The Effect of Hypoalbuminemia on the Therapeutic Concentration and Dosage of Vancomycin in Critically Ill Septic Patients in Low-Resource Countries

Abstract

Purpose: To determine whether severe hypoalbuminemia (<25 mg/L) has a significant effect on serum levels of vancomycin and whether it can effect vancomycin dosage regimen and the loading dose administration. Material and Methods: Prospective, cohort, and a single-center study included 61 patients whose vancomycin serum levels were measured in steady state. Vancomycin trough levels ( C min ) that were in the range 15 to 20 µg/mL were considered therapeutic and trough levels higher than 15 µg/mL were considered potentially nephrotoxic. Results: In the group of patients with severe hypoalbuminemia, C min was significantly higher compared to the those with nonsevere hypoalbuminemia (>25 mg/L; 23.04 [19.14] vs 13.28 [11.28], P = .01). In the group of patients who received the vancomycin loading dose of 2 g, C min was significantly higher in patients with severe hypoalbuminemia compared to the patients with nonsevere hypoalbuminemia (34.52 [25.93] vs 15.37 [10.48], P = .04). Conclusion: In critically ill septic patients with severe hypoalbuminemia, there is a high probability that the loading dose of vancomycin is not necessary since it is associated with potentially toxic vancomycin C min , while in the patients with nonsevere hypoalbuminemia the loading dose may be necessary to achieving therapeutic C min .

Clinical characteristics of hospitalized mild/moderate COVID-19 patients with a prolonged negative conversion time of SARS-CoV-2 nucleic acid detection

“…The SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) has been found in both upper and lower gastrointestinal tract where its expression level was nearly 100 times higher than that of respiratory organs [ 30 , 31 ]. Patients with symptoms of the digestive system have more viruses in their gut [ 8 ], and maybe more likely to cause direct damage to the intestinal mucosa.…”

Hypoalbuminemia as Surrogate and Culprit of Infections

“…Serum albumin concentration is an important predictor of amikacin nephrotoxicity [ 198 ]. In septic, critically ill patients with severe hypoalbuminemia, administration of vancomycin loading doses can lead to potentially toxic serum concentrations [ 199 ]. Thrombocytopenia is one of the most common adverse reactions developed in critically ill adult patients treated with teicoplanin, and concurrent severe hypoalbuminemia significantly increases the risk [ 200 ].…”

Involvement of the effect of renal hypoperfusion medications on vancomycin trough concentration: A secondary analysis using a retrospective observational data

“…Similarly, they have hypoalbuminaemia and lower eGFR, which are known risk factors for high VCM trough concentrations. 18,23,28 Thus, clinicians should recognize that the elderly have many risk factors that can cause VCM overexposure. Moreover, hypoalbuminaemia was identified as a relatively strong variable in the maintenance stage.…”