Vancomycin dosing in critically ill trauma patients: The VANCTIC Study
BACKGROUND Current guidelines from the Infectious Diseases Society of America and the American Society of Health-System Pharmacists recommend vancomycin troughs of 15 mg/L to 20 mg/L for serious methicillin-resistant Staphylococcus aureus infections. The pharmacokinetics of vancomycin are altered in...
Published in: | Journal of Trauma and Acute Care Surgery |
---|---|
Main Authors: | , , , , , , |
Format: | Article in Journal/Newspaper |
Language: | English |
Published: |
Ovid Technologies (Wolters Kluwer Health)
2019
|
Subjects: | |
Online Access: | http://dx.doi.org/10.1097/ta.0000000000002492 https://journals.lww.com/10.1097/TA.0000000000002492 |
id |
crovidcr:10.1097/ta.0000000000002492 |
---|---|
record_format |
openpolar |
spelling |
crovidcr:10.1097/ta.0000000000002492 2024-10-06T13:46:59+00:00 Vancomycin dosing in critically ill trauma patients: The VANCTIC Study Villanueva, Ruben D. Talledo, Oscar Neely, Stephen White, Bryan Celii, Amanda Cross, Alisa Kennedy, Ryan 2019 http://dx.doi.org/10.1097/ta.0000000000002492 https://journals.lww.com/10.1097/TA.0000000000002492 en eng Ovid Technologies (Wolters Kluwer Health) Journal of Trauma and Acute Care Surgery volume 87, issue 5, page 1164-1171 ISSN 2163-0763 2163-0755 journal-article 2019 crovidcr https://doi.org/10.1097/ta.0000000000002492 2024-09-09T05:59:14Z BACKGROUND Current guidelines from the Infectious Diseases Society of America and the American Society of Health-System Pharmacists recommend vancomycin troughs of 15 mg/L to 20 mg/L for serious methicillin-resistant Staphylococcus aureus infections. The pharmacokinetics of vancomycin are altered in critically ill patients, leading to inadequate serum levels. Rates of initial therapeutic vancomycin troughs have ranged from 17.6% to 33% using intermittent infusions (i.e., 15–20 mg/L) and approximately 60% using continuous infusions (i.e., 15–25 mg/L) in critically ill trauma patients (1–4). We hypothesized that our dosing protocol would achieve higher rates of initial therapeutic troughs compared with previously published reports due to more aggressive loading doses than those seen in previously published reports. METHODS This was a retrospective study of all critically ill trauma patients admitted to a Level I trauma intensive care unit over a 39-month period who had a suspected serious infection, who were treated with empiric vancomycin per the “pharmacy to dose” protocol, and who had an appropriately drawn steady state trough level. The primary outcome was the rate of initial therapeutic troughs, which was defined as 14.5 mg/L to 20.5 mg/L. RESULTS One hundred ninety-seven patients were screened. Seventy patients met inclusion criteria. The study cohort had a median age of 47.5 years and a median Injury Severity Score of 28. Augmented renal clearances were observed, with a median creatinine clearance of 159.1 mL/min and a median Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) score of 7. The median vancomycin loading dose was 24.6 mg/kg with an initial maintenance dose of 17.71 mg/kg. An every eight hour dosing interval was initiated on 47.14% of the patients, and 45.71% of the patients were initially started on an every 12 hour dosing interval. Only 15.71% of the study patients achieved an initial therapeutic trough; 42.86% were less than 10 mg/L, and 8.57% were greater than 20.5 mg/L. Acute ... Article in Journal/Newspaper Arctic Ovid Arctic Journal of Trauma and Acute Care Surgery 87 5 1164 1171 |
institution |
Open Polar |
collection |
Ovid |
op_collection_id |
crovidcr |
language |
English |
description |
BACKGROUND Current guidelines from the Infectious Diseases Society of America and the American Society of Health-System Pharmacists recommend vancomycin troughs of 15 mg/L to 20 mg/L for serious methicillin-resistant Staphylococcus aureus infections. The pharmacokinetics of vancomycin are altered in critically ill patients, leading to inadequate serum levels. Rates of initial therapeutic vancomycin troughs have ranged from 17.6% to 33% using intermittent infusions (i.e., 15–20 mg/L) and approximately 60% using continuous infusions (i.e., 15–25 mg/L) in critically ill trauma patients (1–4). We hypothesized that our dosing protocol would achieve higher rates of initial therapeutic troughs compared with previously published reports due to more aggressive loading doses than those seen in previously published reports. METHODS This was a retrospective study of all critically ill trauma patients admitted to a Level I trauma intensive care unit over a 39-month period who had a suspected serious infection, who were treated with empiric vancomycin per the “pharmacy to dose” protocol, and who had an appropriately drawn steady state trough level. The primary outcome was the rate of initial therapeutic troughs, which was defined as 14.5 mg/L to 20.5 mg/L. RESULTS One hundred ninety-seven patients were screened. Seventy patients met inclusion criteria. The study cohort had a median age of 47.5 years and a median Injury Severity Score of 28. Augmented renal clearances were observed, with a median creatinine clearance of 159.1 mL/min and a median Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) score of 7. The median vancomycin loading dose was 24.6 mg/kg with an initial maintenance dose of 17.71 mg/kg. An every eight hour dosing interval was initiated on 47.14% of the patients, and 45.71% of the patients were initially started on an every 12 hour dosing interval. Only 15.71% of the study patients achieved an initial therapeutic trough; 42.86% were less than 10 mg/L, and 8.57% were greater than 20.5 mg/L. Acute ... |
format |
Article in Journal/Newspaper |
author |
Villanueva, Ruben D. Talledo, Oscar Neely, Stephen White, Bryan Celii, Amanda Cross, Alisa Kennedy, Ryan |
spellingShingle |
Villanueva, Ruben D. Talledo, Oscar Neely, Stephen White, Bryan Celii, Amanda Cross, Alisa Kennedy, Ryan Vancomycin dosing in critically ill trauma patients: The VANCTIC Study |
author_facet |
Villanueva, Ruben D. Talledo, Oscar Neely, Stephen White, Bryan Celii, Amanda Cross, Alisa Kennedy, Ryan |
author_sort |
Villanueva, Ruben D. |
title |
Vancomycin dosing in critically ill trauma patients: The VANCTIC Study |
title_short |
Vancomycin dosing in critically ill trauma patients: The VANCTIC Study |
title_full |
Vancomycin dosing in critically ill trauma patients: The VANCTIC Study |
title_fullStr |
Vancomycin dosing in critically ill trauma patients: The VANCTIC Study |
title_full_unstemmed |
Vancomycin dosing in critically ill trauma patients: The VANCTIC Study |
title_sort |
vancomycin dosing in critically ill trauma patients: the vanctic study |
publisher |
Ovid Technologies (Wolters Kluwer Health) |
publishDate |
2019 |
url |
http://dx.doi.org/10.1097/ta.0000000000002492 https://journals.lww.com/10.1097/TA.0000000000002492 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Journal of Trauma and Acute Care Surgery volume 87, issue 5, page 1164-1171 ISSN 2163-0763 2163-0755 |
op_doi |
https://doi.org/10.1097/ta.0000000000002492 |
container_title |
Journal of Trauma and Acute Care Surgery |
container_volume |
87 |
container_issue |
5 |
container_start_page |
1164 |
op_container_end_page |
1171 |
_version_ |
1812175253326004224 |