{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:50:10Z","timestamp":1791528610773,"version":"4.3.4"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bayesian software programs are recommended for area under the concentration\u2010time curve (AUC)\u2010guided vancomycin monitoring, but hesitancy remains for patients with acute kidney injury (AKI). Here, we assessed agreement between population pharmacokinetic model\u2010based Bayesian predictions and observed vancomycin concentrations in patients with and without AKI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were retrospectively analyzed from patients at 162 institutions in the United States. Courses with \u2265\u20092 vancomycin doses, \u2265\u20091 vancomycin level, and \u2265\u20092 serum creatinine values were included. Observed drug levels served as reference values and were classified as occurring in the absence of AKI, during new\u2010onset AKI, or during persistent AKI. Adult, pediatric, and neonate pharmacokinetic models were assessed both a priori and a posteriori. Performance was measured using root mean squared error, mean percentage error, and the proportion of predictions within \u00b120% (P20) and \u00b130% (P30) of observed values. We also evaluated flattened priors and last\u2010observation\u2010only weighting as alternative Bayesian estimation approaches and reported agreement between model\u2010predicted and model\u2010estimated AUCs (classified as in or out of target).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 30,561 adults, 5223 pediatrics, and 1865 neonates included. Prediction performance declined with AKI relative to no AKI, particularly in pediatrics, followed by neonates, with adults showing minimal deterioration. Flattened priors often improved performance, whereas last\u2010observation\u2010only typically worsened it. Overall AKI reduced P20 by 0%\u201333% and P30 by 0%\u201319% (absolute percentage points). AUC classification agreement was similar across no AKI, new\u2010onset AKI, and persistent AKI groups (73%\u201383%, 72%\u201382%, and 72%\u201384%, respectively, a posteriori).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Model predictiveness of vancomycin concentrations was worse in patients with AKI, especially in pediatrics and neonates, and generally less pronounced in persistent versus new\u2010onset AKI. Further studies with denser pharmacokinetic sampling and elucidation of clinical implications of Bayesian\u2010guided vancomycin dosing in AKI are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70203","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:51:42Z","timestamp":1789620702000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multisite Analysis of Vancomycin Concentration Predictions in a Bayesian Software in Adult and Pediatric Patients With and Without Acute Kidney Injury"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7563-9881","authenticated-orcid":false,"given":"Maria\u2010Stephanie A.","family":"Hughes","sequence":"first","affiliation":[{"name":"InsightRX  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5276-1050","authenticated-orcid":false,"given":"Jeffrey C.","family":"Pearson","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3053-1251","authenticated-orcid":false,"given":"Jasmine H.","family":"Hughes","sequence":"additional","affiliation":[{"name":"InsightRX  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000337487"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00220605"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006091060"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxaa036"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01653\u201013"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro862"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/491712"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02042\u201017"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp180034"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc5713"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.03620\u201014"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40262\u2010018\u20100727\u20105"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkz158"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00067\u201019"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000039"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkp085"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000001214"},{"key":"e_1_2_11_19_1","doi-asserted-by":"crossref","unstructured":"R. J.Keizer J. H.Hughes D. M. H.Tong andK. H.Woo \u201cPKPDsim: Tools for Performing Pharmacokinetic\u2010Pharmacodynamic Simulations [Software] \u201d 2023 https:\/\/github.com\/InsightRX\/PKPDsim.","DOI":"10.32614\/CRAN.package.PKPDsim"},{"key":"e_1_2_11_20_1","unstructured":"R. J.Keizer J. H.Hughes andK. H.Woo \u201cPKPDmap: MAP Bayesian Estimates \u201d 2025."},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/psp4.12684"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2088"}],"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.70203","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/phar.70203","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.70203","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T06:10:33Z","timestamp":1791526233000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.70203"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":21,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/phar.70203"],"URL":"https:\/\/doi.org\/10.1002\/phar.70203","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"assertion":[{"value":"2026-04-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70203"}}