Đánh giá tính khả thi của mô hình định lượng vancomycin tập trung phục vụ giám sát nồng độ thuốc tại một số bệnh viện tỉnh Phú Thọ

Abstract

Objective: To evaluate the feasibility of a centralized vancomycin assay model for implementing therapeutic drug monitoring (TDM) across hospitals in Phu Tho Province, Vietnam.Subject and method: A prospective observational study was conducted at three hospitals in Phu Tho Province. Participating in hospitals were responsible for patient selection and blood sampling and handling according to a standardized protocol. Samples were transported to a central assay center for vancomycin concentration measurement. The measured concentrations were combined with dosing regimens and patient characteristics to estimate the 24-hour area under the concentration–time curve (AUC₂₄) using a Bayesian approach and to provide dose adjustment recommendations when indicated. Key outcomes included the proportion of samples meeting analytical requirements, turnaround time, the feasibility of pharmacokinetic interpretation and provision of dose recommendations, implementation of recommendations, and attainment of the target AUC₂₄ of 400-600 mg·h/L. Result: The study included 193 patients and approximately 400 vancomycin concentration measurements. All samples included in the analysis met the requirements for vancomycin assay. The median time from sampling to availability of results was 1.19 hours at the central assay center, 4.25 hours at Phu Tho Provincial General Hospital, and 3.79 hours at Thanh Thuy Regional Medical Center. More than 94% of samples from the referring facilities were available within 24 hours. Target AUC₂₄ attainment at the first TDM assessment ranged from 38.4% to 52.4% and increased to 56.4%–72.7% among patients who underwent reassessment after dose adjustment. Conclusion: The centralized vancomycin assay model was feasible for expanding access to TDM across healthcare facilities, with a high proportion of samples meeting assay requirements and turnaround times compatible with dose decision-making. The model also facilitated AUC-based TDM and supported individualized vancomycin dosing across hospitals with different levels of available resources.