Impact of universal area under the curve modelling on vancomycin‐associated acute kidney injury at an Australian hospital
Melinda James, Kiernan May, Joel Dulhunty, Ann Whitaker, Anna Brischetto, Kevin O'Callaghan, Nicholas Ah YuiAbstract
Background
The benefits of dosing intravenous vancomycin using area under the curve (AUC) modelling in reducing acute kidney injury (AKI) incidence have been observed internationally. The impact of such a model's introduction in an Australian hospital has yet to be described.
Aim
To describe the impact on AKI incidence of a pharmacist‐led, universal vancomycin AUC therapeutic dose monitoring (TDM) model at Redcliffe Hospital, located in Queensland, Australia.
Method
A local procedure and clinician training package for vancomycin AUC‐TDM, utilising DoseMeRx software, was implemented. A retrospective review was conducted, comparing AKI incidence during a six‐month period prior to (1 January 2024–30 June 2024) and post‐implementation (1 October 2024–31 March 2025). AKI incidence during vancomycin treatment or within 5 days of cessation was recorded and analysed using descriptive statistics, univariable analyses and multivariable logistic regression. This study was exempt due to the local policy requirements that constitute research by the Metro North Health Human Research Ethics Committee A (Reference no: 112956). The justification for this exemption was as follows: the study was retrospective, utilised only anonymised data collected as part of routine clinical practice, conforms with the National Health and Medical Research Council Ethical considerations in quality assurance and evaluation activities , and did not include any assessment of staff involved in training and use of DoseMeRx.
Results
Reduced AKI incidence was observed in the post‐intervention group from 26.0% to 13.3% (p = 0.073), a relative risk reduction of 48.8%. The median time to first vancomycin level reduced by 19 h and the median time to therapeutic target attainment reduced by 32.5 h (both p < 0.001). The proportion of courses with one or more uninterpretable vancomycin level reduced from 28% to 19.3%, with an unchanged number of levels per course.
Conclusion
This pharmacist‐led vancomycin AUC‐TDM model showed a promising but non‐significant AKI rate reduction. The demonstrated reductions in time to first serum vancomycin level and to therapeutic target attainment evidenced patient safety, speed, and process improvements replicable in other Australian healthcare facilities.