Augmented renal clearance in neurosurgical patients receiving vancomycin: Limited prognostic value for the duration of hospitalization, treatment course, fever, and changes in the CSF test and CRP.

Objective: In patients with augmented renal clearance (ARC) receiving vancomycin, therapeutic drug monitoring (TDM) is recommended in accordance with the 2020 guidelines. This study was conducted to delineate the profile of ARC and TDM in non-critically ill, non-trauma, non-stroke neurosurgical patients receiving vancomycin, thereby elucidating the additional risk factors and prognostic implications of ARC.

Materials and methods: A single-center retrospective review of clinical data was performed from patients who were consecutively admitted to the Neurosurgical Department of Beijing Tongren Hospital, Capital Medical University, Beijing, China, from November 1, 2017, to October 31, 2022, and received vancomycin. 62 patients with a maximum ICU stay of 72 hours were included. ARC was defined as an estimated glomerular filtration rate (eGFR) of > 130 mL/min/1.73m² in the main analysis. A difference analysis based on ARC risk factors, correlation analysis, and multiple linear regression was conducted.

Results: The eGFR of the total patient cohort was 115.41 ± 13.39 mL/min/1.73m² (mean ± SD), whereas 10 patients (16.13%) had eGFRs > 130 mL/min/1.73m². Younger ages and mannitol co-administration were risk factors for ARC, whereas increased eGFR was not associated with prognostic implications for hospital stay, treatment course, fever duration, or duration to normalization of the CSF test or CRP level.

Conclusion: A minimum of 16.13% of non-critical, non-trauma, non-stroke neurosurgical patients exhibit ARC. ARC was not associated with anti-infection prognosis. This finding suggests that further evaluation of ARC-guided TDM of these populations is warranted.