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Augmented renal clearance in septic patients and implications for vancomycin optimisation
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The aim of this study was to evaluate the effect of augmented renal clearance (ARC) on vancomycin serum concentrations in critically ill patients. This prospective, single-centre, observational, cohort study included 93 consecutive, critically ill septic patients who started treatment that included vancomycin by continuous infusion, admitted over a 2-year period (March 2006 to February 2008). ARC was defined as 24-h creatinine clearance (CL(Cr))>130mL/min/1.73m(2). Two groups were analysed: Group A, 56 patients with a CL(Cr)≤130mL/min/1.73m(2); and Group B, 37 patients with a CL(Cr)>130mL/min/1.73m(2). Vancomycin therapeutic levels were assessed on the first 3 days of treatment (D(1), D(2) and D(3)). Serum vancomycin levels on D(1), D(2) and D(3), respectively, were 13.1, 16.6 and 18.6μmol/L for Group A and 9.7, 11.7 and 13.8μmol/L for Group B (P<0.05 per day). The correlation between CL(Cr) and serum vancomycin on D(1) was -0.57 (P<0.001). ARC was strongly associated with subtherapeutic vancomycin serum concentrations on the first 3 days of treatment.
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Rim Vancomicina
Contexto Educativo
Citação
Int J Antimicrob Agents. 2012 Feb 29. [Epub ahead of print]