Model-informed AUC-guided dosing for parenteral vancomycin in critically ill patients: impact on target attainment and renal safety - a pre-post intervention study.

BACKGROUND: Parenteral vancomycin is essential for the treatment of certain gram-positive infections but is associated with acute kidney injury (AKI). The 2020 IDSA guideline recommends AUC24-based dosing for MRSA to increase treatment safety. Due to the low MRSA prevalence at the University Hospital of Würzburg (UKW), this study investigated the impact of model-informed precision dosing (MIPD) of vancomycin on AKI incidence and target attainment in MRSA and non-MRSA infections. METHODS: This pre-post intervention study compared a retrospective group (January 1, 2019 - June 30, 2021) with a prospective group (October 17, 2022 - December 31, 2023), including critically ill patients from intensive and intermediate care units. The prospective group received AUC24-based MIPD using Bayesian pharmacometric modeling performed by a clinical pharmacist. The primary outcome was the incidence of AKI. Secondary outcomes included vancomycin therapeutic target attainment and the proportions of therapies within, below, and above the therapeutic range. RESULTS: AKI occurred in 27.8% of the retrospective group and 14.0% of the prospective group (p = 0.04). The AUC-based group achieved therapeutic targets more frequently (70.2% vs. 55.1%, p = 0.049) and had fewer supratherapeutic levels (8.8% vs. 24.5%, p = 0.01). CONCLUSIONS: AUC24-based MIPD for vancomycin improved therapeutic target attainment and was associated with a lower observed incidence of AKI. These findings support further evaluation of AUC-guided dosing for both MRSA and non-MRSA infections.