Vancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality

Nadiyah Alshehri,1,2 Anwar E Ahmed,3 Nagarajkumar Yenugadhati,2,4 Sundas Javad,2,4 Khalid Al Sulaiman,1 Hasan M Al-Dorzi,5 Majed Aljerasiy,4 Motasim Badri2,4 1Pharmaceutical Care Department, Ministry of National Guard- Health Affairs, Riyadh, Saudi Arabia; 2Department of Epidemiology & Biost...

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Autores principales:	Alshehri N, Ahmed AE, Yenugadhati N, Javad S, Al Sulaiman K, Al-Dorzi HM, Aljerasiy M, Badri M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	vancomycin dosage pharmacokinetics renal function serum trough levels mortality. Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/b9b3d5da1f5147378d18ffc9bd0ae86f
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spelling	oai:doaj.org-article:b9b3d5da1f5147378d18ffc9bd0ae86f2021-12-02T11:14:39ZVancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality1178-203Xhttps://doaj.org/article/b9b3d5da1f5147378d18ffc9bd0ae86f2020-10-01T00:00:00Zhttps://www.dovepress.com/vancomycin-in-icu-patients-with-gram-positive-infections-initial-troug-peer-reviewed-article-TCRMhttps://doaj.org/toc/1178-203XNadiyah Alshehri,1,2 Anwar E Ahmed,3 Nagarajkumar Yenugadhati,2,4 Sundas Javad,2,4 Khalid Al Sulaiman,1 Hasan M Al-Dorzi,5 Majed Aljerasiy,4 Motasim Badri2,4 1Pharmaceutical Care Department, Ministry of National Guard- Health Affairs, Riyadh, Saudi Arabia; 2Department of Epidemiology & Biostatistics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; 4King Abdullah International Medical Research Center, King Saud Bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Intensive Care Department, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaCorrespondence: Nadiyah AlshehriDepartment of Epidemiology & Biostatistics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, P.O. Box: 47323, Riyadh 11552, Saudi ArabiaEmail alshehrina2@ngha.med.saBackground: Vancomycin is one of the most common therapeutic agents for treating gram-positive infections, particularly in critically ill patients. The aim of this study was to identify factors associated with initial therapeutic vancomycin trough levels and mortality in a tertiary-care intensive care unit (ICU).Methods: This retrospective study evaluated 301 adult ICU patients admitted to King Abdulaziz Medical City in Riyadh between October 1, 2017 and December 31, 2018 with confirmed gram-positive infections and received intravenous vancomycin. Vancomycin trough levels of 15– 20 mg/L for severe infections and 10– 15 mg/L for less severe infections were considered therapeutic.Results: The patients were relatively older with a mean age of 60 (SD ± 20) years. Initial vancomycin trough levels were therapeutic in 168 (55.8%). Factors associated with initial therapeutic vancomycin trough levels were female gender (adjusted odds ratio [aOR]=2.575), older age (aOR=1.024), receiving a loading dose (aOR=2.445), having bacteremia (aOR=2.061), and high platelet count (aOR=1.003). On the other hand, the increase of estimated glomerular filtration rate (eGFR) (aOR=0.993) and albumin levels (aOR=0.944) were associated with lower odds of initial therapeutic vancomycin trough levels. Factors associated with higher mortality were female gender (adjusted hazard ratio [aHR]=2.630), increased body weight (aHR=1.021), cancer (aHR=3.451), and high APACHE II score (aHR=1.068).Conclusion: The study identified several factors associated with achieving initial therapeutic vancomycin trough levels (i.e. older age, female gender, receiving a loading dose, bacteremia, high platelets count, low eGFR and albumin level). These factors should be considered in the dosing of vancomycin in critically ill patients with gram-positive infections.Keywords: vancomycin dosage, pharmacokinetics, renal function, serum trough levels, mortalityAlshehri NAhmed AEYenugadhati NJavad SAl Sulaiman KAl-Dorzi HMAljerasiy MBadri MDove Medical Pressarticlevancomycin dosagepharmacokineticsrenal functionserum trough levelsmortality.Therapeutics. PharmacologyRM1-950ENTherapeutics and Clinical Risk Management, Vol Volume 16, Pp 979-987 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	vancomycin dosage pharmacokinetics renal function serum trough levels mortality. Therapeutics. Pharmacology RM1-950
spellingShingle	vancomycin dosage pharmacokinetics renal function serum trough levels mortality. Therapeutics. Pharmacology RM1-950 Alshehri N Ahmed AE Yenugadhati N Javad S Al Sulaiman K Al-Dorzi HM Aljerasiy M Badri M Vancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality
description	Nadiyah Alshehri,1,2 Anwar E Ahmed,3 Nagarajkumar Yenugadhati,2,4 Sundas Javad,2,4 Khalid Al Sulaiman,1 Hasan M Al-Dorzi,5 Majed Aljerasiy,4 Motasim Badri2,4 1Pharmaceutical Care Department, Ministry of National Guard- Health Affairs, Riyadh, Saudi Arabia; 2Department of Epidemiology & Biostatistics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; 4King Abdullah International Medical Research Center, King Saud Bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Intensive Care Department, College of Medicine King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi ArabiaCorrespondence: Nadiyah AlshehriDepartment of Epidemiology & Biostatistics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, P.O. Box: 47323, Riyadh 11552, Saudi ArabiaEmail alshehrina2@ngha.med.saBackground: Vancomycin is one of the most common therapeutic agents for treating gram-positive infections, particularly in critically ill patients. The aim of this study was to identify factors associated with initial therapeutic vancomycin trough levels and mortality in a tertiary-care intensive care unit (ICU).Methods: This retrospective study evaluated 301 adult ICU patients admitted to King Abdulaziz Medical City in Riyadh between October 1, 2017 and December 31, 2018 with confirmed gram-positive infections and received intravenous vancomycin. Vancomycin trough levels of 15– 20 mg/L for severe infections and 10– 15 mg/L for less severe infections were considered therapeutic.Results: The patients were relatively older with a mean age of 60 (SD ± 20) years. Initial vancomycin trough levels were therapeutic in 168 (55.8%). Factors associated with initial therapeutic vancomycin trough levels were female gender (adjusted odds ratio [aOR]=2.575), older age (aOR=1.024), receiving a loading dose (aOR=2.445), having bacteremia (aOR=2.061), and high platelet count (aOR=1.003). On the other hand, the increase of estimated glomerular filtration rate (eGFR) (aOR=0.993) and albumin levels (aOR=0.944) were associated with lower odds of initial therapeutic vancomycin trough levels. Factors associated with higher mortality were female gender (adjusted hazard ratio [aHR]=2.630), increased body weight (aHR=1.021), cancer (aHR=3.451), and high APACHE II score (aHR=1.068).Conclusion: The study identified several factors associated with achieving initial therapeutic vancomycin trough levels (i.e. older age, female gender, receiving a loading dose, bacteremia, high platelets count, low eGFR and albumin level). These factors should be considered in the dosing of vancomycin in critically ill patients with gram-positive infections.Keywords: vancomycin dosage, pharmacokinetics, renal function, serum trough levels, mortality
format	article
author	Alshehri N Ahmed AE Yenugadhati N Javad S Al Sulaiman K Al-Dorzi HM Aljerasiy M Badri M
author_facet	Alshehri N Ahmed AE Yenugadhati N Javad S Al Sulaiman K Al-Dorzi HM Aljerasiy M Badri M
author_sort	Alshehri N
title	Vancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality
title_short	Vancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality
title_full	Vancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality
title_fullStr	Vancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality
title_full_unstemmed	Vancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality
title_sort	vancomycin in icu patients with gram-positive infections: initial trough levels and mortality
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/b9b3d5da1f5147378d18ffc9bd0ae86f
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Vancomycin in ICU Patients with Gram-Positive Infections: Initial Trough Levels and Mortality

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