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Chest Infections |

Continuous Infusion Vancomycin: Do the Numbers Add up? A Retrospective Look at Medical and Surgical Patients at a Large, Academic Medical Center

Syed Masood, MPH; Christopher Droege, PharmD; Renee Hebbeler-Clark, MD
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University of Cincinnati, Cincinnati, OH


Chest. 2014;145(3_MeetingAbstracts):147A. doi:10.1378/chest.1834410
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Abstract

SESSION TITLE: Respiratory Infections Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Vancomycin is standard of care for the treatment of methicillin-resistant Staphylococcus aureus infection (MRSA). Conventional dosing strategies are intermittent dosing with assessment of therapeutic level. First trough level is obtained before the 4th dose. It often results in readjusting dose and frequency of vancomycin to obtain adequate levels. As the mortality rate for MRSA bacteremia remains high 23.4%, no study has looked at continuous infusion vancomycin (CIV) since the IDSA guidelines in 2009 changing therapeutic level interpretation. We conducted a retrospective review at our academic center to review steady state levels, complications and morbidity.

METHODS: A retrospective chart review of patients who received CIV was performed from January 2009 to August 2012. Patients were included if plateau levels were obtained at least 18 hours after CIV initiation. Steady state was based on following equations: a) ke = (conc1-conc2)/(t1-t2) b) t1/2 = 0.693/ke c) Cl = ke x Vd

RESULTS: A total of 15 patients were identified who received CIV, 14 patients had plateau levels available after 18 hours. The average length of stay was 25.5 days. The mean age was 32 years, 73% were male; with a mean weight of 106.1 kg. One patient developed renal failure, attributed to ATN from septic shock. The median CIV dose was 5 grams/24 hour. The breakdown of infectious causes included: 33% with MRSA bacteremia, 33% with MRSA pneumonia, 27% had empirical therapy for gram positive organisms, and 7% had mediastinitis. 80% of patients reached steady state level of 20 mg/ L between 18 - 33 hours. Rests of 20% patients were able to reach a level above 20 mg/L in next 24 hours.

CONCLUSIONS: CIV in our patients was well tolerated. Limitations of the study include the assumption that patients had rapid clearance of vancomycin at 4 hours, thus after 4.5 half-lives, serum vancomycin is at steady state. CIV needs to be studied in well-designed randomized controlled trial.

CLINICAL IMPLICATIONS: CIV is a viable treatment option for MRSA infection.

DISCLOSURE: The following authors have nothing to disclose: Syed Masood, Christopher Droege, Renee Hebbeler-Clark

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