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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2015 | Research article

Evaluation of a protocol for vancomycin administration in critically patients with and without kidney dysfunction

Authors: Savino Spadaro, Angela Berselli, Alberto Fogagnolo, Maurizia Capuzzo, Riccardo Ragazzi, Elisabetta Marangoni, Sara Bertacchini, Carlo Alberto Volta

Published in: BMC Anesthesiology | Issue 1/2015

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Abstract

Background

Administration of vancomycin in critically ill patients needs close regulation. While subtherapeutical vancomycin serum concentration (VSC) is associated with increased mortality, accumulation is responsible for nephrotoxicity. Our study aimed to estimate the efficacy of a vancomycin-dosing protocol in reaching appropriate serum concentration in patients with and without kidney dysfunction.

Methods

This was a retrospective study in critically ill patients treated with continuous infusion of vancomycin. Patients with creatinine clearance >50 ml/min (Group A) were compared to those with creatinine clearance ≤50 ml/min (Group B).

Results

348 patients were enrolled (210 in Group A, 138 in Group B). At first determination, patients with kidney dysfunction (Group B) had a statistically higher percentage of vancomycin in target range, while the percentage of patients with a VSC under the range was almost equal. These percentages differed at the subsequent measurements. The number of patients with low vancomycin concentration progressively decreased, except in those with augmented renal clearance; the percentage of patients with VSC over 30 mg/L was about 28 %, irrespective of the presence or absence of kidney dysfunction. Patients who reached a subtherapeutic level at the first VSC measurement had a significant correlation with in-hospital mortality.

Conclusions

Our protocol seems to allow a rapid achievement of a target VSC particularly in patients with kidney dysfunction. In order to avoid subtherapeutical VSC, our algorithm should be implemented by the estimation of the presence of an augmented renal clearance.
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Metadata
Title
Evaluation of a protocol for vancomycin administration in critically patients with and without kidney dysfunction
Authors
Savino Spadaro
Angela Berselli
Alberto Fogagnolo
Maurizia Capuzzo
Riccardo Ragazzi
Elisabetta Marangoni
Sara Bertacchini
Carlo Alberto Volta
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-015-0065-1

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