Abstract
Background and Objectives: Management of infectious diseases is a huge burden to every healthcare system worldwide. Antimicrobial resistance, including antibacterial resistance, is an increasing problem worldwide; therefore, more new antibiotics are necessary to be discovered. Meanwhile, “old” antibacterial agents are still administered to fight infectious diseases caused by resistant bacteria. One of these antibacterial agents is vancomycin, which is effective in treating serious systemic infections caused by gram-positive bacteria. Thus, it is necessary to perform vancomycin concentration measurements in plasma due to its narrow therapeutic index. Various approaches are implemented for more precise therapy, including therapeutic drug monitoring (TDM) of vancomycin and with a supervision of a clinical pharmacist. The purpose of the study was to investigate if the TDM practice is improved with a local vancomycin TDM protocol applied in a hospital. The results of TDM in two multidisciplinary hospitals, one with a local TDM protocol implemented and applied and the other with no local TDM protocol implemented and applied, were compared. Materials and Methods: A retrospective study was performed in two multidisciplinary hospitals in Latvia. The data were collected for a time period of 4 years (2016–2020) in a hospital without a local TDM protocol and for a time period of 2 years (2018–2020) in a hospital with a local TDM protocol, starting with a period of time when the vancomycin TDM protocol was developed. The data about the patients included in the study were analyzed based on gender, age, body weight, and renal function. Vancomycin therapy was analyzed based on dosing schemes (vancomycin dose and dosing interval), data about loading and maintenance doses, vancomycin concentration, and details about vancomycin concentration (sampling time and concentration level). Results: Differences between the hospitals were found in terms of the initiation of vancomycin administration and concentration sampling. In the hospital with a TDM protocol compared with the hospital without a TDM protocol, more accurate initiation was found, alongside adaption of therapy (97.22% vs. 18.95%, p < 0.001), better performance of administration of a loading dose (22.73% vs. 1.29%, p < 0.01), and reaching of target concentration (55.56% vs. 35.29%, p < 0.01). Concentration sampling in the correct timeframe before the vancomycin dose and vancomycin administration did not show statistically better results in either of the hospitals (4.60% vs. 6.29%, p = 0.786). Conclusions: Better results of adequate adjustments of vancomycin therapy were achieved in the hospital with a TDM protocol. In the long term, sustainable results and regular medical professionals’ training is necessary.
Highlights
Antimicrobial resistance is an increasing problem worldwide; it is necessary to discover new antibiotics
The loading dose is calculated based on the body weight, which is recommended for an initiation of vancomycin therapy, followed by maintenance doses dependent on renal function
Vancomycin concentration of the first therapeutic drug monitoring (TDM) was in the therapeutic range (10–20 mg/L) for 52.27% of patients in the hospital with a TDM protocol, compared to only 29.37% in the hospital without a TDM protocol (p = 0.011). These results indicate that a more superior choice of the initial dosing regimen of vancomycin is performed in the hospital with a TDM protocol
Summary
Antimicrobial resistance is an increasing problem worldwide; it is necessary to discover new antibiotics. “old” antibacterial agents are still administered to fight infectious diseases caused by resistant bacteria One of these antibacterial agents is vancomycin. Vancomycin is a glycopeptide antibiotic that acts against a variety of Grampositive bacteria, including methicillin-resistant Staphylococcus aureus One of these antibacterial agents is vancomycin, which is effective in treating serious systemic infections caused by gram-positive bacteria. Results: Differences between the hospitals were found in terms of the initiation of vancomycin administration and concentration sampling. In the hospital with a TDM protocol compared with the hospital without a TDM protocol, more accurate initiation was found, alongside adaption of therapy (97.22% vs 18.95%, p < 0.001), better performance of administration of a loading dose (22.73% vs 1.29%, p < 0.01), and reaching of target concentration (55.56% vs 35.29%, p < 0.01). Sustainable results and regular medical professionals’ training is necessary
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