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Vancomycin AUC monitoring in individuals with cystic fibrosis at a pediatric institution S. Duehlmeyer1, C. Oermann1, E. Meier1, E. Elson1. 1Pulmonology, Children’s Mercy Kansas City, Kansas City, USA Background: Antibiotic therapy is essential for the treatment of cystic fibrosis (CF) lung infections. Methicillin-resistant Staphylococcus aureus (MRSA) infects 20% to 25% of people with CF (PwCF) and is associated with increased morbidity. Treatment of pulmonary exacerbations (PEs) often requires hospitalization including respiratory treatments and intravenous (IV) antimicrobials. IV vancomycin, which is commonly used for MRSA infections, requires serum concentration monitoring to ensure efficacy and minimize toxicity. Previous guidelines recommended trough concentrations to monitor efficacy and toxicity. Updated guidelines now recommend area under the curve (AUC) modeling as the optimal parameter for monitoring IV vancomycin. Methods: Children’s Mercy Kansas City (CMKC) changed IV vancomycin monitoring from trough to AUC/minimum inhibitory concentration (MIC) modeling on 01 May 2020 for PwCF. Two serum concentrations, a postdistributive and a trough, are obtained to estimate the AUC/MIC. A retrospective chart review collected trough monitoring data for all PwCF that received IV vancomycin at CMKC from01 January 2019 to 31 December 2019. Data for all PwCF treated with IV vancomycin after the AUC monitoring change were collected through 19 March 2021. Information on patient demographics, details of IV vancomycin therapy (dose, frequency, total exposure, nephrotoxicity), and monitoring data (serum concentrations, AUC modeling) were collected. Descriptive statistics were used to assess pre- and post-implementation data. Results: Before AUC monitoring, 25 patients received 42 courses of IV vancomycin; 14 were female (56%), and the median age was 14.02 years (4.25–20.25). Median treatment duration was 9.62 days (1.79–26.54), and median daily vancomycin exposure was 71.43 mg/kg/day (49.58–99.29). Target vancomycin trough concentration (≥15 μg/mL) was reached during 18 courses (43%). The median time to therapeutic trough was 83.58 hours (11.55–273.55) and required a median of 3 phlebotomies (1–9). Post-AUC there have been 15 courses of IV vancomycin in 8 PwCF; 5 were female (63%), and the median agewas 17.96 years (7.60–20.10). Median treatment duration was 9.52 days (5.68–14.63), and median daily vancomycin exposure was 75 mg/kg/day (48.63–92.80). All treatment courses reached target vancomycin AUC/MIC (400–600 μg/mL*h); median time to therapeutic AUC/MIC was 20.13 hours (11.6–106.12) and required a median of 3 phlebotomies (2–8). A median trough of 10 μg/mL (7–15 μg/mL) correlated with an AUC within target range. Conclusion: Changing to AUC monitoring for IV vancomycin in PwCF was not associated with a significant change in vancomycin daily exposure or duration. Fifty-seven percent more individuals achieved therapeutic targets with AUC monitoring (n = 15, 100%) than with trough monitoring (n = 18, 43%). AUC monitoring decreased time to therapeutic target by 63.45 hours. Trough concentrations of 15 μg/mL or less correlated with target AUC/MIC. A difference in nephrotoxicity was not seen. Study limitations include short postimplementation period (10 months) and small sample size. Ongoing data collection is planned.


Medicine and Health Sciences | Pediatrics | Pharmacy and Pharmaceutical Sciences | Pulmonology


Presented at the North American Cystic Fibrosis Conference, November 2-5, 2021, Virtual.

Vancomycin AUC monitoring in individuals with cystic fibrosis at a pediatric institution