Phân tích kết quả hiệu chỉnh liều vancomycin theo AUC trên bệnh nhân người lớn tại Bệnh viện Phổi Trung ương

Abstract

Objective: To evaluate the results of implementing the AUC-guided vancomycin dosing protocol through therapeutic drug monitoring (TDM) and the Bayesian method, and to identify factors associated with the risk of subtherapeutic (AUC < 400mg·h/L) at the initial measurement. Subject and method: This retrospective, descriptive study was conducted to analyze the medical records of patients who were hospitalized from January 2024 to September 2024. Adult patients (≥ 18 years) receiving intravenous vancomycin underwent TDM following the hospital-approved protocol. The AUC estimated by the Bayesian method via SmartDoseAI software was utilized to adjust the dose with a target exposure of 400-600mg·h/L. Independent predictors of subtherapeutic exposure were identified using logistic regression. Result: A total of 93 patients were included, of whom 84.9% were male, with a median age of 64 years. The proportion of patients achieving the target AUC increased significantly from 52.7% at the first TDM to 83.5% after dose adjustment and re-assessment at the second TDM. Overall, 69.9% of patients attained the AUC target at least once during treatment. Logistic regression analysis indicated that an initial maintenance dose lower than the protocol recommendation was independently associated with a higher risk of subtherapeutic exposure (OR = 4.58, p=0.007). Conclusion: Vancomycin dosing adjustment using the Bayesian approach substantially improved the probability of therapeutic target attainment. These findings emphasize the importance of adherence to the TDM protocol and appropriate initial dose to facilitate earlier target attainment.