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Vancomycin levels for Bayesian dose-optimization in critical care: a prospective cohort study

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dc.contributor.authorDreyse, Natalia
dc.contributor.authorSalazar, Nicole
dc.contributor.authorMunita, Jose M.
dc.contributor.authorRello, Jordi
dc.contributor.authorLópez, René
dc.date.accessioned2026-08-31T17:00:01Z
dc.date.available2026-08-31T17:00:01Z
dc.date.issued2025
dc.description.abstractBackground: Vancomycin dosing in critically ill patients typically requires monitoring the area under the concentration-time curve/minimum inhibitory concentration (AUC/MIC), often using at least two vancomycin levels (VLs). However, the optimal number of VLs needed for accurate AUC/MIC estimation in this population remains uncertain. This study aimed to determine the minimum number of VLs required to accurately estimate the AUC/MIC in critically ill patients treated with intermittent infusion of vancomycin. Methods: A prospective cohort study was conducted in critically ill patients, where VLs were obtained at peak, beta, and trough phases. Five AUC estimates were derived using PrecisePK™, a Bayesian software: AUC-1 [peak, beta (2 h after the end infusion), trough], AUC-2 (beta, trough), AUC-3 (peak, trough), AUC-4 (trough), and AUC-5 (only Bayesian prior, without VL). These estimates were compared for accuracy and bias (mean ± SEM) against the reference AUC calculated via the trapezoidal model (AUCRef). Results: We enrolled 36 adult patients with age of 65 (52–77) years, moderate severity [APACHE II 10 (5–14) and SOFA 5 (4–6)], 6 of them in ECMO and 4 in renal replacement therapy. A total of 108 blood samples for VL were analyzed. The AUC-3 (0.976 ± 0.012) showed greater accuracy compared to AUC-4 (1.072 ± 0.032, p = 0.042) and AUC-5 (1.150 ± 0.071, p = 0.042). AUC-3 also demonstrated lower bias (0.053 ± 0.009) than AUC-4 (0.134 ± 0.026, p = 0.036) and AUC-5 (0.270 ± 0.060, p = 0.003). Bland–Altman analysis indicated better agreement between AUC-3 and AUC-2 with AUCRef. Conclusion: Bayesian software using two vancomycin levels provides a more accurate and less biased AUC/MIC estimation in critically ill patients.
dc.description.versionVersión Publicada
dc.identifier.citationDreyse N, Salazar N, Munita JM, Rello J, López R. Vancomycin levels for Bayesian dose-optimization in critical care: a prospective cohort study. Front Med (Lausanne). 2025 Jul 22;12:1575224. doi: 10.3389/fmed.2025.1575224
dc.identifier.doihttps://doi.org/10.3389/fmed.2025.1575224
dc.identifier.urihttps://hdl.handle.net/11447/11048
dc.language.isoen
dc.subjectPharmacokinetics
dc.subjectArea under curve/minimum inhibitory concentration
dc.subjectIntensive care unit
dc.subjectGlycopeptides
dc.subjectAntibiotics
dc.subjectSepsis
dc.titleVancomycin levels for Bayesian dose-optimization in critical care: a prospective cohort study
dc.typeArticle
dcterms.accessRightsAcceso Abierto
dcterms.sourceFrontiers in medicine
dspace.entity.typePublication
relation.isAuthorOfPublicationec52b0bf-d0bc-4844-9531-eca4a65f2b8e
relation.isAuthorOfPublication.latestForDiscoveryec52b0bf-d0bc-4844-9531-eca4a65f2b8e

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