Vancomycin target attainment improved following population pharmacokinetic model switch: a large-scale quasi-experimental study of precision dosing

Objectives: The aim of this study was to evaluate the impact of switching population pharmacokinetic models used for model-informed precision dosing (MIPD) of vancomycin on target attainment, acute kidney injury rates, dosing, and sampling burden in 90 295 patients across nineteen hospital systems. Methods: We assessed sites that changed their default vancomycin MIPD model on primary endpoints, including vancomycin area under the concentration-time curve (AUC) target attainment, time to target attainment, and vancomycin-associated AKI rates using an interrupted time series model. Secondary endpoints included vancomycin dosing (day 1 and total course) and sampling frequency. Hospital systems that did not change models served as controls. Results: or control cohorts. Conclusions: This large quasi-experimental study shows that switching from one pair of well-validated and highly predictive models to another improves vancomycin target attainment while maintaining low adverse event rates.