Vancomycin clearance during continuous venovenous haemofiltration in critically ill patients

Chaijamorn, Weerachai; Jitsurong, Arnurai; Wiwattanawongsa, Kamonthip; Wanakamanee, Usanee; Dandecha, Phongsak

doi:10.1016/j.ijantimicag.2011.04.010

Cited by 46 publications

(34 citation statements)

References 20 publications

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“…The calculated sieving coefficient of 0.71 Ϯ 0.13 approximated existing literature (0.70 Ϯ 0.15 to 0.89 Ϯ 0.03) (5, 9, 12). Chaijamorn et al identified vancomycin CVVH clearance of 730 ml/h, a rate lower than that documented in prior studies, and 50% of total clearance attributable to nonrenal mechanisms, similar to the findings of Macias and coworkers (9,15). A possible reason for the difference in the CVVH clearance of vancomycin between studies may pertain to differences in the applied hemofiltration rates.…”

Section: Discussionsupporting

confidence: 60%

“…Continuous venovenous hemofiltration is known to impact the clearance of vancomycin, an antimicrobial often recommended for empirical coverage in sepsis (5,10,12,14,23). Published literature on vancomycin clearance during CVVH is limited to small sample sizes, limited patient populations, and lower hemofiltration rates than those currently used (5,9,12,21). With the change in CVVH practices, the adequacy of existing vancomycin dosing strategies has not been investigated.…”

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confidence: 99%

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Effect of Continuous Venovenous Hemofiltration Dose on Achievement of Adequate Vancomycin Trough Concentrations

Frazee

Kuper

Schramm

et al. 2012

Antimicrob Agents Chemother

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The vancomycin dose necessary for the achievement of target serum trough concentrations during continuous venovenous hemofiltration (CVVH) remains to be elucidated. This was a retrospective cohort study of critically ill adults at a tertiary medical center on concurrent CVVH and vancomycin between 2006 and 2010 with a steady-state vancomycin trough concentration. The 87 included patients were grouped according to low (<30 ml/kg/h; n ‫؍‬ 10) or high (>30 ml/kg/h; n ‫؍‬ 77) CVVH hemofiltration rate (HFR) for analysis. Vancomycin goal trough achievement occurred in only 32 (37%) patients. The primary endpoint of trough attainment significantly differed between HFR subgroups: 90% versus 30% in low-and high-HFR individuals, respectively (P < 0.001). Patients with subtherapeutic trough concentrations had a median (interquartile range) HFR of 40 ml/kg/h (range, 37 to 47 ml/kg/h) compared to 36 ml/kg/h (range, 30 to 39 ml/kg/h) in those who achieved the trough goal. Irrespective of goal trough, an inverse correlation existed between HFR and serum vancomycin concentration (r ‫؍‬ ؊0.423; P < 0.001). In the subgroup of 14 methicillin-resistant Staphylococcus aureus (MRSA) patients, trough achievement was similar to the aggregate cohort (36%). Mortality at 28 days was unrelated to trough achievement in both the overall sample (P ‫؍‬ 0.516) and in culturepositive MRSA patients (P ‫؍‬ 0.396). Critically ill patients undergoing CVVH therapy may experience clinically significant reductions in goal vancomycin troughs. The results of the present study justify prospective evaluations in this population to determine the optimal vancomycin dosing strategy for attainment of goal trough concentrations.

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Section: Discussionsupporting

confidence: 60%

mentioning

confidence: 99%

Effect of Continuous Venovenous Hemofiltration Dose on Achievement of Adequate Vancomycin Trough Concentrations

Frazee

Kuper

Schramm

et al. 2012

Antimicrob Agents Chemother

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“…Different dosages, either for continuous or intermittent vancomycin therapy, have been proposed in recent PK observational studies (51)(52)(53)(54)(55)(56) to understand the best dosages in patients receiving CRRT. CoI seems to be more successful under these conditions to achieve the PK/PD targets.…”

Section: Renal Replacement Therapiesmentioning

confidence: 99%

Optimizing the Clinical Use of Vancomycin

Álvarez

López-Cortés

Molina

et al. 2016

Antimicrob Agents Chemother

190

124

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Pharmacists published specific guidelines about vancomycin dosage and monitoring. However, these guidelines have not been updated in the past 6 years. This review analyzes the new available information about vancomycin published in recent years regarding pharmacokinetics and pharmacodynamics, serum concentration monitoring, and optimal vancomycin dosing in special situations (obese people, burn patients, renal replacement therapy, among others). Vancomycin efficacy is linked to a correct dosage which should aim to reach an area under the curve (AUC)/MIC ratio of >400; serum trough levels of 15 to 20 mg/liter are considered a surrogate marker of an AUC/MIC ratio of >400 for a MIC of <1 mg/liter. For Staphylococcus aureus strains presenting with a MIC >1 mg/liter, an alternative agent should be considered. Vancomycin doses must be adjusted according to body weight and the plasma trough levels of the drug. Nephrotoxicity has been associated with target vancomycin trough levels above 15 mg/liter. Continuous infusion is an option, especially for patients at high risk of renal impairment or unstable vancomycin clearance. In such cases, vancomycin plasma steady-state level and creatinine monitoring are strongly indicated. Vancomycin has traditionally been used as a first-line agent for treating methicillin-resistant Staphylococcus aureus (MRSA) and other Gram-positive beta-lactam-resistant bacteria (1), which are frequent etiologies of severe health-related infections (2, 3).Although the effectiveness of vancomycin is supported by more than 5 decades of use and multiple studies, the clinical and microbiological scenario in which it is used is always changing. Attaining an appropriate dosage of vancomycin for S. aureus infections might be difficult due to the clinical impact of the creep in the MIC of vancomycin and heteroresistance among MRSA strains, or due to complex pharmacokinetic and pharmacodynamic (PK/PD) situations. In this context, the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), and the Society of Infectious Diseases Pharmacists (SIDP) introduced a practice guideline in 2009 (4), marking a milestone in vancomycin therapy. However, several questions, such as the optimal dosing in some special clinical situations (e.g., with renal replacement therapies or in burn patients or obese patients), the role of continuous infusion, or the renal toxicity when the suggested vancomycin serum levels are achieved, remain unanswered. The present review mainly focuses on these issues. VANCOMYCIN PHARMACODYNAMICS AND ITS IMPLICATIONS FOR DRUG MONITORINGThe killing effect of vancomycin is characterized by a slow mode of action and is further hampered by a large bacterial inoculum, a stationary growth phase, and anaerobic conditions (5, 6). Although several pharmacodynamic parameters have been proposed to determine vancomycin activity, data from experimental and clinical studies have selected the area under the curve (AUC)/ MIC ratio as the best parameter to predict the...

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“…Numerous pharmacokinetic studies of vancomycin in critically ill patients receiving varying types of RRT have been published (Beumier et al, 2013;Chaijamorn et al, 2011;DelDot et al, 2004;Kielstein et al, 2006;Macias et al, 1991;Petejova et al, 2012bPetejova et al, , 2012c. The vancomycin Sc is reported to be between 0.7 and 0.9 during CVVH/ CVVHDF for effluent flow rates between 20 and 50 mL/min (Chaijamorn et al, 2011;DelDot et al, 2004;Petejova et al, 2012b).…”

Section: Glycopeptidesmentioning

confidence: 99%

How can we ensure effective antibiotic dosing in critically ill patients receiving different types of renal replacement therapy?

Jamal

Mueller

Choi

et al. 2015

Diagnostic Microbiology and Infectious Disease

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Vancomycin clearance during continuous venovenous haemofiltration in critically ill patients

Cited by 46 publications

References 20 publications

Effect of Continuous Venovenous Hemofiltration Dose on Achievement of Adequate Vancomycin Trough Concentrations

Effect of Continuous Venovenous Hemofiltration Dose on Achievement of Adequate Vancomycin Trough Concentrations

Optimizing the Clinical Use of Vancomycin

How can we ensure effective antibiotic dosing in critically ill patients receiving different types of renal replacement therapy?

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