Continuous vancomycin infusion benefits
Abstract:
Background: Vancomycin is a common and critical drug for empiric antimicrobial therapy in the infected burn patient. However, profound physiologic changes may impede the clinical effectiveness and amplify the potential nephrotoxicity of vancomycin.
Methods: This was a retrospective cohort study at a large academic medical center and regional burn center. Patients with ≥10% total body surface area burn that received intravenous vancomycin were considered for study inclusion. Patients were assigned to the intermittent infusion or continuous infusion cohort if they received vancomycin for ≥48 h with ≥1 documented vancomycin serum concentration. The target steady state drug level for continuous infusion was 17-22 mg/L. The target steady state trough drug level for intermittent infusion was 15-20 mg/L. The primary efficacy and safety outcomes were time to therapeutic drug level and nephrotoxicity respectively.
Results: Thirty continuous infusion subjects with 88 plasma drug levels and thirty intermittent infusion subjects with 80 plasma drug levels were analyzed within the study period. There was a significant difference in the number of subjects that achieved a plasma vancomycin level within the target range during the course of therapy (73.3% for continuous infusion vs. 26.7% for intermittent infusion, p = 0.0003). The time to therapeutic level was 3.90 days for continuous infusion and 5.22 days for intermittent infusion (p = 0.0393). Nephrotoxicity occurred less frequently in the continuous infusion cohort (23.3% vs. 53.8%).
Conclusion: Continuous infusion vancomycin was associated with more rapid attainment of target levels and a lower rate of nephrotoxicity.
Reference:
Schlobohm CJ, Zhu E, Duby JJ. Continuous infusion versus intermittent infusion vancomycin in a burn center intensive care unit. Burns. 2021 Sep 3:S0305-4179(21)00236-9. doi: 10.1016/j.burns.2021.08.016. Epub ahead of print. PMID: 34538672.