Performance evaluation of a precision dosing service for vancomycin in a tertiary level pediatric hospital
Introduction: Plasma level-based therapeutic drug monitoring of vancomycin is recommended in the treatment of complex pediatric infections in order to increase the probability of achieving safe and effective pharmacotherapy. Objective: To retrospectively evaluate the activities and performance of ph...
| Autores principales: | , , , , , , , |
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| Formato: | Artículo revista |
| Lenguaje: | Español |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2022
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/37726 |
| Aporte de: |
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I10-R327-article-37726 |
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ojs |
| institution |
Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
| topic |
vancomycin drug monitoring bayes theorem pediatrics precision medicine vancomicina monitoreo de drogas teorema de bayes pediatría medicina de precisión vancomicina monitoramento de medicamento teorema de bayes pediatria medicina de precisão Não se aplica |
| spellingShingle |
vancomycin drug monitoring bayes theorem pediatrics precision medicine vancomicina monitoreo de drogas teorema de bayes pediatría medicina de precisión vancomicina monitoramento de medicamento teorema de bayes pediatria medicina de precisão Não se aplica Caceres Guido, Paulo Licciardone, Nieves Riva, Natalia Pájaro González, Yina Echeverry Martínez, Jhon Jairo Taboada, Guillermo Federico Pagano, Eleonora Schaiquevich, Paula Performance evaluation of a precision dosing service for vancomycin in a tertiary level pediatric hospital |
| topic_facet |
vancomycin drug monitoring bayes theorem pediatrics precision medicine vancomicina monitoreo de drogas teorema de bayes pediatría medicina de precisión vancomicina monitoramento de medicamento teorema de bayes pediatria medicina de precisão Não se aplica |
| author |
Caceres Guido, Paulo Licciardone, Nieves Riva, Natalia Pájaro González, Yina Echeverry Martínez, Jhon Jairo Taboada, Guillermo Federico Pagano, Eleonora Schaiquevich, Paula |
| author_facet |
Caceres Guido, Paulo Licciardone, Nieves Riva, Natalia Pájaro González, Yina Echeverry Martínez, Jhon Jairo Taboada, Guillermo Federico Pagano, Eleonora Schaiquevich, Paula |
| author_sort |
Caceres Guido, Paulo |
| title |
Performance evaluation of a precision dosing service for vancomycin in a tertiary level pediatric hospital |
| title_short |
Performance evaluation of a precision dosing service for vancomycin in a tertiary level pediatric hospital |
| title_full |
Performance evaluation of a precision dosing service for vancomycin in a tertiary level pediatric hospital |
| title_fullStr |
Performance evaluation of a precision dosing service for vancomycin in a tertiary level pediatric hospital |
| title_full_unstemmed |
Performance evaluation of a precision dosing service for vancomycin in a tertiary level pediatric hospital |
| title_sort |
performance evaluation of a precision dosing service for vancomycin in a tertiary level pediatric hospital |
| description |
Introduction: Plasma level-based therapeutic drug monitoring of vancomycin is recommended in the treatment of complex pediatric infections in order to increase the probability of achieving safe and effective pharmacotherapy. Objective: To retrospectively evaluate the activities and performance of pharmacotherapeutic optimization based on vancomycin levels at a tertiary pediatric hospital between 2007 and 2020. Methods: Vancomycin levels of pediatric patients were analyzed, assessing care quality indicators and analytical verifications, as well as aspects related to teaching and research. The predictive performance of vancomycin levels was evaluated after adjustment of the therapeutic regimen using a population pharmacokinetic optimization program (BestDose v1.126) considering the coefficient of determination (R2), the mean absolute percentage error (MAPE), and the root mean square error (RMSE). Results: 13269 vancomycin level determinations were analyzed; 70% were trough levels and 81% belonged to patients in the intensive care units. Forty percent of the trough levels were within the therapeutic range when adjusted without software. Three hundred seventy-four pharmacotherapeutic interventions, of which 97% were accepted by the treating physician; 75% of the post-adjustment trough levels were within the therapeutic range, compared to 40% when the approach was empirical, a difference that was statistically significant (p=0.03). The values associated with predictive performance (n subgroup of patients = 91) were: R2=0.61, MAPE=28.16%, and RMSE=3.3, which all showed to be adequate. Conclusion: The performance of therapeutic vancomycin monitoring and related pharmacokinetic clinical activities showed to be good. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2022 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/37726 |
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I10-R327-article-377262023-03-20T16:24:58Z Performance evaluation of a precision dosing service for vancomycin in a tertiary level pediatric hospital Evaluación de desempeño del servicio de dosificación de precisión para vancomicina en un hospital pediátrico de nivel terciario Avaliação do desempenho de um serviço de dosagem de precisão para vancomicina em um hospital pediátrico de nível terciário Caceres Guido, Paulo Licciardone, Nieves Riva, Natalia Pájaro González, Yina Echeverry Martínez, Jhon Jairo Taboada, Guillermo Federico Pagano, Eleonora Schaiquevich, Paula vancomycin drug monitoring bayes theorem pediatrics precision medicine vancomicina monitoreo de drogas teorema de bayes pediatría medicina de precisión vancomicina monitoramento de medicamento teorema de bayes pediatria medicina de precisão Não se aplica Introduction: Plasma level-based therapeutic drug monitoring of vancomycin is recommended in the treatment of complex pediatric infections in order to increase the probability of achieving safe and effective pharmacotherapy. Objective: To retrospectively evaluate the activities and performance of pharmacotherapeutic optimization based on vancomycin levels at a tertiary pediatric hospital between 2007 and 2020. Methods: Vancomycin levels of pediatric patients were analyzed, assessing care quality indicators and analytical verifications, as well as aspects related to teaching and research. The predictive performance of vancomycin levels was evaluated after adjustment of the therapeutic regimen using a population pharmacokinetic optimization program (BestDose v1.126) considering the coefficient of determination (R2), the mean absolute percentage error (MAPE), and the root mean square error (RMSE). Results: 13269 vancomycin level determinations were analyzed; 70% were trough levels and 81% belonged to patients in the intensive care units. Forty percent of the trough levels were within the therapeutic range when adjusted without software. Three hundred seventy-four pharmacotherapeutic interventions, of which 97% were accepted by the treating physician; 75% of the post-adjustment trough levels were within the therapeutic range, compared to 40% when the approach was empirical, a difference that was statistically significant (p=0.03). The values associated with predictive performance (n subgroup of patients = 91) were: R2=0.61, MAPE=28.16%, and RMSE=3.3, which all showed to be adequate. Conclusion: The performance of therapeutic vancomycin monitoring and related pharmacokinetic clinical activities showed to be good. Introducción: La dosificación de precisión a través del monitoreo de vancomicina basado en sus concentraciones plasmáticas (vancocinemia) es una práctica recomendada en el tratamiento de infecciones pediátricas de alta complejidad para aumentar la probabilidad de lograr una farmacoterapia segura y eficaz. Objetivo: Evaluar retrospectivamente las actividades y el desempeño relacionado a la optimización farmacoterapéutica basada en las vancocinemias (período 2007-2020) de un hospital pediátrico terciario. Métodos: Se analizaron las vancocinemias de pacientes pediátricos, estimándose indicadores de calidad asistencial y verificaciones analíticas, así como también aspectos relacionados a docencia e investigación. Se evaluó el desempeño predictivo de las concentraciones de vancomicina cuando se ajustaron los regímenes terapéuticos con un programa de optimización farmacocinética (BestDose v1.126) considerando el coeficiente de determinación (R2), el error porcentual absoluto medio (MAPE) y la raíz del error cuadrático medio (RMSE). Resultados: Se analizaron 13269 vancocinemias. El 70% fueron valles y el 81% pertenecieron a pacientes de Unidades de Cuidados Intensivos. El 40% de los valles se encontró dentro del margen terapéutico al ajustarse sin programa informático. Se realizaron 347 intervenciones farmacoterapéuticas, el 97% de las cuales fueron aceptadas por el médico tratante; el 75% de los valles posteriores al ajuste entraron en el margen terapéutico, valor significativamente mayor respecto al 40% de cuando el abordaje fue empírico (p=0.03). Los valores asociados al desempeño predictivo, (n subgrupo de pacientes = 91) fueron: R2=0.61, MAPE=28.16% y RMSE=3.3, mostrándose todos adecuados. Conclusión: Las actividades de monitoreo y farmacocinética clínica de vancomicina mostraron un buen rendimiento clínico. Introdução: A dosagem de precisão por meio do monitoramento da vancomicina com base em suas concentrações plasmáticas (vancocinemia) é uma prática recomendada no tratamento de infecções pediátricas de alta complexidade para aumentar a probabilidade de alcançar uma farmacoterapia segura e eficaz. Objetivo: Avaliar retrospectivamente as atividades e o desempenho relacionados à otimização farmacoterapêutica baseada em vancocinemias (período 2007-2020) de um hospital pediátrico terciário. Métodos: Foram analisadas as vancocinemias de pacientes pediátricos, estimando indicadores de qualidade assistencial e verificações analíticas, bem como aspectos relacionados ao ensino e à pesquisa. O desempenho preditivo das concentrações de vancomicina foi avaliado quando os regimes terapêuticos foram ajustados com um programa de otimização farmacocinética (BestDose v1.126) considerando o coeficiente de determinação (R2), o erro percentual absoluto médio (MAPE) e a raiz do erro quadrático médio (RMSE). Resultados: foram analisadas 13.269 vancocinemias. Setenta por cento eram vales e 81% pertenciam a pacientes em Unidades de Terapia Intensiva. Quarenta por cento dos vales estavam dentro da faixa terapêutica quando ajustados sem software. Foram realizadas 347 intervenções farmacoterapêuticas, das quais 97% foram aceitas pelo médico assistente; 75% dos vales pós-ajuste entraram na faixa terapêutica, valor significativamente maior comparado a 40% quando a abordagem foi empírica (p=0,03). Os valores associados ao desempenho preditivo (n subgrupo de pacientes = 91) foram: R2=0,61, MAPE=28,16% e RMSE=3,3, todos se mostrando adequados. Conclusão: As atividades de monitoramento e farmacocinética clínica da vancomicina apresentaram bom desempenho clínico. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2022-12-21 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Text Image Texto Imagen Texto Image application/pdf text/html https://revistas.unc.edu.ar/index.php/med/article/view/37726 10.31053/1853.0605.v79.n4.37726 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 79 No. 4 (2022); 341-346 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 79 Núm. 4 (2022); 341-346 Revista da Faculdade de Ciências Médicas de Córdoba; v. 79 n. 4 (2022); 341-346 1853-0605 0014-6722 10.31053/1853.0605.v79.n4 spa https://revistas.unc.edu.ar/index.php/med/article/view/37726/39803 https://revistas.unc.edu.ar/index.php/med/article/view/37726/39303 Derechos de autor 2022 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |