Abstract：
OBJECTIVE: To evaluate the effectiveness of an antimicrobial guideline for vancomycin prescribing deployed using electronic prescribing aid and web/phone-based app. To define factors associated with guideline compliance and drug levels, and to investigate if antimicrobial dosing recommendations can be refined using routinely collected electronic healthcare record data.
METHODS: We used data from Oxford University Hospitals between 01-January-2016 and 01-June-2021 and multivariable regression models to investigate factors associated with dosing compliance, drug levels and acute kidney injury (AKI).
RESULTS: 3767 patients received intravenous vancomycin for ≥24 h. Compliance with recommended loading and initial maintenance doses reached 84% and 70% respectively; 72% of subsequent maintenance doses were correctly adjusted. However, only 26% first and 32% subsequent levels reached the target range, and for patients with ongoing vancomycin treatment, 55-63% achieved target levels at 5 days. Drug levels were independently higher in older patients. Incidence of AKI was low (5.7%). Model estimates were used to propose updated age, weight and eGFR specific guidelines.
CONCLUSIONS: Despite good compliance with guidelines for vancomycin dosing, the proportion of drug levels achieving the target range remained suboptimal. Routinely collected electronic data can be used at scale to inform pharmacokinetic studies and could improve vancomycin dosing.
METHODS: We used data from Oxford University Hospitals between 01-January-2016 and 01-June-2021 and multivariable regression models to investigate factors associated with dosing compliance, drug levels and acute kidney injury (AKI).
RESULTS: 3767 patients received intravenous vancomycin for ≥24 h. Compliance with recommended loading and initial maintenance doses reached 84% and 70% respectively; 72% of subsequent maintenance doses were correctly adjusted. However, only 26% first and 32% subsequent levels reached the target range, and for patients with ongoing vancomycin treatment, 55-63% achieved target levels at 5 days. Drug levels were independently higher in older patients. Incidence of AKI was low (5.7%). Model estimates were used to propose updated age, weight and eGFR specific guidelines.
CONCLUSIONS: Despite good compliance with guidelines for vancomycin dosing, the proportion of drug levels achieving the target range remained suboptimal. Routinely collected electronic data can be used at scale to inform pharmacokinetic studies and could improve vancomycin dosing.
摘要：
目的：评估使用电子处方辅助和基于网络/电话的应用程序部署的万古霉素处方抗菌指南的有效性。为了定义与指南依从性和药物水平相关的因素，并调查是否可以使用常规收集的电子医疗记录数据来完善抗菌药物给药建议。
方法：我们使用2016年1月1日至2021年6月1日牛津大学医院的数据和多变量回归模型来调查与给药依从性相关的因素，药物水平和急性肾损伤（AKI）。
结果：3767例患者静脉注射万古霉素≥24小时。对推荐剂量和初始维持剂量的依从性分别达到84%和70%；随后72％的维持剂量得到了正确调整。然而,只有26%的第一和32%的后续水平达到目标范围，对于正在进行万古霉素治疗的患者，55-63%在5天达到目标水平。老年患者的药物水平独立较高。AKI发生率较低（5.7%）。模型估计被用来提出更新的年龄，体重和eGFR特定指南。
结论：尽管万古霉素给药指南的依从性良好，药物水平达到目标范围的比例仍然不理想.常规收集的电子数据可以大规模用于药代动力学研究，并可以改善万古霉素的给药。
方法：我们使用2016年1月1日至2021年6月1日牛津大学医院的数据和多变量回归模型来调查与给药依从性相关的因素，药物水平和急性肾损伤（AKI）。
结果：3767例患者静脉注射万古霉素≥24小时。对推荐剂量和初始维持剂量的依从性分别达到84%和70%；随后72％的维持剂量得到了正确调整。然而,只有26%的第一和32%的后续水平达到目标范围，对于正在进行万古霉素治疗的患者，55-63%在5天达到目标水平。老年患者的药物水平独立较高。AKI发生率较低（5.7%）。模型估计被用来提出更新的年龄，体重和eGFR特定指南。
结论：尽管万古霉素给药指南的依从性良好，药物水平达到目标范围的比例仍然不理想.常规收集的电子数据可以大规模用于药代动力学研究，并可以改善万古霉素的给药。
