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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Does contemporary vancomycin dosing achieve therapeutic targets in a heterogeneous clinical cohort of critically ill patients? Data from the multinational DALI study
Critical Care, Volume 18, No. 3, Article R99, Year 2014
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Description
Introduction: The objective of this study was to describe the pharmacokinetics of vancomycin in ICU patients and to examine whether contemporary antibiotic dosing results in concentrations that have been associated with favourable response.Methods: The Defining Antibiotic Levels in Intensive Care (DALI) study was a prospective, multicentre pharmacokinetic point-prevalence study. Antibiotic dosing was as per the treating clinician either by intermittent bolus or continuous infusion. Target trough concentration was defined as ≥15 mg/L and target pharmacodynamic index was defined as an area under the concentration-time curve over a 24-hour period divided by the minimum inhibitory concentration of the suspected bacteria (AUC0-24/MIC ratio) >400 (assuming MIC ≤1 mg/L).Results: Data of 42 patients from 26 ICUs were eligible for analysis. A total of 24 patients received vancomycin by continuous infusion (57%). Daily dosage of vancomycin was 27 mg/kg (interquartile range (IQR) 18 to 32), and not different between patients receiving intermittent or continuous infusion. Trough concentrations were highly variable (median 27, IQR 8 to 23 mg/L). Target trough concentrations were achieved in 57% of patients, but more frequently in patients receiving continuous infusion (71% versus 39%; P = 0.038). Also the target AUC0-24/MIC ratio was reached more frequently in patients receiving continuous infusion (88% versus 50%; P = 0.008). Multivariable logistic regression analysis with adjustment by the propensity score could not confirm continuous infusion as an independent predictor of an AUC0-24/MIC >400 (odds ratio (OR) 1.65, 95% confidence interval (CI) 0.2 to 12.0) or a Cmin ≥15 mg/L (OR 1.8, 95% CI 0.4 to 8.5).Conclusions: This study demonstrated large interindividual variability in vancomycin pharmacokinetic and pharmacodynamic target attainment in ICU patients. These data suggests that a re-evaluation of current vancomycin dosing recommendations in critically ill patients is needed to more rapidly and consistently achieve sufficient vancomycin exposure. © 2014 Blot et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Blot, Stijn I.
Belgium, Ghent
Universiteit Gent
Koulenti, Despoina
Australia, Brisbane
The University of Queensland
Australia, Brisbane
Royal Brisbane and Women's Hospital
Greece, Athens
Attikon University Hospital
Akova, Murat
Turkey, Ankara
Hacettepe Üniversitesi
Bassetti, Matteo
Italy, Udine
Presidio Ospedaliero Universitario Santa Maria Della Misericordia , Udine
De Waele, Jan J.
Belgium, Ghent
Universitair Ziekenhuis Gent
Dimopoulos, George T.
Greece, Athens
Attikon University Hospital
Martin, Claude D.
France, Marseille
Hôpital Nord Ap-hm
Montravers, Philippe
France, Paris
Ap-hp Assistance Publique - Hopitaux de Paris
Rello, Jordi
Spain, Barcelona
Vall D'hebron Institut de Recerca
Rhodes, Andrew
United Kingdom, London
St George’s, University of London
Starr, Therese
Australia, Brisbane
The University of Queensland
Australia, Brisbane
Royal Brisbane and Women's Hospital
Wallis, Steven C.
Australia, Brisbane
The University of Queensland
Lipman, Jeffrey
Australia, Brisbane
The University of Queensland
Australia, Brisbane
Royal Brisbane and Women's Hospital
Roberts, Jason A.
Australia, Brisbane
The University of Queensland
Australia, Brisbane
Royal Brisbane and Women's Hospital
Statistics
Citations: 86
Authors: 14
Affiliations: 13
Identifiers
Doi:
10.1186/cc13874
ISSN:
13648535
Study Design
Cross Sectional Study
Cohort Study
Case-Control Study
Study Approach
Quantitative