Phân tích kết quả hiệu chỉnh liều vancomycin thông qua giám sát nồng độ thuốc trong máu bằng phương pháp ước đoán AUC theo Bayes tại Bệnh viện Sản nhi Nghệ An

Abstract

Objective: To analyze the results of implementing vancomycin dosing adjustments based on therapeutic drug monitoring (TDM) with estimation of area under the curve (AUC) using the Bayesian approach and identify factors associated with the risk of target AUC non-attainment at the first TDM.  Subject and method: This is a prospective study implemented at Nghe An Obstetrics and Pediatrics Hospital from June 2021 to June 2022. Pediatric patients were administered vancomycin and performed TDM according to the hospital’s approved protocol. Based on TDM concentrations, calculations were conducted using the model-based TDM software (SmartDoseAI) to estimate the AUC value and suggest optimal dosing regimens to achieve a target exposure of AUC 400-600mg.h/L. Risk factors for the target AUC non-attainment on the first TDM were identified using logistic regression analysis. Result: A total of 260 pediatric patients were included in this study. The attainment of target AUC significantly improved after the first dosing adjustments, from 50.0% to 70.8%. Logistic regression analyses revealed that augmented renal clearance (OR 3.14, p=0.007), sepsis (OR 2.13, p=0.017), and a maintenance dose below 60mg/kg/day (OR 2.56, p=0.002) were independent predictors for an AUC < 400mg.h/L. Meanwhile, kidney failure (eGFR < 60mL/min) (OR 17.78, p<0.001), and weight (OR 1.10, p=0.018) increased the risk of an AUC > 600mg.h/L. Conclusion: Vancomycin dose adjustment using AUC-based monitoring via the Bayesian approach increased the therapeutic target attainment. This study identified the main determinants of non-attainment for target AUC, emphasizing the importance of vancomycin TDM and consideration of these factors in individualizing doses.