Residents and Fellows Research in Progress
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction:
The ASHP 2020 vancomycin (VAN) guidelines recommend administering a loading dose (LD) to rapidly attain therapeutic concentrations in patients, including critically ill, with suspected Methicillin-resistant Staphylococcus aureus (MRSA) infections. Despite these guidelines, there is reported variability in clinical practices across institutions.
Critically ill patients are often in a hyperdynamic state which can influence the volume of distribution and clearance of hydrophilic drugs, including VAN. Consequently, this population is at higher risk of VAN’s underexposure. Additionally, variability exists in data regarding the correlation between VAN LD, and exposure, nephrotoxicity, and clinical outcomes. Factors contributing to this variability include the assessment of trough levels at steady state, which may fail to capture the true impact of the LD, and the trough levels >15, potentially confounding results by increasing nephrotoxicity risk.
This study will aim characterize VAN AUC0-24 following the administration of 20-25 mg/kg LD and explore the correlation of AUC0-24 and acute kidney injury in critically ill patients.
Research Question or Hypothesis:
Does the administration of 20-25 mg/kg vancomycin LD increase the probability of achieving therapeutic AUC goals during the first 24 hours of treatment in critically ill patients without increasing the risk of nephrotoxicity?
Study Design: Retrospective descriptive study
Methods:
Vigilanz will be used to identify patients who received IV vancomycin for suspected or confirmed infections from January 1st, 2016, to December 31st, 2022. Adult patients treated with vancomycin for = 3 days and had two consecutive serum vancomycin concentrations, collected during the same dosing interval, were screened for study inclusion. Patients who received non-intravenous vancomycin formulation, continuous vancomycin infusion, renal replacement therapies, or had vancomycin MIC > 2 were excluded. AUC will be calculated using the non-trapezoidal method, utilizing patient-specific pharmacokinetics.
Results:
Research ongoing
Conclusion:
Research ongoing
Presenting Author
Abdulwhab Shremo Msdi Doctor of PharmacyLoma Linda University
Authors
Jacinda Abdul-mutakabbir PharmD, MPH, AAHIVP
Loma Linda University
Karen Tan PharmD, BCIDP
Loma Linda University Medical Center