| Characteristic . | Trough-Guided (n = 150) . | AUC-Guided (n = 150) . | P Value . |
|---|---|---|---|
| Age, y, mean ± SD | 53 ± 16 | 55 ± 15 | .400 |
| Race | |||
| White | 88 (58.7) | 95 (63.3) | .407 |
| African American | 53 (35.3) | 48 (32.0) | .541 |
| Hispanic | 4 (2.7) | 2 (1.3) | .684 |
| Other | 5 (3.3) | 5 (3.3) | 1.0 |
| Male sex | 99 (66.0) | 88 (58.7) | .190 |
| Weight, kg, mean ± SD | 88.1 ± 25.8 | 86.2 ± 28.7 | .544 |
| BMI, kg/m2, mean ± SD | 28.3 ± 7.5 | 28.5 ± 9.1 | .852 |
| Baseline eGFR, mL/min | |||
| >60 | 120 (80.0) | 111 (74.0) | .217 |
| 50–60 | 11 (7.3) | 24 (16.0) | .019 |
| 40–49 | 6 (4.0) | 8 (5.3) | .584 |
| 30–39 | 13 (8.7) | 7 (4.7) | .165 |
| Chronic kidney disease | 5 (3.3) | 13 (8.7) | .052 |
| Diabetes mellitus | 47 (31.3) | 40 (26.7) | .373 |
| Cardiovascular disease | 56 (37.3) | 58 (38.7) | .812 |
| Cirrhosis | 5 (3.3) | 7 (4.7) | .556 |
| IV drug use | 11 (7.3) | 14 (9.3) | .531 |
| Immunocompromised | 22 (14.7) | 21 (14.0) | .869 |
| Pitt bacteremia score, mean ± SD | 0.59 ± 0.86 | 0.67 ± 0.97 | .451 |
| ICU level of care at vancomycin initiation | 53 (35.3) | 42 (28.0) | .172 |
| Mechanical ventilation at treatment initiation | 24 (16.0) | 18 (12.0) | .318 |
| Vasopressor support at treatment initiation | 9 (6.0) | 9 (6.0) | 1.0 |
| Concurrent antimicrobials at treatment initiation | 139 (92.7) | 133 (88.7) | .234 |
| Infectious diseases consult | 117 (78.0) | 110 (73.3) | .346 |
| Concurrent nephrotoxinsa | 115 (76.7) | 106 (70.7) | .238 |
| Bacteremia | 98 (65.3) | 97 (64.7) | .904 |
| Source control indicated but not achieved | 14 (9.3) | 14 (9.3) | 1.0 |
| Clinical diagnosis | .131 | ||
| Endocarditis | 4 (2.7) | 12 (8.0) | – |
| Osteomyelitis or prosthetic joint infection | 31 (20.7) | 19 (12.7) | – |
| Skin and soft tissue | 25 (16.7) | 26 (17.3) | – |
| Line-associated infection | 13 (8.7) | 8 (5.3) | – |
| Unknown | 33 (22.0) | 36 (24.0) | – |
| Otherb | 44 (29.3) | 49 (32.7) | – |
| Organism | .170 | ||
| Staphylococcus aureus | 66 (44.0) | 62 (41.3) | – |
| Methicillin susceptible | 15 (10.0) | 9 (6.0) | |
| Methicillin resistant | 51 (34.0) | 53 (35.3) | |
| Coagulase-negative staphylococci | 41 (27.3) | 52 (34.7) | – |
| Enterococcus faecalis | 7 (4.7) | 6 (4.0) | – |
| Streptococcus spp | 5 (3.3) | 11 (7.3) | – |
| Polymicrobial including S aureus | 11 (7.3) | 10 (6.7) | – |
| Polymicrobial not including S aureus | 17 (11.3) | 6 (4) | – |
| Other | 3 (2.0) | 3 (2.0) | – |
| Inpatient vancomycin treatment duration, d, mean ± SD | 9.6 ± 8.0 | 8.5 ± 5.6 | .164 |
| Receipt of loading dose | 13 (8.7) | 14 (9.3) | .840 |
| Loading dose, mg/kg, mean ± SD | 24.6 ± 2.8 | 25.3 ± 2.7 | .525 |
| Total daily dose of initial regimen, mg/kg, mean ± SD | 26.6 ± 11.0 | 21.7 ± 7.8 | <.001 |
| Vancomycin concentrations obtained per course, mean ± SD | 3.6 ± 2.6 | 4.5 ± 2.4 | .003 |
| Time to initial vancomycin concentration, h, mean ± SD | 44.8 ± 22.3 | 23.8 ± 14.1 | <.001 |
| Obtained within 72 h of first dose, mean ± SD | 1.4 ± 0.8 | 1.9 ± 0.8 | <.001 |
| Added to another blood draw, mean ± SD | 0.7 ± 0.9 | 1.7 ± 1.7 | <.001 |
| Characteristic . | Trough-Guided (n = 150) . | AUC-Guided (n = 150) . | P Value . |
|---|---|---|---|
| Age, y, mean ± SD | 53 ± 16 | 55 ± 15 | .400 |
| Race | |||
| White | 88 (58.7) | 95 (63.3) | .407 |
| African American | 53 (35.3) | 48 (32.0) | .541 |
| Hispanic | 4 (2.7) | 2 (1.3) | .684 |
| Other | 5 (3.3) | 5 (3.3) | 1.0 |
| Male sex | 99 (66.0) | 88 (58.7) | .190 |
| Weight, kg, mean ± SD | 88.1 ± 25.8 | 86.2 ± 28.7 | .544 |
| BMI, kg/m2, mean ± SD | 28.3 ± 7.5 | 28.5 ± 9.1 | .852 |
| Baseline eGFR, mL/min | |||
| >60 | 120 (80.0) | 111 (74.0) | .217 |
| 50–60 | 11 (7.3) | 24 (16.0) | .019 |
| 40–49 | 6 (4.0) | 8 (5.3) | .584 |
| 30–39 | 13 (8.7) | 7 (4.7) | .165 |
| Chronic kidney disease | 5 (3.3) | 13 (8.7) | .052 |
| Diabetes mellitus | 47 (31.3) | 40 (26.7) | .373 |
| Cardiovascular disease | 56 (37.3) | 58 (38.7) | .812 |
| Cirrhosis | 5 (3.3) | 7 (4.7) | .556 |
| IV drug use | 11 (7.3) | 14 (9.3) | .531 |
| Immunocompromised | 22 (14.7) | 21 (14.0) | .869 |
| Pitt bacteremia score, mean ± SD | 0.59 ± 0.86 | 0.67 ± 0.97 | .451 |
| ICU level of care at vancomycin initiation | 53 (35.3) | 42 (28.0) | .172 |
| Mechanical ventilation at treatment initiation | 24 (16.0) | 18 (12.0) | .318 |
| Vasopressor support at treatment initiation | 9 (6.0) | 9 (6.0) | 1.0 |
| Concurrent antimicrobials at treatment initiation | 139 (92.7) | 133 (88.7) | .234 |
| Infectious diseases consult | 117 (78.0) | 110 (73.3) | .346 |
| Concurrent nephrotoxinsa | 115 (76.7) | 106 (70.7) | .238 |
| Bacteremia | 98 (65.3) | 97 (64.7) | .904 |
| Source control indicated but not achieved | 14 (9.3) | 14 (9.3) | 1.0 |
| Clinical diagnosis | .131 | ||
| Endocarditis | 4 (2.7) | 12 (8.0) | – |
| Osteomyelitis or prosthetic joint infection | 31 (20.7) | 19 (12.7) | – |
| Skin and soft tissue | 25 (16.7) | 26 (17.3) | – |
| Line-associated infection | 13 (8.7) | 8 (5.3) | – |
| Unknown | 33 (22.0) | 36 (24.0) | – |
| Otherb | 44 (29.3) | 49 (32.7) | – |
| Organism | .170 | ||
| Staphylococcus aureus | 66 (44.0) | 62 (41.3) | – |
| Methicillin susceptible | 15 (10.0) | 9 (6.0) | |
| Methicillin resistant | 51 (34.0) | 53 (35.3) | |
| Coagulase-negative staphylococci | 41 (27.3) | 52 (34.7) | – |
| Enterococcus faecalis | 7 (4.7) | 6 (4.0) | – |
| Streptococcus spp | 5 (3.3) | 11 (7.3) | – |
| Polymicrobial including S aureus | 11 (7.3) | 10 (6.7) | – |
| Polymicrobial not including S aureus | 17 (11.3) | 6 (4) | – |
| Other | 3 (2.0) | 3 (2.0) | – |
| Inpatient vancomycin treatment duration, d, mean ± SD | 9.6 ± 8.0 | 8.5 ± 5.6 | .164 |
| Receipt of loading dose | 13 (8.7) | 14 (9.3) | .840 |
| Loading dose, mg/kg, mean ± SD | 24.6 ± 2.8 | 25.3 ± 2.7 | .525 |
| Total daily dose of initial regimen, mg/kg, mean ± SD | 26.6 ± 11.0 | 21.7 ± 7.8 | <.001 |
| Vancomycin concentrations obtained per course, mean ± SD | 3.6 ± 2.6 | 4.5 ± 2.4 | .003 |
| Time to initial vancomycin concentration, h, mean ± SD | 44.8 ± 22.3 | 23.8 ± 14.1 | <.001 |
| Obtained within 72 h of first dose, mean ± SD | 1.4 ± 0.8 | 1.9 ± 0.8 | <.001 |
| Added to another blood draw, mean ± SD | 0.7 ± 0.9 | 1.7 ± 1.7 | <.001 |
Data are presented as No. (%) unless otherwise indicated.
Abbreviations: AUC, area under the curve; BMI, body mass index; eGFR, estimated glomerular filtration rate; ICU, intensive care unit; IV, intravenous; SD, standard deviation.
aNephrotoxic agents: aminoglycosides, amphotericin B, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, cidofovir, cisplatin, contrast dye, IV cyclosporine, ganciclovir, interferon-α, lithium, loop diuretics, methotrexate, nonsteroidal anti-inflammatory agents, pentamidine, piperacillin-tazobactam, phenytoin, tenofovir disoproxil fumarate, thiazide diuretics, trimethoprim-sulfamethoxazole, tacrolimus.
bOther infection types included pneumonia (trough-guided: n = 7; AUC-guided: n = 10), septic arthritis (trough-guided: n = 5; AUC-guided: n = 4), meningitis (trough-guided: n = 1; AUC-guided: n = 0), urinary tract infections (trough-guided: n = 3; AUC-guided: n = 6), intra-abdominal infections (trough-guided: n = 7; AUC-guided: n = 3), and surgical site infections (trough-guided: n = 10; AUC-guided: n = 8).
| Characteristic . | Trough-Guided (n = 150) . | AUC-Guided (n = 150) . | P Value . |
|---|---|---|---|
| Age, y, mean ± SD | 53 ± 16 | 55 ± 15 | .400 |
| Race | |||
| White | 88 (58.7) | 95 (63.3) | .407 |
| African American | 53 (35.3) | 48 (32.0) | .541 |
| Hispanic | 4 (2.7) | 2 (1.3) | .684 |
| Other | 5 (3.3) | 5 (3.3) | 1.0 |
| Male sex | 99 (66.0) | 88 (58.7) | .190 |
| Weight, kg, mean ± SD | 88.1 ± 25.8 | 86.2 ± 28.7 | .544 |
| BMI, kg/m2, mean ± SD | 28.3 ± 7.5 | 28.5 ± 9.1 | .852 |
| Baseline eGFR, mL/min | |||
| >60 | 120 (80.0) | 111 (74.0) | .217 |
| 50–60 | 11 (7.3) | 24 (16.0) | .019 |
| 40–49 | 6 (4.0) | 8 (5.3) | .584 |
| 30–39 | 13 (8.7) | 7 (4.7) | .165 |
| Chronic kidney disease | 5 (3.3) | 13 (8.7) | .052 |
| Diabetes mellitus | 47 (31.3) | 40 (26.7) | .373 |
| Cardiovascular disease | 56 (37.3) | 58 (38.7) | .812 |
| Cirrhosis | 5 (3.3) | 7 (4.7) | .556 |
| IV drug use | 11 (7.3) | 14 (9.3) | .531 |
| Immunocompromised | 22 (14.7) | 21 (14.0) | .869 |
| Pitt bacteremia score, mean ± SD | 0.59 ± 0.86 | 0.67 ± 0.97 | .451 |
| ICU level of care at vancomycin initiation | 53 (35.3) | 42 (28.0) | .172 |
| Mechanical ventilation at treatment initiation | 24 (16.0) | 18 (12.0) | .318 |
| Vasopressor support at treatment initiation | 9 (6.0) | 9 (6.0) | 1.0 |
| Concurrent antimicrobials at treatment initiation | 139 (92.7) | 133 (88.7) | .234 |
| Infectious diseases consult | 117 (78.0) | 110 (73.3) | .346 |
| Concurrent nephrotoxinsa | 115 (76.7) | 106 (70.7) | .238 |
| Bacteremia | 98 (65.3) | 97 (64.7) | .904 |
| Source control indicated but not achieved | 14 (9.3) | 14 (9.3) | 1.0 |
| Clinical diagnosis | .131 | ||
| Endocarditis | 4 (2.7) | 12 (8.0) | – |
| Osteomyelitis or prosthetic joint infection | 31 (20.7) | 19 (12.7) | – |
| Skin and soft tissue | 25 (16.7) | 26 (17.3) | – |
| Line-associated infection | 13 (8.7) | 8 (5.3) | – |
| Unknown | 33 (22.0) | 36 (24.0) | – |
| Otherb | 44 (29.3) | 49 (32.7) | – |
| Organism | .170 | ||
| Staphylococcus aureus | 66 (44.0) | 62 (41.3) | – |
| Methicillin susceptible | 15 (10.0) | 9 (6.0) | |
| Methicillin resistant | 51 (34.0) | 53 (35.3) | |
| Coagulase-negative staphylococci | 41 (27.3) | 52 (34.7) | – |
| Enterococcus faecalis | 7 (4.7) | 6 (4.0) | – |
| Streptococcus spp | 5 (3.3) | 11 (7.3) | – |
| Polymicrobial including S aureus | 11 (7.3) | 10 (6.7) | – |
| Polymicrobial not including S aureus | 17 (11.3) | 6 (4) | – |
| Other | 3 (2.0) | 3 (2.0) | – |
| Inpatient vancomycin treatment duration, d, mean ± SD | 9.6 ± 8.0 | 8.5 ± 5.6 | .164 |
| Receipt of loading dose | 13 (8.7) | 14 (9.3) | .840 |
| Loading dose, mg/kg, mean ± SD | 24.6 ± 2.8 | 25.3 ± 2.7 | .525 |
| Total daily dose of initial regimen, mg/kg, mean ± SD | 26.6 ± 11.0 | 21.7 ± 7.8 | <.001 |
| Vancomycin concentrations obtained per course, mean ± SD | 3.6 ± 2.6 | 4.5 ± 2.4 | .003 |
| Time to initial vancomycin concentration, h, mean ± SD | 44.8 ± 22.3 | 23.8 ± 14.1 | <.001 |
| Obtained within 72 h of first dose, mean ± SD | 1.4 ± 0.8 | 1.9 ± 0.8 | <.001 |
| Added to another blood draw, mean ± SD | 0.7 ± 0.9 | 1.7 ± 1.7 | <.001 |
| Characteristic . | Trough-Guided (n = 150) . | AUC-Guided (n = 150) . | P Value . |
|---|---|---|---|
| Age, y, mean ± SD | 53 ± 16 | 55 ± 15 | .400 |
| Race | |||
| White | 88 (58.7) | 95 (63.3) | .407 |
| African American | 53 (35.3) | 48 (32.0) | .541 |
| Hispanic | 4 (2.7) | 2 (1.3) | .684 |
| Other | 5 (3.3) | 5 (3.3) | 1.0 |
| Male sex | 99 (66.0) | 88 (58.7) | .190 |
| Weight, kg, mean ± SD | 88.1 ± 25.8 | 86.2 ± 28.7 | .544 |
| BMI, kg/m2, mean ± SD | 28.3 ± 7.5 | 28.5 ± 9.1 | .852 |
| Baseline eGFR, mL/min | |||
| >60 | 120 (80.0) | 111 (74.0) | .217 |
| 50–60 | 11 (7.3) | 24 (16.0) | .019 |
| 40–49 | 6 (4.0) | 8 (5.3) | .584 |
| 30–39 | 13 (8.7) | 7 (4.7) | .165 |
| Chronic kidney disease | 5 (3.3) | 13 (8.7) | .052 |
| Diabetes mellitus | 47 (31.3) | 40 (26.7) | .373 |
| Cardiovascular disease | 56 (37.3) | 58 (38.7) | .812 |
| Cirrhosis | 5 (3.3) | 7 (4.7) | .556 |
| IV drug use | 11 (7.3) | 14 (9.3) | .531 |
| Immunocompromised | 22 (14.7) | 21 (14.0) | .869 |
| Pitt bacteremia score, mean ± SD | 0.59 ± 0.86 | 0.67 ± 0.97 | .451 |
| ICU level of care at vancomycin initiation | 53 (35.3) | 42 (28.0) | .172 |
| Mechanical ventilation at treatment initiation | 24 (16.0) | 18 (12.0) | .318 |
| Vasopressor support at treatment initiation | 9 (6.0) | 9 (6.0) | 1.0 |
| Concurrent antimicrobials at treatment initiation | 139 (92.7) | 133 (88.7) | .234 |
| Infectious diseases consult | 117 (78.0) | 110 (73.3) | .346 |
| Concurrent nephrotoxinsa | 115 (76.7) | 106 (70.7) | .238 |
| Bacteremia | 98 (65.3) | 97 (64.7) | .904 |
| Source control indicated but not achieved | 14 (9.3) | 14 (9.3) | 1.0 |
| Clinical diagnosis | .131 | ||
| Endocarditis | 4 (2.7) | 12 (8.0) | – |
| Osteomyelitis or prosthetic joint infection | 31 (20.7) | 19 (12.7) | – |
| Skin and soft tissue | 25 (16.7) | 26 (17.3) | – |
| Line-associated infection | 13 (8.7) | 8 (5.3) | – |
| Unknown | 33 (22.0) | 36 (24.0) | – |
| Otherb | 44 (29.3) | 49 (32.7) | – |
| Organism | .170 | ||
| Staphylococcus aureus | 66 (44.0) | 62 (41.3) | – |
| Methicillin susceptible | 15 (10.0) | 9 (6.0) | |
| Methicillin resistant | 51 (34.0) | 53 (35.3) | |
| Coagulase-negative staphylococci | 41 (27.3) | 52 (34.7) | – |
| Enterococcus faecalis | 7 (4.7) | 6 (4.0) | – |
| Streptococcus spp | 5 (3.3) | 11 (7.3) | – |
| Polymicrobial including S aureus | 11 (7.3) | 10 (6.7) | – |
| Polymicrobial not including S aureus | 17 (11.3) | 6 (4) | – |
| Other | 3 (2.0) | 3 (2.0) | – |
| Inpatient vancomycin treatment duration, d, mean ± SD | 9.6 ± 8.0 | 8.5 ± 5.6 | .164 |
| Receipt of loading dose | 13 (8.7) | 14 (9.3) | .840 |
| Loading dose, mg/kg, mean ± SD | 24.6 ± 2.8 | 25.3 ± 2.7 | .525 |
| Total daily dose of initial regimen, mg/kg, mean ± SD | 26.6 ± 11.0 | 21.7 ± 7.8 | <.001 |
| Vancomycin concentrations obtained per course, mean ± SD | 3.6 ± 2.6 | 4.5 ± 2.4 | .003 |
| Time to initial vancomycin concentration, h, mean ± SD | 44.8 ± 22.3 | 23.8 ± 14.1 | <.001 |
| Obtained within 72 h of first dose, mean ± SD | 1.4 ± 0.8 | 1.9 ± 0.8 | <.001 |
| Added to another blood draw, mean ± SD | 0.7 ± 0.9 | 1.7 ± 1.7 | <.001 |
Data are presented as No. (%) unless otherwise indicated.
Abbreviations: AUC, area under the curve; BMI, body mass index; eGFR, estimated glomerular filtration rate; ICU, intensive care unit; IV, intravenous; SD, standard deviation.
aNephrotoxic agents: aminoglycosides, amphotericin B, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, cidofovir, cisplatin, contrast dye, IV cyclosporine, ganciclovir, interferon-α, lithium, loop diuretics, methotrexate, nonsteroidal anti-inflammatory agents, pentamidine, piperacillin-tazobactam, phenytoin, tenofovir disoproxil fumarate, thiazide diuretics, trimethoprim-sulfamethoxazole, tacrolimus.
bOther infection types included pneumonia (trough-guided: n = 7; AUC-guided: n = 10), septic arthritis (trough-guided: n = 5; AUC-guided: n = 4), meningitis (trough-guided: n = 1; AUC-guided: n = 0), urinary tract infections (trough-guided: n = 3; AUC-guided: n = 6), intra-abdominal infections (trough-guided: n = 7; AUC-guided: n = 3), and surgical site infections (trough-guided: n = 10; AUC-guided: n = 8).
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