Factors increasing the risk of inappropriate vancomycin therapy in ICU patients: A prospective observational study

Autor:	Victoria D Bakke, Manuela Zucknick, Ingvild Nordøy, Elin Helset, Elisabeth von der Lippe, Karianne Wiger Gammelsrud, Jan F. Bugge, Hilde Sporsem
Rok vydání:	2020
Předmět:	Male Icu patients medicine.medical_specialty Renal function law.invention Vancomycin therapy 03 medical and health sciences Minimum inhibitory concentration 0302 clinical medicine Vancomycin law Internal medicine medicine Humans Prospective Studies 030212 general & internal medicine Retrospective Studies business.industry 030208 emergency & critical care medicine General Medicine Middle Aged Intensive care unit Anti-Bacterial Agents Intensive Care Units Anesthesiology and Pain Medicine SAPS II Female Observational study business medicine.drug
Zdroj:	Acta Anaesthesiologica Scandinavica. 64:1295-1304
ISSN:	1399-6576 0001-5172
DOI:	10.1111/aas.13658
Popis:	Background Vancomycin trough levels are frequently subtherapeutic in intensive care unit (ICU) patients. The aim of this study was to identify patients at risk of therapeutic failure defined as vancomycin area-under-the-curve0-24 /minimum inhibitory concentration (AUC0-24 /MIC) Methods A prospective observational study of ICU patients ≥ 18 years at initiation of vancomycin therapy was conducted from May 2013 to October 2015. The patients were divided into four groups according to renal function and CRRT-mode as follows: normal- or augmented renal clearance and continuous venovenous hemodialysis or -hemofiltration. Vancomycin peak and trough levels were measured at 24, 48, and 72 hours after therapy initiation. Relevance of vancomycin therapy was retrospectively evaluated based on microbiological results. Results Eighty-three patients were included, median age 54.5 years, 74.5% male, SAPS II score 46, and 90 day mortality 28%. Vancomycin therapy was initiated on ICU-day 8 (IQR, 5-12), with a median treatment time of 7.5 (IQR, 5-12) days. AUC0-24 /MIC > 400 was reached in 81% and 8% with MIC = 1 and 2 mg/L respectively. The CRRT groups had higher AUC0-24 /MIC-ratios than the non-CRRT groups (P Conclusion A MIC-value >1 mg/L and augmented renal clearance, were factors increasing the risk of therapeutic failure. Vancomycin treatments could have been omitted or shortened in most of these patients.
Databáze:	OpenAIRE
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