Vancomycin monitoring based on area under the concentration–time curve

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The purpose of this study was to (1) determine whether academic medical centers implemented area under the concentration–time curve (AUC)–based monitoring for vancomycin and (2) characterize perceived barriers to implementation and challenges experienced during the implementation process” Kufel et al (2019).

Abstract:

Purpose: The purpose of this study was to (1) determine whether academic medical centers implemented area under the concentration–time curve (AUC)–based monitoring for vancomycin and (2) characterize perceived barriers to implementation and challenges experienced during the implementation process.

Methods: A multicenter, cross-sectional electronic survey was distributed to pharmacy representatives from 124 academic medical centers within the Vizient University Health System Consortium Pharmacy Network.

Results: Seventy-eight institutions completed the survey, representing a 62.9% response rate. Most institutions were approximately 500–1,000 beds (68/78, 87.2%), and pharmacists were primarily responsible for vancomycin therapeutic drug monitoring (66/78, 84.6%) using pharmacist-driven protocols (57/78, 73.1%). Less than one fourth (18/78, 23.1%) of responding academic medical centers performed AUC-based vancomycin monitoring, and the majority (12/18, 66.7%) used 2-point pharmacokinetics, with a smaller fraction using either Bayesian software or population-based pharmacokinetics. Of the responding institutions that only perform trough-based therapeutic drug monitoring (60/78, 76.9%), most (53/60, 88.3%) did not plan to or were unsure about transitioning to AUC-based monitoring within the next year. Both the most common challenge encountered (13/18, 72.2%) for institutions performing AUC-based monitoring and the most common barrier (44/60, 73.3%) to implementation of this monitoring strategy were pharmacist and/or provider unfamiliarity.

Conclusion: The majority of surveyed academic medical centers have not yet implemented AUC-based vancomycin monitoring, and most institutions did not plan to adopt or were unsure about adopting this monitoring strategy within the next year.

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Reference:

Kufel, W.D., Seabury, R.W., Mogle, B.T., Beccari, M.V., Probst, L.A. and Steele, J.M. (2019) Readiness to implement vancomycin monitoring based on area under the concentration–time curve: A cross-sectional survey of a national health consortium. American Journal of Health-System Pharmacy. 76(12), p.889–894. https://doi.org/10.1093/ajhp/zxz070.

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