Evaluating the consistency of the new and old calculation models of AUC0-24/MIC for vancomycin and com-paring their prediction values on clinical efficacy
OBJECTIVE To evaluate the predictive value of the old(previously developed)and new(recently established)AUC0-24/MIC(ratio of daily area under concentration-time curve to minimal inhibitory concentration)models for vancomycin in terms of clinical efficacy.METHODS The relevant clinical data were retrospectively reviewed for 42 patients with bloodstream infections.A total of 42 strains of methicillin-resistant staphylococci were detected from 5 species.Regarding the differences between two models,65 pairs of AUC0-24/MIC values from 65 regimens were acquired with paired sample t-test and Bland-Altman plot.As for the predictability of two models on clinical efficacy,Spearman's rank correlation analysis was utilized for com-paring the correlation between 97 pairs of model-based efficacy grading and actual efficacy grading in all regimens at various treat-ment stages.Regarding the prediction of models for vancomycin nephrotoxicity,correlation coefficients were utilized for examin-ing the correlation between 42 pairs of model-based AUC0-24/MIC values and altered serum creatinine levels before and after treat-ment.RESULTS The values of AUC0-24/MIC by two models differed greatly.AUC0-24/MIC calculated by novel model was on average 28.9 greater than that predicted by old model with a maximum of 62.2 h.Daily dose calculated by novel model was at least 78 mg higher on average and as high as 1 198 mg higher than that calculated by the previous model.Actual efficacy grading and theoretical efficacy grading predicted by two models were markedly correlated.However,the novel model showed a stronger connection(Spearman grade correlation coefficient for the novel model and the old model was 0.826 vs.0.656).No discernible relationship existed between altered serum creatinine levels and model-based AUC0-24/MIC values.CONCLUSION Two mod-els areinconsistent for calculating the AUC0-24/MIC values of vancomycin.This novel model has better predictive value for clinical efficacy.Nevertheless,neither model can forecast vancomycin's nephrotoxicity.
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