A rapid point-of-care test for vancomycin monitoring at the clinical bedside

Vancomycin is a glycopeptide antibiotic that is used extensively as a first- and last-line defense against gram-positive bacterial pathogens. Although vancomycin therapy is effective, it requires individualized dosing, as excessive exposure increases the risk of acute kidney injury, while low exposure can lead to treatment failure and has been implicated in the development of antibiotic resistance. As a result, clinicians follow strict therapeutic drug monitoring (TDM) guidelines to avoid under- and overdosing. TDM involves routine and repeated—sometimes daily—monitoring of circulating drug concentrations to guide individualized dosing of each patient. Current TDM practices are sub-optimal as they require venous blood draws and centralized laboratory assays, sometimes requiring hours—or days—for results to become available. Point-of-care tests (POCTs) are a promising alternative as they provide rapid results that could accelerate potentially lifesaving treatments, decrease healthcare costs, and reduce the logistical burden for patients and caregivers. Here, we introduce a new POCT to detect vancomycin concentrations directly from a fingerstick volume of whole blood within 30 minutes. This POCT has the potential for on-demand monitoring of patient vancomycin concentrations using fingerstick blood draws that greatly facilitate current demand for area under the curve-based dosing schemes, and with the eventual goal of making vancomycin monitoring as easy as measuring blood glucose concentrations by a glucometer.