Pediatr Infect Dis J. 2025 Sep 17. doi: 10.1097/INF.0000000000005006. Online ahead of print.
ABSTRACT
BACKGROUND: Vancomycin therapeutic drug monitoring (TDM) is essential for optimizing efficacy and minimizing toxicity, particularly in acute kidney injury (AKI). However, recent guidelines favor area under the curve (AUC)-guided dosing over traditional trough monitoring to improve dosing. This study aimed to compare vancomycin TDM strategies in pediatric patients, examine the agreement between 1-point and 2-point sampling methods for AUC estimation, and explore the association between vancomycin exposure and clinical outcomes.
METHODS: This retrospective cohort study included pediatric patients (aged 2 months to 18 years) who underwent vancomycin TDM between 2017 and 2019 (trough-based dosing) and 2020 and 2022 (AUC-based dosing). The pharmacokinetic parameters were estimated using Bayesian software. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Receiver operating characteristic curve analysis was performed to identify the threshold values of AUC and trough concentrations for predicting AKI.
RESULTS: A total of 288 patients were included in the study: 164 were from 2017 to 2019 and 124 were from 2020 to 2022, respectively. A comparison of the 1-point and 2-point sampling methods for estimating the AUC showed no significant differences. The incidence of AKI was slightly lower in the 2020-2022 cohort (2.4%) than in the 2017-2019 cohort (6.7%), though the difference was not statistically significant. The AUC threshold for predicting AKI was similar between 1-point and 2-point sampling methods (588-621 mg h/L).
CONCLUSIONS: AUC-based vancomycin dosing was associated with a reduced incidence of AKI in pediatric patients, without compromising efficacy. Further studies are warranted to refine the exposure targets for bacteremia resolution.
PMID:40966765 | DOI:10.1097/INF.0000000000005006
