AUC-based monitoring. Previously recommended target trough of 15–20&#xa0;mg/L may be associated with increased nephrotoxicity.</p> Methods <p>In this single-center, retrospective study, we compared outcomes of targeting troughs of 10–15&#xa0;mg/L vs 15–20&#xa0;mg/L for intermittent infusion of vancomycin (IIV) in adult hospitalized patients who received ≥ 48&#xa0;h of IIV and had ≥ 1 trough measurement within recommended ranges. Local guidelines recommended target troughs of 15–20&#xa0;mg/L between January 2019 and December 2020 and 10–15&#xa0;mg/L between January 2022 and October 2023. Treatment failure, acute kidney injury (AKI) and inpatient mortality were compared using a desirability of outcome ranking (DOOR) analysis between the two time periods. The most desirable outcome was treatment success and no AKI, and the least desirable outcome was death.</p> Results <p>A total of 173 IIV courses were included. The probability of obtaining a better DOOR was 57.9% (95%CI 50.5–64.9, <i>p</i> = 0.03) when targeting a lower trough. Secondary analyses demonstrated a similar trend. When analyzed separately, the lower target trough group experienced significantly less AKI (OR 0.40, 95%CI 0.16–0.96) with no significant effect on mortality and treatment failure.</p> Conclusion <p>Our study showed that targeting a trough of 10–15&#xa0;mg/L for IIV may be associated with a superior overall outcome compared to targeting 15–20&#xa0;mg/L. In centers not using AUC-based monitoring for vancomycin dosing, a lower target trough may be preferable.</p>

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Evaluating the clinical impact of targeting lower versus higher serum vancomycin trough: a retrospective study using a desirability of outcome ranking (DOOR) analysis

  • 期刊论文

  • 发表日期：

    2025年5月15日

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  • Zong Heng Shi,
  • Sean W. X. Ong,
  • Lesley Palmay,
  • Nathan H. Ma,
  • Marie-Félixe Granger,
  • Philip W. Lam,
  • Marion Elligsen

摘要

Purpose

Guidelines recommend a target AUC24/MIC of 400–600 for vancomycin dosing in serious MRSA infections. However, various challenges hinder the implementation of AUC-based monitoring. Previously recommended target trough of 15–20 mg/L may be associated with increased nephrotoxicity.

Methods

In this single-center, retrospective study, we compared outcomes of targeting troughs of 10–15 mg/L vs 15–20 mg/L for intermittent infusion of vancomycin (IIV) in adult hospitalized patients who received ≥ 48 h of IIV and had ≥ 1 trough measurement within recommended ranges. Local guidelines recommended target troughs of 15–20 mg/L between January 2019 and December 2020 and 10–15 mg/L between January 2022 and October 2023. Treatment failure, acute kidney injury (AKI) and inpatient mortality were compared using a desirability of outcome ranking (DOOR) analysis between the two time periods. The most desirable outcome was treatment success and no AKI, and the least desirable outcome was death.

Results

A total of 173 IIV courses were included. The probability of obtaining a better DOOR was 57.9% (95%CI 50.5–64.9, p = 0.03) when targeting a lower trough. Secondary analyses demonstrated a similar trend. When analyzed separately, the lower target trough group experienced significantly less AKI (OR 0.40, 95%CI 0.16–0.96) with no significant effect on mortality and treatment failure.

Conclusion

Our study showed that targeting a trough of 10–15 mg/L for IIV may be associated with a superior overall outcome compared to targeting 15–20 mg/L. In centers not using AUC-based monitoring for vancomycin dosing, a lower target trough may be preferable.