Vancomycin removal during low-flux and high-flux extended daily hemodialysis in critically ill septic patients

Petejová, Naděžda; Martínek, Arnošt; Zahálková, J; Duricova, Jana; Brozmanová, Hana; Urbánek, Karel; Grundmann, Milan; Kacířová, Ivana

doi:10.5507/bp.2012.002

Cited by 35 publications

(35 citation statements)

References 29 publications

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“…Our strategy led to an AUC being ∼ 350 μg/mL and the target AUC/MIC ratio was reached only in one patient out of 8. Even if only 8 patients were assessable, the risk of vancomycin underdosing in dialyzed patients was already reported in a study that analyzed vancomycin clearance during daily hemodialysis; this target was reached in only onethird of patients [19] . This risk has to be overcome because vancomycin underdosing is associated with treatment failure and the emergence of resistant bacteria [20,21] .…”

Section: Discussionmentioning

confidence: 99%

Vancomycin during the Last Hour of the Hemodialysis Session: A Pharmacokinetic Analysis

Ghouti-terki

Chasseuil²,

Rabot

et al. 2017

Nephron

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Background: Vancomycin is usually administered after the dialysis sessions to patients undergoing hemodialysis. Administration of vancomycin during (as opposed to after) sessions would save time, and would be more acceptable to patients and staff, but may lead to vancomycin underexposure. The aim of this study was to propose a new dosing regimen of vancomycin taking into account the dialysis-related losses of vancomycin when administered during dialysis. Methods: In this monocentric prospective study, vancomycin was infused to dialyzed patients during the last hour of the dialysis session at increased doses. Monitoring of vancomycin was performed using repeated blood samples by pharmacokinetics modeling. Patients were treated according to our protocol and guidelines. Results: Twenty patients were included. Vancomycin protocol was efficient: 17 of 20 (85%) patients were cured, 1 needed additional vancomycin treatment, and 2 died (sepsis n = 1, multiple organ failure n = 1). Median pre-dialysis concentration was adequate (16.2 [10.2-24.4] µg/mL), and there was no emergence of resistant bacteria. Infusion of vancomycin during dialysis therefore decreased the exposure to vancomycin by 25% compared to infusion of vancomycin after dialysis. For a typical patient, the dose of vancomycin to be administered during dialysis would be 1.4 g. Conclusion: Administration of vancomycin during the last hour of dialysis session is safe, efficacious with regards to infection control, achieved recommended vancomycin concentrations despite the use of high-flux membranes, and improved patients' quality of life.

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Section: Discussionmentioning

confidence: 99%

Vancomycin during the Last Hour of the Hemodialysis Session: A Pharmacokinetic Analysis

Ghouti-terki

Chasseuil²,

Rabot

et al. 2017

Nephron

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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: 97%

“…RRT can significantly affect vancomycin clearance with large increases expected when higher effluent flow rates are used (N65 mL/min) (Escobar et al, 2014;Petejova et al, 2012b). PIRRT also substantially increases vancomycin clearance (Kielstein et al, 2006;Petejova et al, 2012c).…”

Section: Glycopeptidesmentioning

confidence: 97%

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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“…Dosing and pharmacokinetic data in patients receiving intermittent hemodialysis are not applicable to those receiving CRRT because of substantial differences in procedure, filters and timing. The clearance of vancomycin changes and can be increased using high-flux membranes 9 . An AUC/MIC ratio of ≥ 400 has been advocated as a target to achieve clinical effectiveness with vancomycin.…”

mentioning

confidence: 99%

Vancomycin pharmacokinetics during high-volume continuous venovenous hemofiltration in critically ill septic patients

Petejová¹,

Martínek²,

Zahálková³

et al. 2014

BIOMED PAP

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Aims.To assess the influence of continuous venovenous hemofiltration (CVVH) at a filtration rate of 45 mL/kg/h on vancomycin pharmacokinetics in critically ill septic patients with acute kidney injury (AKI). Methods. Seventeen adult septic patients with acute kidney injury treated with CVVH and vancomycin were included. All patients received first dose of 1.0 g intravenously followed by 1.0 g/12 h if not adjusted. In sixteen patients vancomycin was introduced on the day of the start of CRRT therapy. Blood samples and ultrafiltrates were obtained before and 0.5, 1, 6 and 12 h after vancomycin administration. Results. On the first day, the median total vancomycin clearance (Cl tot ) was 0.89 mL/min/kg (range 0.31 -2.16). CRRT clearance accounted for around 50-60% of the total clearance of vancomycin found in a population with normal renal function (0.97 mL/min/kg). Vancomycin serum concentrations after the first dose were below the required target of 10 mg/L as early as 6 h in 10 patients, AUC 0-24 /MIC ≥ 400 ratio was achieved in 10 patients on the first day. Conclusions. CVVH at a filtration rate of 45 mL/kg/h leads to high and rapid extracorporeal removal of vancomycin in critically ill patients. Due to the rapid change in patient clinical status it was impossible to predict a fixed dosage regimen. We recommend blood sampling as early as 6 h after first vancomycin dose with maintenance dose based on vancomycin serum level monitoring.

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Vancomycin removal during low-flux and high-flux extended daily hemodialysis in critically ill septic patients

Cited by 35 publications

References 29 publications

Vancomycin during the Last Hour of the Hemodialysis Session: A Pharmacokinetic Analysis

Vancomycin during the Last Hour of the Hemodialysis Session: A Pharmacokinetic Analysis

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

Vancomycin pharmacokinetics during high-volume continuous venovenous hemofiltration in critically ill septic patients

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