{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:12:07Z","timestamp":1784193127568,"version":"3.55.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2019,7,25]],"date-time":"2019-07-25T00:00:00Z","timestamp":1564012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Vancomycin optimization is challenging, requiring careful therapeutic drug monitoring (TDM) to avoid toxicity and ensure an efficacious concentration. Most prescriptions are empiric and often discontinued within 72 hours, which makes early TDM unnecessary. Although TDM using trough levels is common, the area under the concentration\u2013time curve (AUC) is the preferred pharmacodynamic target. We studied the effect of a pharmacy-driven vancomycin collaborative practice agreement (CPA) at a children\u2019s hospital that delayed TDM up to 72 hours and targeted a 2-point 24-hour AUC of \u2265400 mg \u00d7 h\/L.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively reviewed vancomycin courses in patients aged \u226530 days who received vancomycin between April 1, 2011, and August 30, 2017. We implemented the CPA on June 1, 2014. Outcomes included CPA use, use of TDM, dosage adjustments, and development of acute kidney injury; we compared courses given while monitoring only trough levels (TO-TDM) with those given while using the CPA (AUC-TDM). We performed interrupted time series analyses to account for preintervention trends.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We included 2379 courses in the TO-TDM period and 2155 in the AUC-TDM period. During AUC-TDM, 87% of the courses were managed by the CPA. In adjusted interrupted time series analyses, CPA implementation was associated with an initial change in level of \u22120.265 (95% confidence interval [CI], \u22120.336 to \u22120.189) TDM and an initial change in level of \u22120.332 (95% CI, \u22120.506 to \u22120.163) dosage adjustments. The 1-year risk of acute kidney injury decreased after CPA implementation (odds ratio, 0.695 [95% CI, 0.539\u20130.91]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The pharmacy-driven vancomycin CPA resulted in less monitoring and fewer dose adjustments without increasing AKI.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piz036","type":"journal-article","created":{"date-parts":[[2019,5,3]],"date-time":"2019-05-03T19:12:57Z","timestamp":1556910777000},"page":"334-341","source":"Crossref","is-referenced-by-count":17,"title":["Intravenous Vancomycin Therapeutic Drug Monitoring in Children: Evaluation of a Pharmacy-Driven Protocol and Collaborative Practice Agreement"],"prefix":"10.1093","volume":"9","author":[{"given":"Jared","family":"Olson","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Primary Children\u2019s Hospital, Salt Lake City, Utah"},{"name":"Division of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam L","family":"Hersh","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Sorensen","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care, Intermountain Medical Center, Murray, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Zobell","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Primary Children\u2019s Hospital, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collin","family":"Anderson","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Primary Children\u2019s Hospital, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily A","family":"Thorell","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,25]]},"reference":[{"key":"2020071317224152800_CIT0001","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1017\/ice.2015.159","article-title":"Cost of antimicrobial therapy across US children\u2019s hospitals","volume":"36","author":"Ross","year":"2015","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2020071317224152800_CIT0002","doi-asserted-by":"crossref","first-page":"e0202439","DOI":"10.1371\/journal.pone.0202439","article-title":"Vancomycin associated acute kidney injury in pediatric patients","volume":"13","author":"Moffett","year":"2018","journal-title":"PLoS One"},{"key":"2020071317224152800_CIT0003","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1002\/ppul.23718","article-title":"Piperacillin-tazobactam versus cefepime incidence of acute kidney injury in combination with vancomycin and tobramycin in pediatric cystic fibrosis patients","volume":"52","author":"LeCleir","year":"2017","journal-title":"Pediatr Pulmonol"},{"key":"2020071317224152800_CIT0004","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1186\/s13054-017-1899-3","article-title":"Co-administration of vancomycin and piperacillin-tazobactam is associated with increased renal dysfunction in adult and pediatric burn patients","volume":"21","author":"Hundeshagen","year":"2017","journal-title":"Crit Care"},{"key":"2020071317224152800_CIT0005","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1177\/1060028018757497","article-title":"Comparison of the nephrotoxicity of vancomycin in combination with cefepime, meropenem, or piperacillin\/tazobactam: a prospective, multicenter study","volume":"52","author":"Mullins","year":"2018","journal-title":"Ann Pharmacother"},{"key":"2020071317224152800_CIT0006","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1086\/600877","article-title":"Vancomycin therapeutic guidelines: a summary of consensus recommendations from the Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists","volume":"49","author":"Rybak","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2020071317224152800_CIT0007","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.ijantimicag.2018.08.024","article-title":"Implementation of a two-point pharmacokinetic AUC-based vancomycin therapeutic drug monitoring approach in patients with methicillin-resistant Staphylococcus aureus bacteraemia","volume":"52","author":"Mogle","year":"2018","journal-title":"Int J Antimicrob Agents"},{"key":"2020071317224152800_CIT0008","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1093\/cid\/ciq146","article-title":"Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children","volume":"52","author":"Liu","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2020071317224152800_CIT0009","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1097\/INF.0b013e3181db7398","article-title":"Use of vancomycin in pediatrics","volume":"29","author":"Dehority","year":"2010","journal-title":"Pediatr Infect Dis J"},{"key":"2020071317224152800_CIT0010","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1345\/aph.1P588","article-title":"Assessment of vancomycin dosing and subsequent serum concentrations in pediatric patients","volume":"45","author":"Eiland","year":"2011","journal-title":"Ann Pharmacother"},{"key":"2020071317224152800_CIT0011","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1592\/phco.31.9.871","article-title":"Impact of a hospitalwide increase in empiric pediatric vancomycin dosing on initial trough concentrations","volume":"31","author":"Frymoyer","year":"2011","journal-title":"Pharmacotherapy"},{"key":"2020071317224152800_CIT0012","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1002\/phar.1331","article-title":"The effect of age and weight on vancomycin serum trough concentrations in pediatric patients","volume":"33","author":"Madigan","year":"2013","journal-title":"Pharmacotherapy"},{"key":"2020071317224152800_CIT0013","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1542\/peds.2016-2423","article-title":"The impact of pediatric-specific vancomycin dosing guidelines: a quality improvement initiative","volume":"139","author":"Miloslavsky","year":"2017","journal-title":"Pediatrics"},{"key":"2020071317224152800_CIT0014","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1093\/jpids\/piy032","article-title":"Experience with continuous infusion vancomycin dosing in a large pediatric hospital","volume":"8","author":"Hurst","year":"2019","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2020071317224152800_CIT0015","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s40272-018-0282-4","article-title":"The relationship between vancomycin trough concentrations and AUC\/MIC ratios in pediatric patients: a qualitative systematic review","volume":"20","author":"Tkachuk","year":"2018","journal-title":"Paediatr Drugs"},{"key":"2020071317224152800_CIT0016","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1097\/MPH.0000000000000470","article-title":"Vancomycin therapeutic targets and nephrotoxicity in critically Ill children with cancer","volume":"38","author":"Seixas","year":"2016","journal-title":"J Pediatr Hematol Oncol"},{"key":"2020071317224152800_CIT0017","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.bjid.2012.06.011","article-title":"Vancomycin serum concentrations in pediatric oncologic\/hematologic intensive care patients","volume":"16","author":"Silva","year":"2012","journal-title":"Braz J Infect Dis"},{"key":"2020071317224152800_CIT0018","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1093\/jpids\/pis083","article-title":"Vancomycin dosing practices, trough concentrations, and predicted area under the curve in children with suspected invasive staphylococcal infections","volume":"2","author":"Chhim","year":"2013","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2020071317224152800_CIT0019","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.jmii.2015.08.027","article-title":"Vancomycin dosing and target attainment in children","volume":"50","author":"Hwang","year":"2017","journal-title":"J Microbiol Immunol Infect"},{"key":"2020071317224152800_CIT0020","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1097\/INF.0b013e318299f75c","article-title":"Desired vancomycin trough serum concentration for treating invasive methicillin-resistant staphylococcal infections","volume":"32","author":"Frymoyer","year":"2013","journal-title":"Pediatr Infect Dis J"},{"key":"2020071317224152800_CIT0021","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1097\/INF.0b013e3181906e40","article-title":"Current recommended dosing of vancomycin for children with invasive methicillin-resistant Staphylococcus aureus infections is inadequate","volume":"28","author":"Frymoyer","year":"2009","journal-title":"Pediatr Infect Dis J"},{"key":"2020071317224152800_CIT0022","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1002\/jcph.1323","article-title":"An evaluation of vancomycin area under the curve estimation methods for children treated for acute pulmonary exacerbations of cystic fibrosis due to methicillin-resistant Staphylococcus aureus","volume":"59","author":"Stockmann","year":"2019","journal-title":"J Clin Pharmacol"},{"key":"2020071317224152800_CIT0023","doi-asserted-by":"crossref","first-page":"e01293-17","DOI":"10.1128\/AAC.01293-17","article-title":"A quasi-experiment to study the impact of vancomycin area under the concentration\u2013time curve-guided dosing on vancomycin-associated nephrotoxicity","volume":"61","author":"Finch","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"2020071317224152800_CIT0024","doi-asserted-by":"crossref","first-page":"e02042-17","DOI":"10.1128\/AAC.02042-17","article-title":"Prospective trial on the use of trough concentration versus area under the curve to determine therapeutic vancomycin dosing","volume":"62","author":"Neely","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"key":"2020071317224152800_CIT0025","doi-asserted-by":"crossref","first-page":"e01684-17","DOI":"10.1128\/AAC.01684-17","article-title":"Identification of vancomycin exposure-toxicity thresholds in hospitalized patients receiving intravenous vancomycin","volume":"62","author":"Zasowski","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"key":"2020071317224152800_CIT0026","doi-asserted-by":"crossref","first-page":"e109","DOI":"10.1093\/jpids\/piu110","article-title":"Pharmacodynamic characteristics of nephrotoxicity associated with vancomycin use in children","volume":"4","author":"Le","year":"2015","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2020071317224152800_CIT0027","doi-asserted-by":"crossref","first-page":"e155","DOI":"10.1097\/INF.0b013e318286378e","article-title":"Improved vancomycin dosing in children using area under the curve exposure","volume":"32","author":"Le","year":"2013","journal-title":"Pediatr Infect Dis J"},{"key":"2020071317224152800_CIT0028","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1128\/AAC.01485-12","article-title":"Vancomycin AUC\/MIC ratio and 30-day mortality in patients with Staphylococcus aureus bacteremia","volume":"57","author":"Holmes","year":"2013","journal-title":"Antimicrob Agents Chemother"},{"key":"2020071317224152800_CIT0029","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.clinthera.2013.05.008","article-title":"A stewardship program\u2019s retrospective evaluation of vancomycin AUC24\/MIC and time to microbiological clearance in patients with methicillin-resistant Staphylococcus aureus bacteremia and osteomyelitis","volume":"35","author":"Gawronski","year":"2013","journal-title":"Clin Ther"},{"key":"2020071317224152800_CIT0030","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1128\/AAC.05609-11","article-title":"Vancomycin AUC24\/MIC ratio in patients with complicated bacteremia and infective endocarditis due to methicillin-resistant Staphylococcus aureus and its association with attributable mortality during hospitalization","volume":"56","author":"Brown","year":"2012","journal-title":"Antimicrob Agents Chemother"},{"key":"2020071317224152800_CIT0031","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/INF.0000000000000991","article-title":"Healthcare-associated Staphylococcus aureus bacteremia in children: evidence for reverse vancomycin creep and impact of vancomycin trough values on outcome","volume":"35","author":"McNeil","year":"2016","journal-title":"Pediatr Infect Dis J"},{"key":"2020071317224152800_CIT0032","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1097\/INF.0000000000001503","article-title":"The influence of the route of antibiotic administration, methicillin susceptibility, vancomycin duration and serum trough concentration on outcomes of pediatric Staphylococcus aureus bacteremic osteoarticular infection","volume":"36","author":"McNeil","year":"2017","journal-title":"Pediatr Infect Dis J"},{"key":"2020071317224152800_CIT0033","first-page":"338","article-title":"Association between vancomycin trough concentrations and duration of methicillin-resistant Staphylococcus aureus bacteremia in children","volume":"7","author":"Hsu","year":"2018","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2020071317224152800_CIT0034","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3346\/jkms.2017.32.1.22","article-title":"Impact of initial vancomycin trough concentration on clinical and microbiological outcomes of methicillin-resistant Staphylococcus aureus bacteremia in children","volume":"32","author":"Yoo","year":"2017","journal-title":"J Korean Med Sci"}],"container-title":["Journal of the Pediatric Infectious Diseases Society"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jpids\/article-pdf\/9\/3\/334\/33493023\/piz036.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jpids\/article-pdf\/9\/3\/334\/33493023\/piz036.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,7,13]],"date-time":"2020-07-13T22:32:42Z","timestamp":1594679562000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jpids\/article\/9\/3\/334\/5538716"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,25]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,7,25]]},"published-print":{"date-parts":[[2020,7,13]]}},"URL":"https:\/\/doi.org\/10.1093\/jpids\/piz036","relation":{},"ISSN":["2048-7207"],"issn-type":[{"value":"2048-7207","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,7]]},"published":{"date-parts":[[2019,7,25]]}}}