Evaluation of a protocol for vancomycin administration in critically patients with and without kidney dysfunction

Spadaro, Savino; Berselli, Angela; Fogagnolo, Alberto; Capuzzo, Maurizia; Ragazzi, Riccardo; Marangoni, Elisabetta; Bertacchini, Sara; Volta, Carlo Alberto

doi:10.1186/s12871-015-0065-1

Cited by 27 publications

(48 citation statements)

References 28 publications

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“…Currently, studies on the clinical outcome of subtherapeutic serum concentration of vancomycin in ARC patients are scarce. However, it has been reported that in patients who did not reach therapeutic trough target 15–25 mg/L 48 h post treatment initiation, in-hospital mortality was significantly higher than those who have attained therapeutic target trough (OR = 2.1, p = 0.003) [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing

2017

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Augmented renal clearance (ARC) is a manifestation of enhanced renal function seen in critically ill patients. The use of regular unadjusted doses of renally eliminated drugs in patients with ARC might lead to therapy failure. The purpose of this scoping review was to provide and up-to-date summary of the available evidence pertaining to the phenomenon of ARC. A literature search of databases of available evidence in humans, with no language restriction, was conducted. Databases searched were MEDLINE (1946 to April 2017), EMBASE (1974 to April 2017) and the Cochrane Library (1999 to April 2017). A total of 57 records were included in the present review: 39 observational studies (25 prospective, 14 retrospective), 6 case reports/series and 12 conference abstracts. ARC has been reported to range from 14 to 80%. ARC is currently defined as an increased creatinine clearance of greater than 130 mL/min/1.73 m2 best measured by 8–24 h urine collection. Patients exhibiting ARC tend to be younger (<50 years old), of male gender, had a recent history of trauma, and had lower critical illness severity scores. Numerous studies have reported antimicrobials treatment failures when using standard dosing regimens in patients with ARC. In conclusion, ARC is an important phenomenon that might have significant impact on outcome in critically ill patients. Identifying patients at risk, using higher doses of renally eliminated drugs or use of non-renally eliminated alternatives might need to be considered in ICU patients with ARC. More research is needed to solidify dosing recommendations of various drugs in patients with ARC.

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Section: Resultsmentioning

confidence: 99%

Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing

2017

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“…Thus, increased initial loading dose or increased dosing frequency is necessary for patients with ARC. A recent article also recommended that it was essential to adjust the dose of vancomicyn, both in terms of loading and continuous infusion dose in order to avoid subtherapeutical serum concentration (Spadaro et al 2015).…”

Section: Discussionmentioning

confidence: 99%

Application of vancomycin in patients with varying renal function, especially those with augmented renal clearance

Chu

Luo

et al. 2016

Pharmaceutical Biology

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Context: Augmented renal clearance (ARC) refers to enhanced renal elimination of circulating solute, and has attracted wide attention in recent years. Objective: This study evaluates the effects of ARC on serum vancomycin concentration in patients administered vancomycin. Materials and methods: This was a retrospective study in patients receiving vancomycin treatment at a dose of 1000 mg in every 12 h and undergoing serum monitoring admitted over a 2-year period (May 2013 to May 2015, in order to estimate the influence of ARC on serum vancomycin concentration. In this study, statistical comparisons were made on the results from patients grouped according to creatinine clearance (CL cr ). Results: One hundred forty-eight patients were enrolled in our study. The results showed that ARC patients were significantly younger, with a significantly lower S cr and higher GFR. The CL cr and steady-state trough concentrations of serum vancomycin exhibited a logarithmic correlation (Rs ¼ À0.699, R 2 ¼ 0.488, p < 0.01) in the patients included in our study. The trough vancomycin concentrations of 62.9% patients in high CL cr group were under 10 lg/mL. Discussion and conclusion: Since ARC was significantly associated with subtherapeutic serum vancomycin concentration, it was necessary to devise adjusted dosage regimens for these patients based on their CL cr .ARTICLE HISTORY

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“…The renal consequence of aggressive dosing of vancomycin is of particular significance in patients with chronic kidney disease (CKD) [Spadaro et al 2015]. This is because approximately one third of the patients admitted into the intensive care unit had a pre-existing CKD [Uchino et al 2005].…”

Section: Vancomycin Toxicity In Chronic Kidney Diseasementioning

confidence: 99%

Review of vancomycin-induced renal toxicity: an update

Bamgbola

2016

Therapeutic Advances in Endocrinology

166

138

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Abstract:In recent times the use of larger doses of vancomycin aimed at curbing the increasing incidence of resistant strains of Staphylococcus aureus has led to a wider report of acute kidney injury (AKI). Apart from biological plausibility, causality is implied by the predictive association of AKI with larger doses, longer duration, and graded plasma concentrations of vancomycin. AKI is more likely to occur with the concurrent use of nephrotoxic agents, and in critically ill patients who are susceptible to poor renal perfusion. Although most vancomycin-induced AKI cases are mild and therefore reversible, their occurrence may be associated with greater incidence of end-stage kidney disease and higher mortality rate. The strategy for its prevention includes adequate renal perfusion and therapeutic drug monitoring in high-risk individuals. In the near future, there is feasibility of renoprotective use of antioxidative substances in the delivery of vancomycin.

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Evaluation of a protocol for vancomycin administration in critically patients with and without kidney dysfunction

Cited by 27 publications

References 28 publications

Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing

Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing

Application of vancomycin in patients with varying renal function, especially those with augmented renal clearance

Review of vancomycin-induced renal toxicity: an update

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