title: Continuous Infusion Vancomycin Through the Addition of Vancomycin to the Continuous Renal Replacement Therapy Solution in the PICU: A Case Series.
abstract: OBJECTIVE
  To describe our experience with achieving therapeutic serum vancomycin concentrations in pediatric continuous renal replacement therapy by using continuous infusion vancomycin by mixing vancomycin into the continuous renal replacement therapy solution.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  A 189-bed, freestanding children's tertiary care teaching hospital in Philadelphia, PA.
  
  
  METHODS
  Pediatric patients receiving continuous renal replacement therapy from April 1, 2009, through December 31, 2014.
  
  
  METHODS
  None.
  
  
  RESULTS
  There were a total of 21 patients who received continuous renal replacement therapy during the study period. Of these, 11 (52.3%) received vancomycin in the continuous renal replacement therapy solution. The median (range) concentration of vancomycin added to the continuous renal replacement therapy solution was 25 mg/L (18-35 mg/L). The mean vancomycin plateau level was 22.8 ± 3.3 mg/L. All patients achieved a serum vancomycin plateau level that was greater than 15 mg/L. There were no adverse events related to the addition of vancomycin to the continuous renal replacement therapy solution.
  
  
  CONCLUSIONS
  The addition of vancomycin to the continuous renal replacement therapy solution(s) is an effective modality that is used for delivering vancomycin continuous infusion and for ensuring therapeutic vancomycin serum plateau levels in the setting of pediatric continuous renal replacement therapy. Further studies are required to evaluate whether this delivery method can lead to improved patient outcomes.
authors.affiliation: 1Center for Pediatric Pharmacotherapy, LLC, Pottstown, PA. 2Department of Pediatrics, Section of Pharmacy, St. Christopher's Hospital for Children, Philadelphia, PA. 3Department of Pediatrics, Section of Pharmacy, Drexel University College of Medicine, Philadelphia, PA. 4Department of Pediatrics, Section of Nephrology, St. Christopher's Hospital for Children, Philadelphia, PA. 5Department of Pediatrics, Section of Nephrology, Drexel University College of Medicine, Philadelphia, PA. 6Department of Pediatrics, Section of Critical Care Medicine, St. Christopher's Hospital for Children, Philadelphia, PA. 7Department of Pediatrics, Section of Critical Care Medicine, Drexel University College of Medicine, Philadelphia, PA. 8Department of Pediatrics, Section of Critical Care Medicine, NYU Langone Medical Center, New York, NY. 9Department of Pediatrics, Section of Critical Care Medicine, NYU School of Medicine, New York, NY.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Cies
authors.forename: Wayne S
authors.initials: WS
authors.lastname: Moore
authors.forename: Susan B
authors.initials: SB
authors.lastname: Conley
authors.forename: Samina
authors.initials: S
authors.lastname: Muneeruddin
authors.forename: Jason
authors.initials: J
authors.lastname: Parker
authors.forename: Paul
authors.initials: P
authors.lastname: Shea
authors.forename: Arun
authors.initials: A
authors.lastname: Chopra
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D017582:Renal Replacement Therapy / Q000379:methods; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000097:blood
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin