Evaluation Of Vancomycin Therapeutic Drug Monitoring in Intensive Care Units of a University Hospital

Abstract

Introduction and aim: Therapeutic drug monitoring (TDM) of vancomycin aims to achieve an optimal response and minimize the risk of toxicity by keeping plasma levels within the therapeutic range. In this study, we aimed to evaluate the treatment and appropriateness of TDM in patients receiving vancomycin. Method: For this purpose, patients who received vancomycin in the ICUs of a university hospital during 8-month period between January and August 2022 were retrospectively evaluated. Demographic data, presence of renal dysfunction, length of stay, duration of treatment, dose, concomitant medications, presence of extracorporeal method, TDM, sampling time (trough and peak level) were collected. Results: Within the scope of the study, 213 prescriptions of 202 patients were evaluated and it was revealed that TDM was performed in 18 (8%). A total of 26 trough (n=12) and peak (n=14) level were obtained. Three (25%) of the trough and eight (57%) of the peak samples were taken at the wrong time. 50% of the trough and 64% of the peak level results were outside the reference range. TDM was not performed in 174 patients taking nephrotoxic drugs concomitantly with vancomycin. There were 84 patients who developed acute kidney injury during treatment. TDM was performed in 10 (15%) of 65 patients with pretreatment renal dysfunction. Conclusion: In order to minimize the risk of nephrotoxicity and to get the appropriate response, it is recommended that physicians should have a conscious approach, clinical pharmacists should take an active role and hospital pharmacists should make arrangements in the orders of patients who do not have TDM.