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Retrospective multicentre matched cohort study comparing safety and efficacy outcomes of intermittent-infusion versus continuous-infusion vancomycin.

Authors :
Ma, Nathan H
Walker, Sandra A N
Elligsen, Marion
Kiss, Alex
Palmay, Lesley
Ho, Grace
Powis, Jeff
Bansal, Vikas
Leis, Jerome A
Source :
Journal of Antimicrobial Chemotherapy (JAC). Apr2020, Vol. 75 Issue 4, p1038-1046. 9p.
Publication Year :
2020

Abstract

<bold>Background: </bold>Patients with good renal function receiving intermittent-infusion vancomycin (IIV) may require total daily doses ≥4 g to achieve trough concentrations of 15-20 mg/L, increasing the risk of vancomycin-associated nephrotoxicity. Continuous-infusion vancomycin (CIV) may be associated with a lower risk of vancomycin-associated nephrotoxicity compared with IIV, but studies comparing safety of both dosing strategies are lacking.<bold>Objectives: </bold>To compare the risk of nephrotoxicity with CIV versus IIV when target concentration ranges were the same with both dosing modalities.<bold>Methods: </bold>A retrospective multicentre matched cohort study of admitted patients between 1 January 2010 and 31 December 2016 was completed. Adult patients who received ≥48 h of vancomycin with at least one steady-state vancomycin concentration were eligible. The primary outcome was to compare the rates of nephrotoxic risk and renal injury, defined by the RIFLE criteria, between CIV and IIV.<bold>Results: </bold>Of 2136 patients who received vancomycin during the study period, 146 CIV patients were eligible and matched to 146 IIV patients. After adjustment of potential confounders, CIV was found to have a lower odds of developing nephrotoxic risk (OR 0.42, 95% CI 0.21-0.98, P = 0.025) and renal injury (OR 0.19, 95% CI 0.05-0.59, P = 0.004).<bold>Conclusions: </bold>CIV is associated with a lower odds of nephrotoxicity compared with IIV when targeting the same concentration range and should be an alternative dosing strategy for patients who will receive prolonged therapy or require >4 g/day to achieve therapeutic levels. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
03057453
Volume :
75
Issue :
4
Database :
Academic Search Index
Journal :
Journal of Antimicrobial Chemotherapy (JAC)
Publication Type :
Academic Journal
Accession number :
142279725
Full Text :
https://doi.org/10.1093/jac/dkz531