Vancomycin therapy in critically ill patients on continuous renal replacement therapy; are we doing enough?

Omrani, Ali S.; Mously, Alaa; Cabaluna, Marylie P.; Kawas, John; AlBarrak, Mohammed; Alfahad, Wafa

doi:10.1016/j.jsps.2014.08.005

Cited by 13 publications

(10 citation statements)

References 16 publications

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“…Dose recommendations for vancomycin in CRRT vary widely in the literature from 500 mg every 12 h, to 1000 mg every 48 h, to continuous infusions 9–13 . Researchers have found that vancomycin concentrations are often subtherapeutic in patients on CRRT 14–16 . A study by Franzee et al found that only 37% of patients achieved target trough concentration, defined as 10–15 mcg/ml or 15–20 mg/L, when vancomycin was dosed based on institutional guidelines of 15–20 mg/kg every 24 h. Failure to achieve target trough was more common in patients on high ultrafiltration rates of >30 ml/kg/h 14 .…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12][13] Researchers have found that vancomycin concentrations are often subtherapeutic in patients on CRRT. [14][15][16] A study by Franzee et al found that only 37% of patients achieved target trough concentration, defined as 10-15 mcg/ml or 15-20 mg/L, when vancomycin was dosed based on institutional guidelines of 15-20 mg/ kg every 24 h. Failure to achieve target trough was more common in patients on high ultrafiltration rates of >30 ml/kg/h. 14 Continuous infusion vancomycin is an alternative to intermittent dosing and may achieve AUC24/MIC ratio ≥400 more consistently.…”

Section: Pharmacokinetic Data Provided By Neely Et Al Demonstrated High Inter-mentioning

confidence: 99%

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Evaluation of dosing strategies and trough concentrations of vancomycin in patients undergoing continuous venovenous hemofiltration

et al. 2021

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Study Objective: Recommendations regarding vancomycin dosing in critically ill patients on continuous venovenous hemofiltration (CVVH) are limited. The purpose of this study was to evaluate current dosing practices of pharmacists for patients treated with CVVH, develop guidelines for optimal dosing and monitoring of vancomycin to improve target trough attainment, and reduce pharmacist workload.Design: A retrospective cohort study. was performed of critically ill adult patients from January 2015 to December 2018. Patients were included if they received vancomycin during CVVH for at least 48 h. Patients with significant residual kidney function, defined as daily urine output >400 ml or significant fluctuations (≥1000 ml/h in a 24-h period) in their hemofiltration rates, were excluded. Interruptions in CVVH up to 6 h/day were permitted. Dosing strategies with two dosing categories were defined:(1) dosing based on random serum levels (dosing by level, DBL) or (2) scheduled vancomycin dosing (SD).Setting: Academic medical center in Detroit, Michigan.Patients: Critically ill adult patients. Measurements and Main Results:During the study period, 942 patients were evaluated and 200 met inclusion criteria, for a total of 586 serum vancomycin levels. There were 141 patients with 443 random vancomycin serum levels in the DBL group and 59 patients with143 vancomycin trough levels in the SD group. Mean vancomycin trough levels were similar between groups (17.1 ± 6 vs. 16.5 ± 4 mcg/ml) for the DBL and SD groups, respectively. For the primary end point of overall target trough achievement of 15-20 mcg/ml, significantly more trough levels in the SD group were in the 15-20 mcg/ml range compared with the DBL group, 50% vs. 38%; p < 0.001, respectively.When target trough range was extended to 10-20 mcg/ml, success rates were similar between groups (74% DBL vs. 82% SD, p = 0.021). The number of interventions required by the pharmacist, including notes per day and orders per day, were reduced by approximately 50% when the SD strategy was utilized. Scheduled vancomycin dosing regimens of 15-22 mg/kg every 12-24 h were required to yield trough levels in the 15-20 mcg/ml range.Conclusions: Target vancomycin trough achievement of 15-20 mcg/ml occurred more frequently when vancomycin was scheduled at a dose of 15-22 mg/kg every 12-24 h | 555 WAHBY et Al.

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Section: Discussionmentioning

confidence: 99%

Section: Pharmacokinetic Data Provided By Neely Et Al Demonstrated High Inter-mentioning

confidence: 99%

Evaluation of dosing strategies and trough concentrations of vancomycin in patients undergoing continuous venovenous hemofiltration

et al. 2021

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“…Although vancomycin clearance in patients receiving CVVHDF appears to be easily predicted by the known principles of hemofiltration, hemodialysis, and pharmacokinetic properties of vancomycin, it is recommended that TDM be performed instead of relying only on the predicted value because the actual clinically measured value is often different from the predicted value [ 3 , 7 , 8 , 14 , 35 , 36 ]. In particular, vancomycin has a narrow therapeutic range, thus accurate prediction and maintenance of proper serum concentration are more important [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Factors affecting serum concentration of vancomycin in critically ill oliguric pediatric patients receiving continuous venovenous hemodiafiltration

et al. 2018

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Vancomycin is known to be unintentionally eliminated by continuous renal replacement therapy, and the protein bound fraction of vancomycin is also known to be different in adults and children. However, there are only a few studies investigating the relationship between the dose of continuous venovenous hemodiafiltration (CVVHDF) parameters and serum concentration of vancomycin in pediatric patients. The aim of this study was to determine clinical and demographic parameters that significantly affect serum vancomycin concentrations. This retrospective cohort study was conducted at a pediatric intensive care unit in a tertiary university children’s hospital. Data from oliguric patients who underwent CVVHDF and vancomycin therapeutic drug monitoring were collected. The correlation between factors affecting serum concentration of vancomycin was analyzed using mixed effect model. A total of 177 serum samples undergoing vancomycin therapeutic drug monitoring were analyzed. The median age of study participants was 2.23 (interquartile range, 0.3–11.84) years, and 126 (71.19%) were male patients. Serum concentration of vancomycin decreased significantly as the effluent flow rate (EFR; P < 0.001), dialysate flow rate (DFR; P = 0.009), replacement fluid flow rate (RFFR; P = 0.008), the proportion of RFFR in the sum of DFR and RFFR (P = 0.025), and residual urine output increased. The adjusted R2 of the multivariate regression model was 0.874 (P < 0.001) and the equation was as follows: Vancomycin trough level (mg/L) = (0.283 × daily dose of vancomycin [mg/kg/d]) + (365.139 / EFR [mL/h/kg])–(15.842 × residual urine output [mL/h/kg]). This study demonstrated that the serum concentration of vancomycin was associated with EFR, DFR, RFFR, the proportion of RFFR, and residual urine output in oliguric pediatric patients receiving CVVHDF.

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“…About 80-90% vancomycin is excreted as unchanged drug in the first 24 h from urine. Vancomycin serum levels are difficult to maintain in CRRT patients (Omrani et al, 2015), and are significantly affected by CRRT intensity (Beumier et al, 2013). Early study suggested vancomycin 1 g q48h under CVVH and 1 g q24h under CVVHD and CVVHDF (Trotman et al, 2005).…”

Section: Vancomycinmentioning

confidence: 99%

Recommendation of Antimicrobial Dosing Optimization During Continuous Renal Replacement Therapy

Xia

et al. 2020

Front. Pharmacol.

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Continuous Renal Replacement Therapy (CRRT) is more and more widely used in patients for various indications recent years. It is still intricate for clinicians to decide a suitable empiric antimicrobial dosing for patients receiving CRRT. Inappropriate doses of antimicrobial agents may lead to treatment failure or drug resistance of pathogens. CRRT factors, patient individual conditions and drug pharmacokinetics/pharmacodynamics are the main elements effecting the antimicrobial dosing adjustment. With the development of CRRT techniques, some antimicrobial dosing recommendations in earlier studies were no longer appropriate for clinical use now. Here, we reviewed the literatures involving in new progresses of antimicrobial dosages, and complied the updated empirical dosing strategies based on CRRT modalities and effluent flow rates. The following antimicrobial agents were included for review:

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Vancomycin therapy in critically ill patients on continuous renal replacement therapy; are we doing enough?

Abstract: Therapeutic vancomycin levels are difficult to maintain in critically ill patients who are receiving IV vancomycin therapy whilst on CRRT. Aggressive dosing schedules and frequent monitoring are required to ensure adequate vancomycin therapy in this setting.

Cited by 13 publications

References 16 publications

Evaluation of dosing strategies and trough concentrations of vancomycin in patients undergoing continuous venovenous hemofiltration

Evaluation of dosing strategies and trough concentrations of vancomycin in patients undergoing continuous venovenous hemofiltration

Factors affecting serum concentration of vancomycin in critically ill oliguric pediatric patients receiving continuous venovenous hemodiafiltration

Recommendation of Antimicrobial Dosing Optimization During Continuous Renal Replacement Therapy

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