{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T20:18:15Z","timestamp":1761164295823,"version":"build-2065373602"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Vancomycin guidelines recommend area\u2010under\u2010the\u2010curve (AUC) therapeutic monitoring for patients with severe methicillin\u2010resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (MRSA) infections. No recommendations exist for patients with non\u2010severe staphylococcal infections or those with other Gram\u2010positive infections. AUC\u2010based vancomycin dosing can be resource\u2010intensive and may not be necessary for all patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>New institutional guidelines for vancomycin dosing were implemented across an eight\u2010hospital health system in 2023. The new guidelines recommended either AUC or trough\u2010based dosing depending on the severity of the infection and the likelihood of MRSA. Adult patient encounters with at least one vancomycin administration were compared retrospectively 6\u2009months pre\u2010implementation and 6\u2009months post\u2010implementation. Cumulative vancomycin dose, administrations, and serum levels were assessed. The rate of acute kidney injury (AKI) was compared in a subgroup of patient encounters with four or more administrations. Pharmacist time saved using a blended approach compared to a uniform AUC dosing guideline was estimated based on the number of patients receiving trough\u2010based dosing in the post\u2010implementation group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 8155 patient encounters were included in the analysis (3916 pre\u2010implementation, 4239 post\u2010implementation). The primary outcome of median cumulative vancomycin dose (mg) was 500\u2009mg lower in the post\u2010implementation group (3000\u2009mg pre\u2010implementation vs 2500\u2009mg post\u2010implementation, Odds ratio [OR] 0.94 95% confidence interval [CI] 0.90\u20130.97,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Patients in the post\u2010implementation group were significantly less likely to have vancomycin serum levels drawn (OR 0.86; 95% CI 0.78, 0.96,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). A subgroup of patient encounters receiving four or more vancomycin administrations included 2483 patient encounters (1251 pre\u2010implementation, 1232 post\u2010implementation). AKI occurred in 120 (9.6%) cases pre\u2010implementation and 89 (7.2%) cases post\u2010implementation. The risk of AKI was significantly lower post\u2010implementation (OR 0.73; 95% CI 0.55, 0.98,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.038). Estimated pharmacist time saved was between 2229 to 5201\u2009min, equating to an estimated $16,851.24 to $39,319.56 saved over 6\u2009months, with blended vancomycin dosing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large multi\u2010hospital cohort, the implementation of a blended dosing method using a majority of AUC\u2010based dosing reduced cumulative vancomycin doses, serum levels, and AKI. Including trough recommendations for patients with less severe infections and non\u2010MRSA, Gram\u2010positive pathogens may have saved significant pharmacist time and associated costs compared to a uniform AUC dosing policy. This study further highlights the sizeable amount of unnecessary vancomycin use with a corresponding low incidence of severe MRSA infections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70011","type":"journal-article","created":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T11:35:53Z","timestamp":1742816153000},"page":"273-281","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Better together? Reducing vancomycin use and acute kidney injury with a blended\n                    <scp>AUC<\/scp>\n                    and trough\u2010based dosing guideline"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1497-3116","authenticated-orcid":false,"given":"Alyssa","family":"Christensen","sequence":"first","affiliation":[{"name":"HealthPartners and Park Nicollet Health Services  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan","family":"Ryberg","sequence":"additional","affiliation":[{"name":"HealthPartners and Park Nicollet Health Services  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary","family":"Nelson","sequence":"additional","affiliation":[{"name":"HealthPartners and Park Nicollet Health Services  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ella","family":"Chrenka","sequence":"additional","affiliation":[{"name":"HealthPartners Research Institute  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxx","family":"Enzmann","sequence":"additional","affiliation":[{"name":"HealthPartners and Park Nicollet Health Services  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. Rebecca","family":"Peglow","sequence":"additional","affiliation":[{"name":"HealthPartners and Park Nicollet Health Services  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brent","family":"Footer","sequence":"additional","affiliation":[{"name":"University of North Carolina Health  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxaa036"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.18923"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2024.1370040"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/08971900211012395"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxab132"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.1092"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxac094"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.1951"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01492-7"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2008.81"},{"key":"e_1_2_7_12_1","unstructured":"US Bureau of Labor Statistics.Occupational employment and wages.2021.https:\/\/www.bls.gov\/oes\/current\/oes291051.htm. Accessed July 5 2021."},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae217"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1128\/aac.02042-17"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2722"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxae014"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1128\/iai.05496-11"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/pharma2040024"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.15386\/mpr-1742"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1128\/aac.01276-22"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15429"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxab121"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2021.296"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2482"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/10600280221141402"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/10600280231171373"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.5863\/1551-6776-26.7.740"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.03313-22"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-022-06811-0"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.70011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T18:03:03Z","timestamp":1761069783000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.70011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,24]]},"references-count":28,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/phar.70011"],"URL":"https:\/\/doi.org\/10.1002\/phar.70011","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"type":"print","value":"0277-0008"},{"type":"electronic","value":"1875-9114"}],"subject":[],"published":{"date-parts":[[2025,3,24]]},"assertion":[{"value":"2024-12-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}