Duration of Systemic Inflammatory Response Syndrome Influences Serum Vancomycin Concentration in Patients With Sepsis

Chuma, Masayuki; Makishima, Makoto; Imai, Toru; Tochikura, Naohiro; Sakaue, Takako; Kikuchi, Norikazu; Kinoshita, Kosaku; Kaburaki, Morio; Yoshida, Yoshikazu

doi:10.1016/j.clinthera.2016.10.009

Cited by 14 publications

(6 citation statements)

References 32 publications

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“…Cardiac surgery patients with fluid shifts and inflammatory response regularly require increased vasopressor and fluid substitution [4][5][6][7]16]. However, the duration of the inflammatory response varies, but is seldom as long as in patients suffering from septic shock or sepsis where it might last for days (not hours) [6,7,35,36]. This raises the question how hemodynamic resuscitation is best achieved after cardiac surgery.…”

Section: Longitudinal Egfr Trajectories After Hes Administrationmentioning

confidence: 99%

WITHDRAWN: Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

Morath¹,

Meid²,

Rickmann³

et al. 2020

Preprint

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Background: Fluid management is an everyday challenge in intensive care units worldwide. Data from recent trials suggest that the use of hydroxyethyl starch leads to a higher rate of acute kidney injury and mortality in septic patients. Evidence on the safety of hydroxyethyl starch used in postoperative cardiac surgery patients is lacking Methods: The aim was to determine the impact of postoperatively administered hydroxyethylstarch 130/0.42 on renal function and 90-day mortality compared to with or without balanced crystalloids in patients after elective cardiac surgery. A retrospective cohort analysis was performed including 2245 patients undergoing elective coronary artery bypass grafting or, aortic valve replacement, or a combination of both between 2015 - 2019. Acute kidney injury was defined according to the ‘kidney disease improving global outcomes’ criteria. Multivariate logistic regression yielded adjusted associations of postoperative hydroxyethyl starch administration with acute kidney injury during hospital stay and 90-day mortality. Linear mixed-effects models predicted trajectories of estimated glomerular filtration rates over the postoperative period to explore the impact of dosage and timing of hydroxyethyl starch administration.Results: A total of 1009 patients (45.0 %) suffered from acute kidney injury. Significantly less acute kidney injury of any stage occurred in patients receiving hydroxyethyl starch compared to patients receiving only crystalloids for fluid resuscitation (43.7 % vs. 51.2 % p=0.008). In multivariate analysis, the administration of hydroxyethyl starch showed a protective effect (OR 0.89 95% confidence interval (CI) (0.82-0.96)) which was less prominent in patients receiving only crystalloids (OR 0.98, 95% CI (0.95-1.00)). No association between hydroxyethyl starch and 90-day mortality (OR 1.05 95% CI (0.88-1.25)) was detected. Renal function trajectories were dose-dependent and biphasic and hydroxyethyl starch could even slow down the late postoperative decline of kidney function.Conclusion: This study showed no association between hydroxyethyl starch and the postoperative occurrence of acute kidney injury and may add evidence to the discussion about the use of hydroxyethyl starch in cardiac surgery patients. In addition, hydroxyethyl starch administered early after surgery in adequate low doses might even prevent the decline of the kidney function after cardiac surgery.

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Section: Longitudinal Egfr Trajectories After Hes Administrationmentioning

confidence: 99%

WITHDRAWN: Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

Morath¹,

Meid²,

Rickmann³

et al. 2020

Preprint

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“…Systemic inflammatory response syndrome (SIRS) duration was identified as influencing vancomycin concentration. Modifying dosing according to SIRS duration will improve prediction accuracy of vancomycin concentration based on TDM …”

Section: Therapeutic Drug Monitoringmentioning

confidence: 99%

Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations

Monteiro

Hahn

Gonçalves

et al. 2018

Pharmacology Res & Perspec

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Vancomycin is a fundamental antibiotic in the management of severe Gram‐positive infections. Inappropriate vancomycin dosing is associated with therapeutic failure, bacterial resistance and toxicity. Therapeutic drug monitoring (TDM) is acknowledged as an important part of the vancomycin therapy management, at least in specific patient subpopulations, but implementation in clinical practice has been difficult because there are no consensus and agglutinator documents. The aims of the present work are to present an overview of the current knowledge on vancomycin TDM and population pharmacokinetic (PPK) models relevant to specific patient subpopulations. Based on three published international guidelines (American, Japanese and Chinese) on vancomycin TDM and a bibliographic review on available PPK models for vancomycin in distinct subpopulations, an analysis of evidence was carried out and the current knowledge on this topic was summarized. The results of this work can be useful to redirect research efforts to address the detected knowledge gaps. Currently, TDM of vancomycin presents a moderate level of evidence and practical recommendations with great robustness in neonates, pediatric and patients with renal impairment. However, it is important to investigate in other subpopulations known to present altered vancomycin pharmacokinetics (eg neurosurgical, oncological and cystic fibrosis patients), where evidence is still unsufficient.

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“…The CCR was the most important predictor of vancomycin serum trough concentrations in elderly patients. Studies have shown that age, body weight, serum creatinine level, CCR and the duration of systemic inflammatory response syndrome 9,10,18,20 are all independent predictors of vancomycin trough concentrations, but the predictors were not consistent across different patient groups. Spadaro et al 21 developed a protocol for vancomycin administration in critically ill patients with and without kidney dysfunction.…”

Section: Resultsmentioning

confidence: 99%

“…Vancomycin serum trough concentrations are correlated with a variety of factors, including renal function, which is one of the most commonly recognized 9,10 . Age, 9,11 blood level of albumin, 11 sepsis duration, 10 and the time from severe acute pancreatitis onset to vancomycin therapy 11 have also been identified as variables that influence vancomycin concentrations. However, the results of different studies are not consistent.…”

Section: What Is Known and Objectivementioning

confidence: 99%

An individualized administration model of vancomycin in elderly patients with sepsis and factors influencing augmented renal clearance

2020

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What is known and objective Vancomycin efficacy is dependent on appropriate dosing, which should aim to achieve a target serum trough level. The purpose of this study was to determine the variables that predicted vancomycin serum trough concentrations in elderly patients with sepsis. Methods This retrospective cohort study, which was conducted in the medical ICU of a university‐affiliated teaching hospital in China, included 87 medical patients with sepsis who were enrolled from January 2014 to December 2017. Results and discussion All the patients were at least 60 years old (mean age = 74.8 ± 8.2 years), and 51.7% (n = 45) of them were male. The most common primary site of infection was the lungs (67.8%), followed by the abdomen (12.6%). Patients with septic shock accounted for 21.8% (n = 19) of the cases. The proportion of patients with vancomycin serum trough concentrations reaching target concentrations (≥15 mg/L) was 47.1% (41 cases). Multivariate linear regression showed that the creatinine clearance rate (CCR) and the daily dosage of vancomycin were independent predictors of vancomycin serum trough concentrations (both p's < 0.05), and the model for predicting vancomycin trough concentrations should be: serum trough concentration (mg/L) = 15.942 − 0.101 × CCR (mL/min) + 0.347 × vancomycin daily doses (mg/kg/d). Augmented renal clearance (ARC) was present in 13 patients (14.9%), and logistic regression revealed body mass index (OR = 1.420, p = .002) and serum creatinine level (OR = 0.883, p = .002) were independent predictors of ARC. What is new and conclusion The CCR and daily dosage of vancomycin were significantly correlated with vancomycin serum trough concentrations in elderly patients with sepsis, and the individualized administration model should be verified through further clinical trials. BMI and serum creatinine level were identified to be independent predictors of ARC in elderly patients.

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Duration of Systemic Inflammatory Response Syndrome Influences Serum Vancomycin Concentration in Patients With Sepsis

Cited by 14 publications

References 32 publications

WITHDRAWN: Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

WITHDRAWN: Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations

An individualized administration model of vancomycin in elderly patients with sepsis and factors influencing augmented renal clearance

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