Vancomycin prophylaxis in paediatric patients following cardiac surgery: a retrospective evaluation of trough levels and associated variables

Vallesi, Leonardo; Fragasso, Tiziana; Benegni, Simona; Insom, Giulia; Chiara, Luca Di; Corsetti, Tiziana; Ricci, Zaccaria

doi:10.1093/icvts/ivaa162

Cited by 2 publications

(3 citation statements)

References 16 publications

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“…Being a post-hoc analysis a formal sample size was not conducted. Even if similar experiences 19–25 have been reported with smallest samples, these conclusions should be confirmed by other reports or larger samples. First, this study has been planned in a population receiving a prophylaxis with vancomycin and cefoxitin.…”

Section: Discussionsupporting

confidence: 70%

“…Interestingly, creatinine levels were positively associated with vancomycin concentrations in the postoperative period in a previous retrospective analysis conducted by our group. 22 In that study, neonates were those with the highest vancomycin levels (and patients ⩾10 years old had the lowest levels), possibly due to reduced renal clearance. In this study, it is possible that hemodilution induced by CPB circuit on vancomycin concentrations possibly had a greater impact on VPC in neonates with respect to renal function.…”

Section: Discussionmentioning

confidence: 81%

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Vancomycin concentrations during cardiopulmonary bypass in pediatric cardiac surgery: a prospective study

et al. 2021

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Introduction: Few data are available regarding intraoperative plasma concentrations of vancomycin administered as prophylaxis in pediatric cardiac surgery. The aims of this study were to investigate during pediatric cardiac surgery with cardiopulmonary bypass(CPB) the attainment of the area-under-the-curve of the vancomycin serum concentrations versus time over surgery to minimum inhibitory concentration ratio(AUCintra/MIC) of 400 (mg × h)/l and/or a target concentration of 15–20 mg/l. Methods: In a prospective study, 40 patients divided into four subgroups (neonates, infants, children <10 years-old, ⩾10 years-old) undergoing cardiac surgery with cardiopulmonary bypass (CPB) were enrolled. A slow vancomycin bolus of 20 mg/kg, up to a maximum dose of 1000 mg was administered before skin incision and a further dose of 10 mg/kg (up to 500 mg) at CPB start. Vancomycin samples were collected intraoperatively at four time points. Results: The median (interquartile range) age was 241.5 days (47–3898) and the median weight was 7.1 kg (3.1–37). The median AUCintra/MIC was 254.73 (165.89–508.06). In 11 patients the AUCintra/MIC target was not reached. Neonates displayed the lowest AUCintra/MIC values, and these were significantly lower than those of children ⩾10 years old (p = 0.02). Vancomycin concentrations were above the maximal target of 20 mg/l in 82.5% and 80% of patients at surgery and CPB start, respectively. At CPB and surgery end, 42.5% of patients showed vancomycin concentrations above 20 mg/l and 42.5% below 15 mg/l. Patients⩾10 years old showed the highest peak values whereas neonates were those with the lowest troughs. AUCintra/MIC correlated with age(r:0.36, p = 0.02), weight(r:0.35, p = 0.03), intraoperative protein value(r:0.40, p = 0.01), CPB priming volume/kg(r:−0.33, p = 0.04), CPB duration(r:0.36, p = 0.02) and vancomycin troughs(r:0.35, p = 0.04). Conclusions: An AUCintra/MIC ⩾400 target was not reached in one-quarter of children undergoing heart surgery. Vancomycin peaked before the start of surgery and neonates were those with the lowest troughs. Vancomycin concentrations are affected by CPB hemodilution and by patients’ age and weight.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 81%

Vancomycin concentrations during cardiopulmonary bypass in pediatric cardiac surgery: a prospective study

et al. 2021

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“…In addition, to the best of our knowledge, although the direct evidence about the correlation between prophylactic vancomycin concentration and SSI risk has not been reported. Vallesi et al 23 noticed an association between duration of mechanical ventilation and intraoperative concentrations of vancomycin. In our study, vancomycin concentration >15 mg/L at surgical closure was used as the target, which was also the target adopted by other studies that focused on evaluating the effectiveness of vancomycin prophylaxis in cardiac surgery 15,16,18 .…”

Section: Discussionmentioning

confidence: 99%

Modification of Vancomycin Dosing in Cardiac Surgery With Cardiopulmonary Bypass

Wang

Zhou

et al. 2023

The Journal of Clinical Pharma

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This study aims to assess the risk factors for insufficient vancomycin concentrations for its prophylactic use in adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and to modify the dosing regimen to achieve appropriate plasma concentrations. A total of 27 patients with vancomycin dosing of 1 to 1.5 g based on a weight cutoff of 67 kg were included, of which only 13 (48.15%) had vancomycin plasma concentration >15 mg/L at surgical closure. Risk factors of vancomycin concentration <15 mg/L at surgical-site closure were confirmed by multivariate logistic regression analysis, which showed that CPB duration was an independent predictor. Patients with CPB duration >4 hours had significantly lower vancomycin concentrations and lower proportion in achieving target vancomycin concentration at the end of CPB and surgical closure. For patients with CPB >4 hours, the modified dosing regimen that a second dose of 0.5 to 0.75 g added at 4 hours since the onset of CPB improved the target achievement of vancomycin concentration at surgical closure. Taken together, CPB duration >4 hours was the risk factor for insufficient vancomycin concentration at surgical closure, while our modified dosing could improve the vancomycin concentrations for its prophylactic use in patients undergoing cardiac surgery with CPB.

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Vancomycin prophylaxis in paediatric patients following cardiac surgery: a retrospective evaluation of trough levels and associated variables

Cited by 2 publications

References 16 publications

Vancomycin concentrations during cardiopulmonary bypass in pediatric cardiac surgery: a prospective study

Vancomycin concentrations during cardiopulmonary bypass in pediatric cardiac surgery: a prospective study

Modification of Vancomycin Dosing in Cardiac Surgery With Cardiopulmonary Bypass

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