Impact of vancomycin therapeutic drug monitoring on mortality in sepsis patients across different age groups: a propensity score-matched retrospective cohort study
BackgroundDue to its potent antibacterial activity, vancomycin is widely used in the treatment of sepsis. Therapeutic drug monitoring (TDM) can optimize personalized vancomycin dosing regimens, enhancing therapeutic efficacy and minimizing nephrotoxic risk, thereby potentially improving patient outc...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2024.1498337/full |
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| author | Huaidong Peng Ruichang Zhang Shuangwu Zhou Tingting Xu Ruolun Wang Qilin Yang Xunlong Zhong Xiaorui Liu |
| author_facet | Huaidong Peng Ruichang Zhang Shuangwu Zhou Tingting Xu Ruolun Wang Qilin Yang Xunlong Zhong Xiaorui Liu |
| author_sort | Huaidong Peng |
| collection | DOAJ |
| description | BackgroundDue to its potent antibacterial activity, vancomycin is widely used in the treatment of sepsis. Therapeutic drug monitoring (TDM) can optimize personalized vancomycin dosing regimens, enhancing therapeutic efficacy and minimizing nephrotoxic risk, thereby potentially improving patient outcomes. However, it remains uncertain whether TDM affects the mortality rate among sepsis patients or whether age plays a role in this outcome.MethodsWe analyzed data from the Medical Information Mart of Intensive Care–IV database, focusing on sepsis patients who were admitted to the intensive care unit (ICU) and treated with vancomycin. The primary variable of interest was the use of vancomycin TDM during the ICU stay. The primary outcome was 30-day mortality. To control for potential confounding factors and evaluate associations, we used Cox proportional hazards regression and propensity score matching (PSM). Subgroup and sensitivity analyses were performed to assess the robustness of our findings. Furthermore, restricted cubic spline models were utilized to investigate the relationship between age and mortality among different groups of sepsis patients, to identify potential non-linear associations.ResultsA total of 14,053 sepsis patients met the study criteria, of whom 6,826 received at least one TDM during their ICU stay. After PSM, analysis of 4,329 matched pairs revealed a significantly lower 30-day mortality in the TDM group compared with the non-TDM group (23.3% vs.27.7%, p < 0.001). Multivariable Cox proportional hazards regression showed a significantly reduced 30-day mortality risk in the TDM group [adjusted hazard ratio (HR): 0.66; 95% confidence interval (CI): 0.61–0.71; p < 0.001]. This finding was supported by PSM-adjusted analysis (adjusted HR: 0.71; 95% CI: 0.66–0.77; p < 0.001) and inverse probability of treatment weighting analysis (adjusted HR: 0.72; 95% CI: 0.67–0.77; p < 0.001). Kaplan–Meier survival curves also indicated significantly higher 30-day survival in the TDM group (log-rank test, p < 0.0001). Subgroup analyses by gender, age, and race yielded consistent results. Patients with higher severity of illness—indicated by sequential organ failure assessment scores ≥6, acute physiology score III ≥40, or requiring renal replacement therapy, vasopressors, or mechanical ventilation—experienced more pronounced mortality improvement from vancomycin TDM compared with those with lower severity scores or not requiring these interventions. The results remained robust after excluding patients with ICU stays <48 h, those with methicillin-resistant Staphylococcus aureus infections, or when considering only patients with septic shock. In subgroup analyses, patients under 65 years (adjusted HR: 0.50; 95% CI: 0.43–0.58) benefited more from vancomycin TDM than those aged 65 years and older (adjusted HR: 0.75; 95% CI: 0.67–0.83). Notably, sepsis patients aged 18–50 years had the lowest mortality rate among all age groups, at 15.2% both before and after PSM. Furthermore, in this age group, vancomycin TDM was associated with a greater reduction in 30-day mortality risk, with adjusted HRs of 0.32 (95% CI: 0.24–0.41) before PSM and 0.30 (95% CI: 0.22–0.32) after PSM.ConclusionVancomycin TDM is associated with reduced 30-day mortality in sepsis patients, with the most significant benefit observed in patients aged 18–50. This age group exhibited the lowest mortality rates and experienced the greatest reduction in mortality following TDM compared with older patients. |
| format | Article |
| id | doaj-art-08e0a7c056b64d3e9ce7258922548fa0 |
| institution | DOAJ |
| issn | 2296-858X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-08e0a7c056b64d3e9ce7258922548fa02025-08-20T02:50:26ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2024-12-011110.3389/fmed.2024.14983371498337Impact of vancomycin therapeutic drug monitoring on mortality in sepsis patients across different age groups: a propensity score-matched retrospective cohort studyHuaidong Peng0Ruichang Zhang1Shuangwu Zhou2Tingting Xu3Ruolun Wang4Qilin Yang5Xunlong Zhong6Xiaorui Liu7Department of Pharmacy, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, ChinaDepartment of Critical Care, Guangzhou Twelfth People' Hospital, Guangzhou, ChinaThe Second School of Clinical Medicine, Guangzhou Medical University, Guangzhou, ChinaSchool of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou, ChinaDepartment of Pharmacy, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, ChinaDepartment of Critical Care, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, ChinaDepartment of Pharmacy, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, ChinaDepartment of Pharmacy, Guangzhou Institute of Cancer Research, The Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, ChinaBackgroundDue to its potent antibacterial activity, vancomycin is widely used in the treatment of sepsis. Therapeutic drug monitoring (TDM) can optimize personalized vancomycin dosing regimens, enhancing therapeutic efficacy and minimizing nephrotoxic risk, thereby potentially improving patient outcomes. However, it remains uncertain whether TDM affects the mortality rate among sepsis patients or whether age plays a role in this outcome.MethodsWe analyzed data from the Medical Information Mart of Intensive Care–IV database, focusing on sepsis patients who were admitted to the intensive care unit (ICU) and treated with vancomycin. The primary variable of interest was the use of vancomycin TDM during the ICU stay. The primary outcome was 30-day mortality. To control for potential confounding factors and evaluate associations, we used Cox proportional hazards regression and propensity score matching (PSM). Subgroup and sensitivity analyses were performed to assess the robustness of our findings. Furthermore, restricted cubic spline models were utilized to investigate the relationship between age and mortality among different groups of sepsis patients, to identify potential non-linear associations.ResultsA total of 14,053 sepsis patients met the study criteria, of whom 6,826 received at least one TDM during their ICU stay. After PSM, analysis of 4,329 matched pairs revealed a significantly lower 30-day mortality in the TDM group compared with the non-TDM group (23.3% vs.27.7%, p < 0.001). Multivariable Cox proportional hazards regression showed a significantly reduced 30-day mortality risk in the TDM group [adjusted hazard ratio (HR): 0.66; 95% confidence interval (CI): 0.61–0.71; p < 0.001]. This finding was supported by PSM-adjusted analysis (adjusted HR: 0.71; 95% CI: 0.66–0.77; p < 0.001) and inverse probability of treatment weighting analysis (adjusted HR: 0.72; 95% CI: 0.67–0.77; p < 0.001). Kaplan–Meier survival curves also indicated significantly higher 30-day survival in the TDM group (log-rank test, p < 0.0001). Subgroup analyses by gender, age, and race yielded consistent results. Patients with higher severity of illness—indicated by sequential organ failure assessment scores ≥6, acute physiology score III ≥40, or requiring renal replacement therapy, vasopressors, or mechanical ventilation—experienced more pronounced mortality improvement from vancomycin TDM compared with those with lower severity scores or not requiring these interventions. The results remained robust after excluding patients with ICU stays <48 h, those with methicillin-resistant Staphylococcus aureus infections, or when considering only patients with septic shock. In subgroup analyses, patients under 65 years (adjusted HR: 0.50; 95% CI: 0.43–0.58) benefited more from vancomycin TDM than those aged 65 years and older (adjusted HR: 0.75; 95% CI: 0.67–0.83). Notably, sepsis patients aged 18–50 years had the lowest mortality rate among all age groups, at 15.2% both before and after PSM. Furthermore, in this age group, vancomycin TDM was associated with a greater reduction in 30-day mortality risk, with adjusted HRs of 0.32 (95% CI: 0.24–0.41) before PSM and 0.30 (95% CI: 0.22–0.32) after PSM.ConclusionVancomycin TDM is associated with reduced 30-day mortality in sepsis patients, with the most significant benefit observed in patients aged 18–50. This age group exhibited the lowest mortality rates and experienced the greatest reduction in mortality following TDM compared with older patients.https://www.frontiersin.org/articles/10.3389/fmed.2024.1498337/fullvancomycintherapeutic drug monitoringsepsismortalityage |
| spellingShingle | Huaidong Peng Ruichang Zhang Shuangwu Zhou Tingting Xu Ruolun Wang Qilin Yang Xunlong Zhong Xiaorui Liu Impact of vancomycin therapeutic drug monitoring on mortality in sepsis patients across different age groups: a propensity score-matched retrospective cohort study Frontiers in Medicine vancomycin therapeutic drug monitoring sepsis mortality age |
| title | Impact of vancomycin therapeutic drug monitoring on mortality in sepsis patients across different age groups: a propensity score-matched retrospective cohort study |
| title_full | Impact of vancomycin therapeutic drug monitoring on mortality in sepsis patients across different age groups: a propensity score-matched retrospective cohort study |
| title_fullStr | Impact of vancomycin therapeutic drug monitoring on mortality in sepsis patients across different age groups: a propensity score-matched retrospective cohort study |
| title_full_unstemmed | Impact of vancomycin therapeutic drug monitoring on mortality in sepsis patients across different age groups: a propensity score-matched retrospective cohort study |
| title_short | Impact of vancomycin therapeutic drug monitoring on mortality in sepsis patients across different age groups: a propensity score-matched retrospective cohort study |
| title_sort | impact of vancomycin therapeutic drug monitoring on mortality in sepsis patients across different age groups a propensity score matched retrospective cohort study |
| topic | vancomycin therapeutic drug monitoring sepsis mortality age |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2024.1498337/full |
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