Members of our team had the opportunity to present a new poster abstract at the 2025 ASHP Midyear Clinical Meeting & Exhibition, which was held from December 7-10, 2025.
Authors
Rebecca Volkert, PharmD; Casey Fitzpatrick, PharmD; Robert Reichenbach, PharmD, MBA; Colin Lombardi, PharmD, MS; Bella Mehta, PharmD, FaPhA
Background
-
Vancomycin is a cornerstone antibiotic for treating serious Gram-positive infections. However, it's narrow therapeutic index requires precise dosing to be effective while minimizing the risk of adverse drug reactions.1
-
Historically, therapeutic drug monitoring relied on steady state trough concentrations, with target levels varying based on infection type and severity.1
-
Driven by evidence that trough concentrations do not reliably predict true vancomycin exposure and that higher troughs increase nephrotoxicity risk, clinical guidelines have shifted to AUC/MIC-based vancomycin dosing to optimize efficacy and minimize toxicity.1, 2, 3, 4, 5
-
Literature Gap: Understanding how smaller, resource-limited institutions with staffing and budget constraints can safely and effectively implement AUC/MIC guided vancomycin dosing.
Objectives
Primary
To compare the incidence of vancomycin-associated acute kidney injury (AKI) between patients monitored using trough-based versus Bayesian AUC/MIC-guided dosing.
Secondary
To assess the proportion of patients achieving therapeutic vancomycin exposure in each cohort.
To evaluate the average time to onset of AKI among affected patients.
-
1
Rybak MJ, Le J, Lodise TP, et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by ASHP, IDSA, PIDS, and SIDP. Am J Health Syst Pharm. 2020;77(11):835–864.
-
2
Lodise TP, Drusano GL, Zasowski E, Dihmess A, Lazariu V, Cosler L, McNutt LA. Vancomycin exposure in patients with methicillin-resistant Staphylococcus aureus bloodstream infections: how much is enough? Clin Infect Dis. 2014 Sep 1;59(5):666-75.
-
3
Neely MN, Kato L, Youn G, Kraler L, Bayard D, van Guilder M, Schumitzky A, Yamada W, Jones B, Minejima E. Prospective Trial on the Use of Trough Concentration versus Area under the Curve To Determine Therapeutic Vancomycin Dosing. Antimicrob Agents Chemother. 2018 Jan 25;62(2):e02042-17.
-
4
Finch NA, Zasowski EJ, Murray KP, Mynatt RP, Zhao JJ, Yost R, Pogue JM, Rybak MJ. A Quasi-Experiment To Study the Impact of Vancomycin Area under the Concentration-Time Curve-Guided Dosing on Vancomycin-Associated Nephrotoxicity. Antimicrob Agents Chemother. 2017 Nov 22;61(12):e01293-17.
-
5
Suzuki A, Hamada Y, Ikeda H, Tanaka H, Yanagihara M, Namiki M, Watanabe T, Sasaki T. Comparison of trough concentration and area under the curve of vancomycin associated with the incidence of nephrotoxicity and predictors of a high trough level. J Infect Chemother. 2021 Mar;27(3):455-460.