Research Article

Correlation between Serum Vancomycin Trough Level and Therapeutic Response in Septic Patients during Augmented Renal Clearance Phase

Abstract

Background: Vancomycin is a glycopeptide antibiotic that was extensively used for treatment of gram positive infections. Therapeutic drug monitoring (TDM) is recommended to optimize efficacy and safety of vancomycin. Data regarding TDM of vancomycin are scant in septic patients especially during augmented renal clearance (ARC) phase.
Methods: In this observational study, 39 patients with diagnosis of sepsis that were in ARC phase were evaluated. The breakpoint for serum trough level of vancomycin was considered as 15 mg/l. The patients were stratified in two groups based on the measured serum trough levels (< 15 mg/l versus ≥15 mg/l).
Results: Clinical response and microbiological clearance were compared between the groups. In terms of clinical response, there was no significant difference between the groups (P = 0.677). Also, the microbiological clearance was not different between the groups (P= 1.00).
Conclusion: Septic patients during ARC phase had comparable clinical and microbial responses regardless of serum trough levels of vancomycin.

1. Sime FB, Udy AA, Roberts JA. Augmented renal clearance in critically ill patients: etiology, definition and implications for beta-lactam dose optimization. Curr Opin Pharmacol. 2015; 24:1-6.
2. Hobbs AL, Shea KM, Roberts KM, Daley MJ. Implications of augmented renal clearance on drug dosing in critically ill patients: a focus on antibiotics. Pharmacotherapy. 2015; 35(11):1063-75.
3. Campassi ML, Gonzalez MC, Masevicius FD, Vazquez AR, Moseinco M, Navarro NC, et al. Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment. Rev Bras Ter Intensiva. 2014; 26(1):13-20.
4. Mahmoud S, Shen C. Augmented renal clearance in critical illness: an important consideration in drug dosing. Pharmaceutics. 2017; 9(3):36.
5. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017; 43(3):304-77.
6. Rybak M, Lomaestro B, Rotschafer JC, Moellering Jr R, Craig W, Billeter M, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Ame J Health-Syst Pharm. 2009; 66(1):82-98.
7. Steinmetz T, Eliakim-Raz N, Goldberg E, Leibovici L, Yahav D. Association of vancomycin serum concentrations with efficacy in patients with MRSA infections: a systematic review and meta-analysis. Clin Microbiol Infect. 2015; 21(7):665-73.
8. Bosso JA, Nappi J, Rudisill C, Wellein M, Bookstaver PB, Swindler J, et al. Relationship between vancomycin trough concentrations and nephrotoxicity: a prospective multicenter trial. Antimicrob Agents Chemother. 2011; 55(12):5475-9.
9. Pritchard L, Baker C, Leggett J, Sehdev P, Brown A, Bayley KB. Increasing vancomycin serum trough concentrations and incidence of nephrotoxicity. Am J Med. 2010; 123(12):1143-9.
10. Hale CM, Seabury RW, Steele JM, Darko W, Miller CD. Are vancomycin trough concentrations of 15 to 20 mg/L associated with increased attainment of an AUC/MIC≥ 400 in patients with presumed MRSA infection? J Pharm Pract. 2017; 30(3):329-35.
11. Hermsen ED, Hanson M, Sankaranarayanan J, Stoner JA, Florescu MC, Rupp ME. Clinical outcomes and nephrotoxicity associated with vancomycin trough concentrations during treatment of deep-seated infections. Expert Opin Drug Saf 2010;9(1):9-14.
12. Elyasi S, Khalili H, Dashti-Khavidaki S, Emadi-Koochak H, Mohammadpour A, Abdollahi A. Elevated Vancomycin Trough Concentration: Increased Efficacy and/or Toxicity? Iran J Pharm Res. 2014; 13(4):1241-7.
13. Neely MN, Youn G, Jones B, Jelliffe RW, Drusano GL, Rodvold KA, et al. Are vancomycin trough concentrations adequate for optimal dosing? Antimicrob Agents Chemother 2014;58(1):309-16.
14. Prybylski JP. Vancomycin trough concentration as a predictor of clinical outcomes in patients with Staphylococcus aureus bacteremia: a meta‐analysis of observational studies. Pharmacotherapy 2015; 35(10):889-98.
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IssueVol 5 No 3 (2019): Summer QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v5i3.1203
Keywords
Vancomycin Clinical response Microbiological clearance Sepsis

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How to Cite
1.
Arasteh O, Khalili H, Beigmohammadi MT, Abdollahi A, Mohammadpour A, Salehi M. Correlation between Serum Vancomycin Trough Level and Therapeutic Response in Septic Patients during Augmented Renal Clearance Phase. Arch Anesth & Crit Care. 2019;5(3):77-80.