Effect of Continuous Venovenous Hemofiltration Dose on Achievement of Adequate Vancomycin Trough Concentrations
Open Access
- 1 December 2012
- journal article
- research article
- Published by American Society for Microbiology in Antimicrobial Agents and Chemotherapy
- Vol. 56 (12), 6181-6185
- https://doi.org/10.1128/aac.00459-12
Abstract
The vancomycin dose necessary for the achievement of target serum trough concentrations during continuous venovenous hemofiltration (CVVH) remains to be elucidated. This was a retrospective cohort study of critically ill adults at a tertiary medical center on concurrent CVVH and vancomycin between 2006 and 2010 with a steady-state vancomycin trough concentration. The 87 included patients were grouped according to low (≤30 ml/kg/h; n = 10) or high (>30 ml/kg/h; n = 77) CVVH hemofiltration rate (HFR) for analysis. Vancomycin goal trough achievement occurred in only 32 (37%) patients. The primary endpoint of trough attainment significantly differed between HFR subgroups: 90% versus 30% in low- and high-HFR individuals, respectively ( P < 0.001). Patients with subtherapeutic trough concentrations had a median (interquartile range) HFR of 40 ml/kg/h (range, 37 to 47 ml/kg/h) compared to 36 ml/kg/h (range, 30 to 39 ml/kg/h) in those who achieved the trough goal. Irrespective of goal trough, an inverse correlation existed between HFR and serum vancomycin concentration ( r = −0.423; P < 0.001). In the subgroup of 14 methicillin-resistant Staphylococcus aureus (MRSA) patients, trough achievement was similar to the aggregate cohort (36%). Mortality at 28 days was unrelated to trough achievement in both the overall sample ( P = 0.516) and in culture-positive MRSA patients ( P = 0.396). Critically ill patients undergoing CVVH therapy may experience clinically significant reductions in goal vancomycin troughs. The results of the present study justify prospective evaluations in this population to determine the optimal vancomycin dosing strategy for attainment of goal trough concentrations.This publication has 33 references indexed in Scilit:
- Variability of antibiotic concentrations in critically ill patients receiving continuous renal replacement therapyCritical Care Medicine, 2012
- Higher Renal Replacement Therapy Dose Delivery Influences on Drug TherapyArtificial Organs, 2003
- Continuous is not continuous: the incidence and impact of circuit "down-time" on uraemic control during continuous veno-venous haemofiltrationIntensive Care Medicine, 2003
- Clearance of vancomycin during high-volume haemofiltration: impact of pre-dilutionIntensive Care Medicine, 2002
- Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: A prospective, randomized trialCritical Care Medicine, 2002
- Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of careCritical Care Medicine, 2001
- Vancomycin clearance during continuous venovenous haemofiltration in critically ill patientsIntensive Care Medicine, 1999
- Determinants of vancomycin clearance by continuous venovenous hemofiltration and continuous venovenous hemodialysisAmerican Journal of Kidney Diseases, 1998
- Clinical Pharmacokinetics During Continuous HaemofiltrationClinical Pharmacokinetics, 1994
- Vancomycin pharmacokinetics in acute renal failure: Preservation of nonrenal clearanceClinical Pharmacology & Therapeutics, 1991