{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:01:25Z","timestamp":1773792085820,"version":"3.50.1"},"reference-count":0,"publisher":"Canadian Society of Healthcare-Systems Pharmacy","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJHP"],"abstract":"<jats:p>Background: Little is known about the current landscape of vancomycin therapeutic drug monitoring (TDM) in Canadian hospitals, which operate within publicly funded health care systems.\nObjectives: To determine current TDM practices for vancomycin and associated challenges and to gather perceptions about TDM based on area under the concentration\u2013time curve (AUC) in Canadian hospitals. \nMethods: An electronic survey was distributed to hospital pharmacists in spring 2021 through multiple national and provincial antimicrobial stewardship, public health, and pharmacy organizations. The survey gathered data about hospital characteristics, TDM methods, inclusion criteria for patient selection, pharmacokinetic and pharmacodynamic targets, vancomycin susceptibility testing and reporting, and perceived barriers and challenges. \nResults: In total, 120 pharmacists from 10 of the 13 provincial and territorial jurisdictions in Canada, representing 12.5% of Canadian acute care hospitals (n = 962), completed at least 90% of survey questions. The predominant TDM method was trough-based (107\/119, 89.9%); another 10.1% of respondents (12\/119) reported performing AUC-based TDM (with or without trough-based TDM), and 17.9% (19\/106) of those not already using AUC-based TDM were considering implementing it within 1 to 2 years. Among hospitals performing trough-based TDM, 60.5% (66\/109) targeted trough levels between 15 and 20 mg\/L for serious infections with methicillin-resistant Staphylococcus aureus. One-quarter of the respondents using this method (27\/109, 24.8%) agreed that trough-based TDM was of uncertain benefit, and about one-third (33\/109, 30.3%) were neutral on this question. Multiple challenges were identified for trough-based TDM, including sub- or supra-therapeutic concentrations and collection of specimens at inappropriate times. Overall, 40.5% (47\/116) of respondents agreed that AUC-based TDM was likely safer than trough-based TDM, whereas 23.3% (27\/116) agreed that AUC-based TDM was likely more effective. \nConclusions: This survey represents a first step in developing evidence-based, standardized best practices for vancomycin TDM that are uniquely suited to the Canadian health care system.\nR\u00c9SUM\u00c9\nContexte\u00a0: On conna\u00eet peu de choses sur le paysage actuel du suivi th\u00e9rapeutique pharmacologique (STP) de la vancomycine dans les h\u00f4pitaux canadiens, dont les activit\u00e9s s\u2019inscrivent dans le cadre des syst\u00e8mes de soins de sant\u00e9 financ\u00e9s par les deniers publics.\nObjectifs\u00a0: D\u00e9terminer les pratiques actuelles de STP de la vancomycine et les d\u00e9fis associ\u00e9s et recueillir les perceptions concernant le STP sur la base de l\u2019aire sous la courbe de la concentration en fonction du temps (ASC) dans les h\u00f4pitaux canadiens.\nM\u00e9thodes : Un sondage a \u00e9t\u00e9 distribu\u00e9 \u00e9lectroniquement aux pharmaciens d\u2019h\u00f4pitaux au printemps 2021 par plusieurs organismes nationaux et provinciaux de gestion de l\u2019utilisation des antimicrobiens, de sant\u00e9 publique et de pharmacie. Le sondage a permis de rassembler des donn\u00e9es concernant les caract\u00e9ristiques des h\u00f4pitaux, les m\u00e9thodes de STP, les crit\u00e8res d\u2019inclusion pour la s\u00e9lection des patients, les objectifs pharmacocin\u00e9tiques et pharmacodynamiques, les tests de sensibilit\u00e9 \u00e0 la vancomycine et les rapports des r\u00e9sultats, ainsi que les obstacles et les d\u00e9fis per\u00e7us.\nR\u00e9sultats : Au total, 120 pharmaciens de 10 des 13 provinces et territoires du Canada, repr\u00e9sentant 12,5 % des h\u00f4pitaux canadiens de soins actifs (n = 962), ont r\u00e9pondu \u00e0 au moins 90 % des questions du sondage. La m\u00e9thode de STP pr\u00e9dominante utilis\u00e9e \u00e9tait celle de la concentration minimale (107\/119, 89,9 %); un autre 10,1 % des r\u00e9pondants (12\/119) ont d\u00e9clar\u00e9 effectuer un STP bas\u00e9 sur l\u2019ASC (avec ou sans STP bas\u00e9 sur la concentration minimale), et 17,9 % (19\/106) de ceux qui n\u2019effectuaient pas d\u00e9j\u00e0 le STP bas\u00e9 sur l\u2019ASC envisageaient de le mettre en \u0153uvre d\u2019ici 1 \u00e0 2 ans. Parmi les h\u00f4pitaux pratiquant le STP bas\u00e9 sur la concentration minimale, 60,5 % (66\/109) ciblaient des concentrations minimales entre 15 et 20 mg\/L pour les infections graves \u00e0 Staphylococcus aureus r\u00e9sistant \u00e0 la m\u00e9thicilline. Un quart des r\u00e9pondants qui utilisaient cette m\u00e9thode (27\/109, 24,8 %) convenaient que les avantages du STP bas\u00e9 sur la concentration minimale \u00e9taient incertains, et environ un tiers (33\/109, 30,3 %) \u00e9taient neutres. De multiples d\u00e9fis ont \u00e9t\u00e9 identifi\u00e9s pour le STP bas\u00e9 sur la concentration minimale, notamment des concentrations sous- ou supra-th\u00e9rapeutiques et la collecte d\u2019\u00e9chantillons \u00e0 des moments inappropri\u00e9s. Dans l\u2019ensemble, 40,5 % (47\/116) des r\u00e9pondants convenaient que le STP bas\u00e9 sur l\u2019ASC \u00e9tait probablement plus s\u00fbr que le STP bas\u00e9 sur la concentration minimale, tandis que 23,3 % (27\/116) convenaient que le STP bas\u00e9 sur l\u2019ASC \u00e9tait probablement plus efficace. \nConclusions : Ce sondage repr\u00e9sente une premi\u00e8re \u00e9tape dans l\u2019\u00e9laboration de pratiques exemplaires normalis\u00e9es et fond\u00e9es sur des donn\u00e9es probantes pour le STP de la vancomycine qui sont particuli\u00e8rement adapt\u00e9es au syst\u00e8me de sant\u00e9 canadien.<\/jats:p>","DOI":"10.4212\/cjhp.3337","type":"journal-article","created":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T14:52:01Z","timestamp":1682952721000},"page":"203-208","source":"Crossref","is-referenced-by-count":7,"title":["Vancomycin Therapeutic Drug Monitoring:  A\u00a0Cross-Sectional Survey of Canadian Hospitals"],"prefix":"10.4212","volume":"76","author":[{"given":"Sarah C J","family":"Jorgensen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"McIntyre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Curran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miranda","family":"So","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2732","published-online":{"date-parts":[[2023,7,5]]},"container-title":["Canadian Journal of Hospital Pharmacy"],"original-title":[],"link":[{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3337\/4944","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3337\/4965","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3337\/4944","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T15:37:35Z","timestamp":1690904255000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/view\/3337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,5]]},"references-count":0,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,7,5]]}},"URL":"https:\/\/doi.org\/10.4212\/cjhp.3337","relation":{},"ISSN":["1920-2903","0008-4123"],"issn-type":[{"value":"1920-2903","type":"electronic"},{"value":"0008-4123","type":"print"}],"subject":[],"published":{"date-parts":[[2023,7,5]]}}}