(502) Retrospective Review of Vancomycin Trough versus Area Under the Curve Monitoring in Pediatric and Adult Patients with Cystic Fibrosis

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is isolated in 20% of cystic fibrosis (CF) patients. In managing acute pulmonary exacerbations (APE) caused by MRSA, vancomycin is the drug of choice. However, vancomycin therapy has been associated with nephrotoxicity and therefore requires monitoring. The ideal monitoring method for vancomycin therapy has not been established in CF patients.

Methods: A retrospective review was conducted in CF patients of any age admitted to the University of Kentucky who received IV vancomycin between October 2015 and January 2021. Included patients received 5 or more days of IV vancomycin. The primary objective of this study was to compare the occurrence and severity of acute kidney injury (AKI) in patients receiving IV vancomycin for an APE using either trough concentration monitoring (2015-2018) compared to AUC monitoring (goal AUC-400-600) from 2018-2021. The secondary objectives included comparing time to next exacerbation and return to baseline lung function.

Results: A total of 113 adult and 42 pediatric encounters met inclusion criteria. There was no statistically significant difference in occurrence of AKI, however all grade 2 – 3 AKIs were in the serum trough monitoring group. Adult patients monitored with AUC also had a higher return to baseline lung function over trough monitoring (86% vs. 57%) (p=0.002). There was not a statistically significant difference in time to next exacerbation in either group.

Conclusions: The results of this study indicate that AUC monitoring may enhance efficacy of IV vancomycin in adult patients with CF. Adult patients with CF also experienced less severe AKIs when monitored with AUC over trough.

Acknowledgements: Aric Schadler, PhD

References: