title: Continuous infusion of vancomycin in septic patients receiving continuous renal replacement therapy.
abstract: Vancomycin is frequently administered as a continuous infusion to treat severe infections caused by Gram-positive bacteria. Previous studies have suggested a loading dose of 15 mg/kg followed by continuous infusion of 30 mg/kg in patients with normal renal function; however, there are no dosing recommendations in patients with renal failure undergoing continuous renal replacement therapy (CRRT). Data from all adult septic patients admitted to a Department of Intensive Care over a 3-year period in whom vancomycin was given as a continuous infusion were reviewed. Patients were included if they received vancomycin for ≥48h during CRRT. Vancomycin levels were obtained daily. During the study period, 85 patients (56 male; mean age 65±15 years; weight 85±24kg) met the inclusion criteria. Median (interquartile range) APACHE II and SOFA scores were 24 (20-29) and 11 (7-14), respectively, and the overall mortality rate was 59%. Mean vancomycin doses were 16.4±6.4 (loading dose), 23.5±8.1 (Day 1), 23.2±7.4 (Day 2) and 23.3±11.0 (Day 3) mg/kg, resulting in blood concentrations of 24.7±9.0 (Day 1), 26.0±8.1 (Day 2) and 27.7±9.3 (Day 3) μg/mL. On Day 1, 43 patients (51%) had adequate drug concentrations (20-30 μg/mL), 17 (20%) had levels >30 μg/mL and 25 (29%) had levels <20 μg/mL. Most patients with adequate drug concentrations received a daily dose of 16-35 mg/kg. The intensity of CRRT directly influenced vancomycin concentrations on Day 1 of therapy.
authors: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles-ULB, Route de Lennik 808, 1070 Brussels, Belgium.
authors: Cecilia
authors: C
authors: Covajes
authors: Sabino
authors: S
authors: Scolletta
authors: Laura
authors: L
authors: Penaccini
authors: Eva
authors: E
authors: Ocampos-Martinez
authors: Ali
authors: A
authors: Abdelhadii
authors: Marjorie
authors: M
authors: Beumier
authors: Frédérique
authors: F
authors: Jacobs
authors: Daniel
authors: D
authors: de Backer
authors: Jean-Louis
authors: JL
authors: Vincent
authors: Fabio Silvio
authors: FS
authors: Taccone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000379:methods*; D018805:Sepsis / Q000188:drug therapy*; D044967:Serum / Q000737:chemistry; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin