title: Currently used dosage regimens of vancomycin fail to achieve therapeutic levels in approximately 40% of intensive care unit patients.
abstract: This study aimed to assess whether currently used dosages of vancomycin for treatment of serious gram-positive bacterial infections in intensive care unit patients provided initial therapeutic vancomycin trough levels and to examine possible factors associated with the presence of adequate initial vancomycin trough levels in these patients.
  A prospective descriptive study with convenience sampling was performed. Nursing note and medical record data were collected from September 2013 to July 2014 for patients who met inclusion criteria. Eighty-three patients were included. Initial vancomycin trough levels were obtained immediately before vancomycin fourth dose. Acute kidney injury was defined as an increase of at least 0.3mg/dL in serum creatinine within 48 hours.
  Considering vancomycin trough levels recommended for serious gram-positive infection treatment (15 - 20µg/mL), patients were categorized as presenting with low, adequate, and high vancomycin trough levels (35 [42.2%], 18 [21.7%], and 30 [36.1%] patients, respectively). Acute kidney injury patients had significantly greater vancomycin trough levels (p = 0.0055, with significance for a trend, p = 0.0023).
  Surprisingly, more than 40% of the patients did not reach an effective initial vancomycin trough level. Studies on pharmacokinetic and dosage regimens of vancomycin in intensive care unit patients are necessary to circumvent this high proportion of failures to obtain adequate initial vancomycin trough levels. Vancomycin use without trough serum level monitoring in critically ill patients should be discouraged.
authors.affiliation: Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Londrina - Londrina (PR), Brasil.
authors.forename: Vitor Yuzo
authors.initials: VY
authors.lastname: Obara
authors.affiliation: Universidade Estadual de Londrina - Londrina (PR), Brasil.
authors.forename: Carolina Petrus
authors.initials: CP
authors.lastname: Zacas
authors.affiliation: Universidade Estadual de Londrina - Londrina (PR), Brasil.
authors.forename: Claudia Maria Dantas de Maio
authors.initials: CM
authors.lastname: Carrilho
authors.affiliation: Universidade Estadual de Londrina - Londrina (PR), Brasil.
authors.forename: Vinicius Daher Alvares
authors.initials: VD
authors.lastname: Delfino
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D003404:Creatinine