Optimization of time to initial vancomycin target trough improves clinical outcomes

• Published in: SpringerPlus 2015-07, Vol.4 (1), p.364-364, Article 364
• Main Authors: Cardile, Anthony P, Tan, Christopher, Lustik, Michael B, Stratton, Amy N, Madar, Cristian S, Elegino, Jun, Hsue, Günther
• Format: Article
• Language: English
• Subjects: Clinical outcomes; Humanities and Social Sciences; Medicine; multidisciplinary; Science; Science (multidisciplinary)
• ISSN: 2193-1801; 2193-1801
• DOI: 10.1186/s40064-015-1146-9

Background Outcomes data for the efficacy of interventions designed to decrease the time to initial target vancomycin troughs are sparse. Objective A vancomycin therapeutic drug monitoring (TDM) program was initiated to reduce the time to initial target troughs and to examine the impact on clinical outcomes. Methods Single-center, pre- and post-intervention observational study in a 250 bed teaching facility. Adult inpatients treated with physician-guided, vancomycin therapy (historical control, CTRL) were compared to high trough, pharmacist-guided vancomycin therapy (TDM). Nephrotoxicity analyses were conducted to the ensure safety of the TDM. Clinical outcome analysis was limited to patients with normal renal function and culture-confirmed gram positive infections and a pre-defined MRSA subset. Results 340 patients met initial inclusion criteria for the nephrotoxicity analysis (TDM, n = 173; CTRL, n = 167). Acute kidney injury occurrence was similar between the CTRL (n = 20) and TDM (n = 23) groups (p = 0.7). Further exclusions yielded 145 patients with gram positive infections for clinical outcomes evaluation (TDM, n = 66; CTRL, n = 75). The time to initial target trough was shorter in the TDM group (3 vs. 5 days, p