Association between Augmented Renal Clearance and Inadequate Vancomycin Pharmacokinetic/Pharmacodynamic Targets in Chinese Adult Patients: A Prospective Observational Study

• Published in: Antibiotics
• Main Authors: Zhao, Jinjin, Fan, Yaxin, Yang, Minjie, Liang, Xiaoyu, Wu, Jufang, Chen, Yuancheng, Guo, Beining, Zhang, Huifang, Wang, Ruilan, Zhang, Fengying, Hang, Jingqing, Li, Huayin, Zhang, Jing
• Format: Text
• Language: English
• Published: MDPI 2022
• Subjects: Article; Arctic
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9312211/; http://www.ncbi.nlm.nih.gov/pubmed/35884091; https://doi.org/10.3390/antibiotics11070837

This study aimed to examine the risk factors of augmented renal clearance (ARC) and the association between ARC and vancomycin pharmacokinetic/pharmacodynamic (PK/PD) indices in Chinese adult patients. A prospective, observational, multicenter study was conducted, and 414 adult patients undergoing vancomycin therapeutic drug monitoring (TDM) were enrolled. Clinical and PK/PD data were compared between ARC and non-ARC groups. Independent risk factors were examined using a multivariate logistic regression analysis. The ARC and augmented renal clearance in trauma intensive care (ARCTIC) scoring systems were evaluated. Eighty-eight of the enrolled patients (88/414, 21.3%) had ARC before vancomycin therapy. Patients with ARC were more likely to have subtherapeutic vancomycin PK/PD indices, including trough concentration (p = 0.003) and 24 h area under the concentration–time curve (AUC(24)) to minimal inhibitory concentration (MIC) ratio (p < 0.001). Male sex (OR = 2.588), age < 50 years (OR = 2.713), overweight (OR = 2.072), receiving mechanical ventilation (OR = 1.785), enteral nutrition (OR = 2.317), neutrophil percentage (OR = 0.975), and cardiovascular diseases (OR = 0.281) were significantly associated with ARC. In conclusion, ARC is associated with subtherapeutic vancomycin trough concentration and AUC(24)/MIC; therefore, higher than routine doses may be needed. Risk factors and ARC risk scoring systems are valuable for early identification.