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Open Access 01-12-2022 | Hemofiltration | Research

Continuous infusion versus intermittent infusion of vancomycin in critically ill patients undergoing continuous venovenous hemofiltration: a prospective interventional study

Authors: Jinhui Xu, Lufen Duan, Jiahui Li, Fang Chen, Xiaowen Xu, Jian Lu, Zhiwei Zhuang, Yifei Cao, Yunlong Yuan, Xin Liu, Jiantong Sun, Qin Zhou, Lu Shi, Lian Tang

Published in: BMC Infectious Diseases | Issue 1/2022

Abstract

Background

A prospective interventional study comparing outcomes in critically ill patients receiving intermittent infusion (II) or continuous infusion (CI) of vancomycin during continuous venovenous hemofiltration (CVVH) is lacking. The objective of this study was to compare the pharmacokinetic/pharmacodynamics (PK/PD) target attainment, therapeutic efficacy and safety among critically ill patients who received CI or II of vancomycin in a prospective interventional trial and to explore the correlations of effluent flow rate (EFR) with PK/PD indices.

Methods

This prospective interventional study was conducted in two independent intensive care units (ICUs) from February 2021 to January 2022. Patients in one ICU were assigned to receive CI (intervention group) of vancomycin, whereas patients in the other ICU were assigned to receive II regimen (control group). The primary outcome was to compare the PK/PD target attainment, including target concentration and target area under the curve over 24 h to minimum inhibitory concentration (AUC₂₄/MIC).

Results

Overall target attainment of PK/PD indices was higher with CI compared with II, irrespective of target concentration (78.7% vs. 40.5%; P < 0.05) or AUC₂₄/MIC (53.2% vs. 28.6%; P < 0.05). There were no significant differences in clinical success (72.2% vs. 50.0%; P = 0.183) and microbiological success (83.3% vs. 75.0%, P = 0.681) between the patients treated with CI or II of vancomycin. Adverse reactions occurred at similar rates (0.0% vs. 4.4%; P = 0.462), and mortality between the two modalities was also not significant different (21.7% vs. 17.9%; P = 0.728). Correlation analysis showed a weak to moderately inverse correlation of EFR with observed concentration (r = − 0.3921, P = 0.01) and AUC₂₄/MIC (r = − 0.3811, P = 0.013) in the II group, whereas the correlation between EFR and observed concentration (r = − 0.5711, P < 0.001) or AUC₂₄/MIC (r = − 0.5458, P < 0.001) in the CI group was stronger.

Conclusion

As compared to II, CI of vancomycin in critically ill patients undergoing CVVH was associated with improved attainment of PK/PD indices. Furthermore, the inverse correlation of PK/PD indices with EFR was stronger among patients treated with CI of vancomycin.

Trial registration The trial was registered in the Chinese clinical trial registration center (21/01/2021-No. ChiCTR2100042393).

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Title: Continuous infusion versus intermittent infusion of vancomycin in critically ill patients undergoing continuous venovenous hemofiltration: a prospective interventional study
Authors: Jinhui Xu
Lufen Duan
Jiahui Li
Fang Chen
Xiaowen Xu
Jian Lu
Zhiwei Zhuang
Yifei Cao
Yunlong Yuan
Xin Liu
Jiantong Sun
Qin Zhou
Lu Shi
Lian Tang
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Hemofiltration
Vancomycin
Published in: BMC Infectious Diseases / Issue 1/2022
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-022-07618-6

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