title: Evaluation of a protocol for vancomycin administration in critically patients with and without kidney dysfunction.
abstract: BACKGROUND
  Administration of vancomycin in critically ill patients needs close regulation. While subtherapeutical vancomycin serum concentration (VSC) is associated with increased mortality, accumulation is responsible for nephrotoxicity. Our study aimed to estimate the efficacy of a vancomycin-dosing protocol in reaching appropriate serum concentration in patients with and without kidney dysfunction.
  
  
  METHODS
  This was a retrospective study in critically ill patients treated with continuous infusion of vancomycin. Patients with creatinine clearance > 50 ml/min (Group A) were compared to those with creatinine clearance ≤ 50 ml/min (Group B).
  
  
  RESULTS
  348 patients were enrolled (210 in Group A, 138 in Group B). At first determination, patients with kidney dysfunction (Group B) had a statistically higher percentage of vancomycin in target range, while the percentage of patients with a VSC under the range was almost equal. These percentages differed at the subsequent measurements. The number of patients with low vancomycin concentration progressively decreased, except in those with augmented renal clearance; the percentage of patients with VSC over 30 mg/L was about 28 %, irrespective of the presence or absence of kidney dysfunction. Patients who reached a subtherapeutic level at the first VSC measurement had a significant correlation with in-hospital mortality.
  
  
  CONCLUSIONS
  Our protocol seems to allow a rapid achievement of a target VSC particularly in patients with kidney dysfunction. In order to avoid subtherapeutical VSC, our algorithm should be implemented by the estimation of the presence of an augmented renal clearance.
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy. savinospadaro@gmail.com.
authors.forename: Savino
authors.initials: S
authors.lastname: Spadaro
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy. angela.berselli@student.unife.it.
authors.forename: Angela
authors.initials: A
authors.lastname: Berselli
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy. alberto.fogagnolo@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Fogagnolo
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy. maurizia.capuzzo@unife.it.
authors.forename: Maurizia
authors.initials: M
authors.lastname: Capuzzo
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy. rgc@unife.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ragazzi
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy. e.marangoni@ospfe.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Marangoni
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy. s.bertacchini@ospfe.it.
authors.forename: Sara
authors.initials: S
authors.lastname: Bertacchini
authors.affiliation: Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy. vlc@unife.it.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Volta
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood; D015331:Cohort Studies; D016638:Critical Illness; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D014640:Vancomycin / Q000008:administration & dosage* / Q000097:blood
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin