Faculty Collaboration Database

Prospective evaluation of a continuous infusion vancomycin dosing nomogram in critically ill patients undergoing continuous venovenous haemofiltration. J Antimicrob Chemother 2018 Jan 01;73(1):199-203

Date

10/19/2017

Pubmed ID

29040561

DOI

10.1093/jac/dkx356

Scopus ID

2-s2.0-85040615995 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

OBJECTIVES: The most optimal method of attaining therapeutic vancomycin concentrations during continuous venovenous haemofiltration (CVVH) remains unclear. Studies have shown continuous infusion vancomycin (CIV) achieves target concentrations more rapidly and consistently when compared with intermittent infusion. Positive correlations between CVVH intensity and vancomycin clearance (CLvanc) have been noted. This study is the first to evaluate a CIV regimen in patients undergoing CVVH that incorporates weight-based CVVH intensity (mL/kg/h) into the dosing nomogram.

METHODS: This was a prospective, observational study of patients undergoing CVVH and receiving CIV based on the nomogram. The primary outcome was achievement of a therapeutic vancomycin concentration (15-25 mg/L) at 24 h. Secondary outcomes included the achievement of therapeutic concentrations at 48 and 72 h.

RESULTS: The nomogram was analysed in 52 critically ill adults. Vancomycin concentrations were therapeutic in 43/52 patients (82.7%) at 24 h. Of the nine patients who were not therapeutic at 24 h, seven were supratherapeutic and two were subtherapeutic. The mean (SD) concentration was 20.1 (4.2)  mg/L at 24 h, 20.7 (3.7) mg/L at 48 h and 21.9 (3.5)  mg/L at 72 h. Patients with CVVH intensity >20 mL/kg/h experienced higher CLvanc at 24 h compared with patients with CVVH intensity <20 mL/kg/h (3.1 versus 2.6 L/h; P = 0.013).

CONCLUSIONS: By incorporating CVVH intensity into the CIV dosing nomogram, the majority of patients achieved therapeutic concentrations at 24 h and maintained them within range at 48 and 72 h. Additional studies are required to validate this nomogram before widespread implementation may be considered.

Author List

Sin JH, Newman K, Elshaboury RH, Yeh DD, de Moya MA, Lin H

Author

Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anti-Bacterial Agents
Critical Illness
Gram-Positive Bacterial Infections
Hemofiltration
Humans
Metabolic Clearance Rate
Nomograms
Prospective Studies
Renal Insufficiency
Tertiary Care Centers
Vancomycin