What proportion of vancomycin trough levels are drawn too early?: frequency and impact on clinical actions

American Journal of Clinical Pathology
Aileen P MorrisonMilenko J Tanasijevic

Abstract

Vancomycin trough levels are recommended to predict vancomycin efficacy, and inaccurate levels may lead to inappropriate clinical actions. However, the frequency of timing errors and associated clinical impact is unknown. We retrospectively analyzed vancomycin levels (n = 2,597) measured during 13 months at a large academic medical center. Of the specimens, 41.3% were drawn too early. These samples yielded significantly higher average ± SD vancomycin concentrations than correctly timed samples (22.1 ± 11.7 mg/L vs 15.5 mg/L ± 8.6 mg/L; P < .001), and, consequently, clinicians were more likely to decrease, discontinue, or hold a patient's vancomycin dose (25.6% vs 21.4%; P < .02) or repeat the vancomycin level (29.2% vs 20.0%; P < .001). A substantial proportion of specimens collected to assess vancomycin efficacy were drawn too early, leading to overestimation of patients' true trough level and possible underdosing of vancomycin or a high rate of repeat tests for vancomycin.

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Citations

Apr 14, 2015·Journal of Clinical Pharmacy and Therapeutics·M F WaineoD L Brown
Jul 24, 2015·SpringerPlus·Anthony P CardileGünther Hsue
Jul 28, 2016·American Journal of Clinical Pathology·Vilte E BarakauskasKamisha L Johnson-Davis
Nov 15, 2013·American Journal of Clinical Pathology·Stacy E F MelansonMilenko J Tanasijevic
Jan 24, 2015·Journal of Pharmacy Practice·Lindsay K Coleman, Ashley S Wilson
Dec 21, 2017·European Journal of Drug Metabolism and Pharmacokinetics·Fawzy Elbarbry
Jan 27, 2018·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Vincent Peyko, Michelle Friedman-Jakubovics
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Apr 13, 2018·Journal of Intensive Care Medicine·Brittany D BissellChristopher Morrison
Jul 30, 2018·European Journal of Clinical Pharmacology·Joanne Oi Sze ChanRichard Osborne Day
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Jun 8, 2021·The Journal of Antimicrobial Chemotherapy·Mark E MurphyKevin J Downes
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