Abstract
Vancomycin is a glycopeptide antibiotic that is used to treat serious infections. When present in toxic concentrations, vancomycin can cause renal damage and hearing loss, 1 so therapeutic monitoring of the drug is advocated, particularly in the presence of renal impairment. Auores- cence polarization assay using the Abbott TDx (Abbott Laboratories, Abbott Park IL, USA) is still a common method of measuring vancomy- cin, although many laboratories have switched to an updated method employing a monoclonal antibody (Vancomycin II) on the Abbott AxSYM. In the process of making this change in our laboratory, we conducted comparison studies of vancomycin results from the two instruments and found marked discrepancies in plasma samples that had very high concentra- tions of conjugated bilirubin. We then carried out spiking experiments to determine which method was giving the incorrect results. METHODS AND RESULTS The Abbott TDx and AxSYM systems were used to measure vancomycin concentrations in 28 plasma samples obtained from patients with total bilirubin concentrations of less than
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