Outcomes Study: Impact of Single-Concentration Bayesian AUC/MIC Vancomycin Dosing and Monitoring on Nephrotoxicity and Target Attainment in a Community Hospital

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.