What proportion of vancomycin trough levels are drawn too early?: frequency and impact on clinical actions.

Morrison AP, Melanson SE, Carty MG, Bates DW, Szumita PM, Tanasijevic MJ
Am J Clin Pathol. 2012 137 (3): 472-8

PMID: 22338061 · DOI:10.1309/AJCPDSYS0DVLKFOH

Vancomycin trough levels are recommended to predict vancomycin efficacy, and inaccurate levels may lead to inappropriate clinical actions. However, the frequency of timing errors and associated clinical impact is unknown. We retrospectively analyzed vancomycin levels (n = 2,597) measured during 13 months at a large academic medical center. Of the specimens, 41.3% were drawn too early. These samples yielded significantly higher average ± SD vancomycin concentrations than correctly timed samples (22.1 ± 11.7 mg/L vs 15.5 mg/L ± 8.6 mg/L; P < .001), and, consequently, clinicians were more likely to decrease, discontinue, or hold a patient's vancomycin dose (25.6% vs 21.4%; P < .02) or repeat the vancomycin level (29.2% vs 20.0%; P < .001). A substantial proportion of specimens collected to assess vancomycin efficacy were drawn too early, leading to overestimation of patients' true trough level and possible underdosing of vancomycin or a high rate of repeat tests for vancomycin.

MeSH Terms (10)

Anti-Bacterial Agents Drug Monitoring Female Hospitals, Teaching Humans Male Middle Aged Retrospective Studies Time Factors Vancomycin

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