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Volume 11
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10.3390/antibiotics11070837
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Article

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

by
Jinjin Zhao
1,2,3,†,
Yaxin Fan
1,2,3,†,
Minjie Yang
1,2,3,
Xiaoyu Liang
1,2,3,
Jufang Wu
1,3,4,
Yuancheng Chen
1,3,4,
Beining Guo
1,2,3,
Huifang Zhang
5,
Ruilan Wang
5,
Fengying Zhang
6,
Jingqing Hang
6,
Huayin Li
7 and
Jing Zhang
1,2,3,4,*
1
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China
2
Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People′s China, Shanghai 200040, China
3
National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
4
Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai 200040, China
5
Emergency and Critical Care Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
6
Department of Pulmonary Medicine, Shanghai Putuo District People′s Hospital, Shanghai 200060, China
7
Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Antibiotics 2022, 11(7), 837; https://doi.org/10.3390/antibiotics11070837
Submission received: 6 May 2022 / Revised: 19 June 2022 / Accepted: 20 June 2022 / Published: 22 June 2022
(This article belongs to the Section Pharmacokinetics and Pharmacodynamics of Drugs)
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Abstract

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 (AUC24) 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 AUC24/MIC; therefore, higher than routine doses may be needed. Risk factors and ARC risk scoring systems are valuable for early identification.
Keywords: augmented renal clearance; vancomycin; pharmacokinetic/pharmacodynamic; area under the concentration–time curve to the minimal inhibitory concentration ratio; risk factor augmented renal clearance; vancomycin; pharmacokinetic/pharmacodynamic; area under the concentration–time curve to the minimal inhibitory concentration ratio; risk factor

Share and Cite

MDPI and ACS Style

Zhao, J.; Fan, Y.; Yang, M.; Liang, X.; Wu, J.; Chen, Y.; Guo, B.; Zhang, H.; Wang, R.; Zhang, F.; et al. Association between Augmented Renal Clearance and Inadequate Vancomycin Pharmacokinetic/Pharmacodynamic Targets in Chinese Adult Patients: A Prospective Observational Study. Antibiotics 2022, 11, 837. https://doi.org/10.3390/antibiotics11070837

AMA Style

Zhao J, Fan Y, Yang M, Liang X, Wu J, Chen Y, Guo B, Zhang H, Wang R, Zhang F, et al. Association between Augmented Renal Clearance and Inadequate Vancomycin Pharmacokinetic/Pharmacodynamic Targets in Chinese Adult Patients: A Prospective Observational Study. Antibiotics. 2022; 11(7):837. https://doi.org/10.3390/antibiotics11070837

Chicago/Turabian Style

Zhao, Jinjin, Yaxin Fan, Minjie Yang, Xiaoyu Liang, Jufang Wu, Yuancheng Chen, Beining Guo, Huifang Zhang, Ruilan Wang, Fengying Zhang, and et al. 2022. "Association between Augmented Renal Clearance and Inadequate Vancomycin Pharmacokinetic/Pharmacodynamic Targets in Chinese Adult Patients: A Prospective Observational Study" Antibiotics 11, no. 7: 837. https://doi.org/10.3390/antibiotics11070837

APA Style

Zhao, J., Fan, Y., Yang, M., Liang, X., Wu, J., Chen, Y., Guo, B., Zhang, H., Wang, R., Zhang, F., Hang, J., Li, H., & Zhang, J. (2022). Association between Augmented Renal Clearance and Inadequate Vancomycin Pharmacokinetic/Pharmacodynamic Targets in Chinese Adult Patients: A Prospective Observational Study. Antibiotics, 11(7), 837. https://doi.org/10.3390/antibiotics11070837

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