The Effects of Fasting and Massive Diarrhea on Absorption of Enteral Vancomycin in Critically Ill Patients: A Retrospective Observational Study

Abstract

PurposeAlthough vancomycin (VCM) is not absorbed from healthy intestinal mucosa, elevations in the serum VCM concentrations have been reported in some cases. The aims of this study are to evaluate the necessity of therapeutic drug monitoring (TDM) during enteral VCM administration in critically ill patients.Materials and methodsIn this retrospective study, we enrolled 19 patients admitted to our intensive care unit who were treated with enteral VCM from December 2006 to January 2014. Clinical factors were compared between two groups: Group E whose serum concentrations were detectable, and Group N whose concentrations were below the detection limit of the VCM assay.ResultsGroup E comprises 7 patients, and Group N comprises 12 patients. The fasting duration in Group E was significantly longer compared with that in Group N (17 vs. 8 days, p = 0.023). Furthermore, there was a significant correlation between the serum VCM concentrations and the fasting duration (r = 0.79, p < 0.0001), and the amount of diarrhea (r = 0.46, p = 0.046). No difference was observed in the amount of diarrhea at the time of TDM (Group E; 1,850 mL vs. Group N; 210 mL, p = 0.055) and in the Sequential Organ Failure Assessment subscore for the renal system at the time of TDM (Group E; 4.0 vs. Group N; 1.5, p = 0.068).ConclusionLong durations of fasting and massive diarrhea were associated with elevations in the serum VCM concentrations, which suggested that TDM might be necessary during enteral VCM administration in critically ill patients.Trial registrationUMIN Clinical Trials Registry identifier UMIN000016955.

Rash induced by enteral vancomycin therapy in an older patient in a long-term care ventilator unit: case report and review of the literature

“…Several patients also had a history of other hypersensitivities or cystic fibrosis, both general risk factors for drug hypersensitivity. In one study, prolonged fasting and massive diarrhea were risk factors for systemic absorption [ 19 ].…”

Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations

“…Long duration of fasting and massive diarrhea have been associated with elevations in serum vancomycin concentrations, which suggest that TDM might be necessary during enteral vancomycin administration in critically ill patients . Less than 40% of these patients attained therapeutic trough serum concentrations during the first 3 days of therapy .…”

Detectable Vancomycin Stool Concentrations in Hospitalized Patients with Diarrhea Given Intravenous Vancomycin

“…Patients' electronic health records were screened for (1) IV vancomycin receipt for ≥48 h prior to stool collection, (2) ≥1 dose of IV vancomycin administered <24 h prior to stool collection (exception for hemodialysis patients with documented serum level), and (3) no oral vancomycin administration prior to stool collection. Factors associated with increased risk of vancomycin bowel penetration were collected and included renal function/renal replacement therapy, active bowel pathology (irritable bowel syndrome (IBS), diverticulitis, Crohn's disease, history of bariatric surgery, GI surgery within the last month, GI bleed within the last month), and active inflammatory states (active bowel pathology, active infection, shock as evidenced by vasopressor support, and active malignancy) [15,17,23,24]. This study was approved by the Committee for the Protection of Research Subjects at the University of Houston (CPHS000128).…”