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Kanazawa N, Shigemi A, Amadatsu N, Arimura K, Shimono S, Oda K, Chuang VTG, Matsumoto K, Kawamura H, Terazono H. A cohort study of the risk factors and the target AUC to avoid vancomycin-associated acute kidney injury in pediatric patients. J Infect Chemother 2024; 30:323-328. [PMID: 37940038 DOI: 10.1016/j.jiac.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES In recent years, Vancomycin (VCM) dosing design using area under the concentration-time curve (AUC) has been recommended as a measure of efficacy and safety, but there are fewer reports on pediatric patients than on adults. In this study, we evaluated the threshold of AUC for AKI occurrence in pediatric patients and investigated the factors that contribute to the occurrence of AKI. METHODS Pediatric patients aged 1-15 years on VCM treatment who underwent TDM at Kagoshima University Hospital from April 2016 to March 2022 were included in the computation of AUC using pediatric population pharmacokinetic parameters. RESULTS The ROC curve showed that the AUC threshold for the risk of developing AKI was 583.0 μg・h/mL, and the AUC-ROC curve was 0.873 (sensitivity 0.930, specificity 0.750). Univariate analysis showed that factors associated with AKI incidence were the duration of VCM administration, ICU admission, and AUCSS. Concomitant medications identified as risk factors for AKI incidence were tazobactam/piperacillin, liposomal amphotericin B, calcineurin inhibitors, contrast agents, and H2-receptor blockers. The multivariate analysis showed that AUC ≧ 583.0 μg・h/mL (odds ratio 20.14, 95% CI 3.52-115.22, p < 0.001) and H2-receptor blockers (odds ratio 8.70, 95% confidence interval = 1.38-54.87, p = 0.02) were independent factors for AKI incidence. CONCLUSIONS We showed that in pediatric patients receiving VCM, the risk of AKI increases as AUC increases. The findings imply that concurrent use of VCM and H2-receptor blockers may increase the risk of AKI.
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Affiliation(s)
- Naoko Kanazawa
- Department of Pharmacy, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-shi, 890-8520, Japan
| | - Akari Shigemi
- Department of Pharmacy, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-shi, 890-8520, Japan; Department of Infection Control and Prevention, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-shi, 890-8520, Japan
| | - Nao Amadatsu
- Department of Pharmacy, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-shi, 890-8520, Japan
| | - Kotaro Arimura
- Department of Pharmacy, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-shi, 890-8520, Japan
| | - Shohei Shimono
- Department of Pharmacy, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-shi, 890-8520, Japan
| | - Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan
| | - Victor Tuan Giam Chuang
- Discipline of Pharmacy, Curtin Medical School, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Hideki Kawamura
- Department of Infection Control and Prevention, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-shi, 890-8520, Japan
| | - Hideyuki Terazono
- Department of Pharmacy, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-shi, 890-8520, Japan.
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Hanna PE, Wang Q, Strohbehn IA, Moreno D, Harden D, Ouyang T, Katz-Agranov N, Seethapathy H, Reynolds KL, Gupta S, Leaf DE, Sise ME. Medication-Related Adverse Events and Discordancies in Cystatin C-Based vs Serum Creatinine-Based Estimated Glomerular Filtration Rate in Patients With Cancer. JAMA Netw Open 2023; 6:e2321715. [PMID: 37405775 PMCID: PMC10323710 DOI: 10.1001/jamanetworkopen.2023.21715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/19/2023] [Indexed: 07/06/2023] Open
Abstract
Importance Serum creatinine-based estimated glomerular filtration rate (eGFRcr) may overestimate the glomerular filtration rate (GFR) in patients with cancer. Cystatin C-based eGFR (eGFRcys) is an alternative marker of GFR. Objective To determine whether the therapeutic drug levels and adverse events (AEs) associated with renally cleared medications were higher in patients with cancer whose eGFRcys was more than 30% lower than their eGFRcr. Design, Setting, and Participants This cohort study analyzed adult patients with cancer at 2 major academic cancer centers in Boston, Massachusetts. These patients had their creatinine and cystatin C measured on the same day between May 2010 and January 2022. The date of the first simultaneous eGFRcr and eGFRcys measurement was considered to be the baseline date. Exposure The primary exposure was eGFR discordance, defined as an eGFRcys that was more than 30% lower than the eGFRcr. Main Outcomes and Measures The primary outcome was risk of the following medication-related AEs within 90 days of the baseline date: (1) supratherapeutic vancomycin trough level greater than 30 μg/mL, (2) trimethoprim-sulfamethoxazole-related hyperkalemia (>5.5 mEq/L), (3) baclofen toxic effect, and (4) supratherapeutic digoxin level (>2.0 ng/mL). For the secondary outcome, a multivariable Cox proportional hazards regression model was used to compare 30-day survival of those with vs without eGFR discordance. Results A total of 1869 adult patients with cancer (mean [SD] age, 66 [14] years; 948 males [51%]) had simultaneous eGFRcys and eGFRcr measurement. There were 543 patients (29%) with an eGFRcys that was more than 30% lower than their eGFRcr. Patients with an eGFRcys that was more than 30% lower than their eGFRcr were more likely to experience medication-related AEs compared with patients with concordant eGFRs (defined as eGFRcys within 30% of eGFRcr), including vancomycin levels greater than 30 μg/mL (43 of 179 [24%] vs 7 of 77 [9%]; P = .01), trimethoprim-sulfamethoxazole-related hyperkalemia (29 of 129 [22%] vs 11 of 92 [12%]; P = .07), baclofen toxic effects (5 of 19 [26%] vs 0 of 11; P = .19), and supratherapeutic digoxin levels (7 of 24 [29%] vs 0 of 10; P = .08). The adjusted odds ratio for vancomycin levels more than 30 μg/mL was 2.59 (95% CI, 1.08-7.03; P = .04). Patients with an eGFRcys more than 30% lower than their eGFRcr had an increased 30-day mortality (adjusted hazard ratio, 1.98; 95% CI, 1.26-3.11; P = .003). Conclusions and relevance Results of this study suggest that among patients with cancer with simultaneous assessment of eGFRcys and eGFRcr, supratherapeutic drug levels and medication-related AEs occurred more commonly in those with an eGFRcys more than 30% lower than their eGFRcr. Future prospective studies are needed to improve and personalize GFR estimation and medication dosing in patients with cancer.
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Affiliation(s)
- Paul E. Hanna
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Qiyu Wang
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Ian A. Strohbehn
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Daiana Moreno
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Destiny Harden
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Tianqi Ouyang
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Nurit Katz-Agranov
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Harish Seethapathy
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Kerry L. Reynolds
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston
| | - Shruti Gupta
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Adult Survivorship Program, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David E. Leaf
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Meghan E. Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston
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Ibe Y, Ishigo T, Fujii S, Takahashi S, Fukudo M, Sato H. Simulation of Vancomycin Exposure Using Trough and Peak Levels Achieves the Target Area under the Steady-State Concentration-Time Curve in ICU Patients. Antibiotics (Basel) 2023; 12:1113. [PMID: 37508208 PMCID: PMC10376485 DOI: 10.3390/antibiotics12071113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
The therapeutic drug monitoring (TDM) of vancomycin (VCM) in critically ill patients often results in the estimated area being under the concentration-time curve (AUC) values that deviate from individual observations. In this study, we investigated the factors influencing the achievement of the target AUC of VCM at steady-state in critically ill patients. We retrospectively collected data from patients treated with VCM in an intensive care unit (ICU). Multivariate analysis was used to adjust for significant factors with p < 0.05 and identify new factors affecting the achievement of the target AUC at steady-state for VCM. Among the 113 patients included in this study, 72 (64%) were in the 1-point group (trough only), whereas 41 (36%) were in the 2-point group (trough/peak). The percentage of patients achieving the target AUC at the follow-up TDM evaluation was significantly higher in the two-point group. Multivariate analysis showed that being in the 2-point group and those with a 20% or more increase (or decrease) in creatinine clearance (CCr) were both significantly associated with the success rate of achieving the target AUC at the follow-up TDM. Novel findings revealed that in patients admitted to the ICU, changes in renal function were a predictor of AUC deviation, with a 20% or more increase (or decrease) in CCr being an indicator. We believe the indicators obtained in this study are simple and can be applied clinically in many facilities. If changes in renal function are anticipated, we recommend an AUC evaluation of VCM with a two-point blood collection, close monitoring of renal function, and dose adjustment based on reanalyzing the serum concentrations of VCM.
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Affiliation(s)
- Yuta Ibe
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo 060-8543, Japan
| | - Tomoyuki Ishigo
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo 060-8543, Japan
| | - Satoshi Fujii
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo 060-8543, Japan
| | - Satoshi Takahashi
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8543, Japan
| | - Masahide Fukudo
- Department of Pharmacy, Sapporo Medical University Hospital, Sapporo 060-8543, Japan
| | - Hideki Sato
- Department of Pharmacotherapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Sapporo 006-8585, Japan
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Hanna PE, Wang Q, Strohbehn I, Moreno D, Harden D, Ouyang T, Katz-Agranov N, Seethapathy H, Reynolds KL, Gupta S, Leaf DE, Sise ME. Medication-related adverse events in patients with cancer and discrepancies in cystatin C- versus creatinine-based eGFR. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.18.23284656. [PMID: 36711583 PMCID: PMC9882433 DOI: 10.1101/2023.01.18.23284656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Creatinine-based estimated glomerular filtration rate (eGFRCRE) may overestimate kidney function in patients with cancer. Cystatin C-based eGFR (eGFRCYS) is an alternative marker of kidney function. We investigated whether patients with an eGFR discrepancy, defined as eGFRCYS >30% lower than the concurrent eGFRCRE, had an increased risk of adverse events resulting from renally-cleared medications. Patients and Methods We conducted a cohort study of adult patients with cancer who had serum creatinine and cystatin C measured on the same day between May 2010 and January 2022 at two academic cancer centers in Boston, MA. The primary outcome was the incidence of each of the following medication-related adverse events: 1) supratherapeutic vancomycin levels (>30μg/mL); 2) trimethoprim-sulfamethoxazole-related hyperkalemia (>5.5mEq/L); 3) baclofen-induced neurotoxicity; and 4) supratherapeutic digoxin levels (>2.0ng/mL). Results 1988 patients with cancer had simultaneous eGFRCYS and eGFRCRE. The mean age was 66 years (SD±14), 965 (49%) were female, and 1555 (78%) were non-Hispanic white. eGFR discrepancy occurred in 579 patients (29%). Patients with eGFR discrepancy were more likely to experience medication-related adverse events compared to those without eGFR discrepancy: vancomycin levels >30μg/mL (24% vs. 10%, p=0.004), trimethoprim- sulfamethoxazole-related hyperkalemia (24% vs. 12%, p=0.013), baclofen-induced neurotoxicity (25% vs. 0%, p=0.13), and supratherapeutic digoxin levels (38% vs. 0%, p=0.03). The adjusted OR for vancomycin levels >30μg/mL was 2.30 (95% CI 1.05 - 5.51, p = 0.047). Conclusion Among patients with cancer with simultaneous assessment of eGFRCYS and eGFRCRE, medication-related adverse events occur more commonly in those with eGFR discrepancy. These findings underscore the importance of accurate assessment of kidney function and appropriate dosing of renally-cleared medications in patients with cancer.
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Affiliation(s)
- Paul E Hanna
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Qiyu Wang
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ian Strohbehn
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Daiana Moreno
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Destiny Harden
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Tianqi Ouyang
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Nurit Katz-Agranov
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Harish Seethapathy
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kerry L Reynolds
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Shruti Gupta
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
- Adult Survivorship Program, Dana-Farber Cancer Institute, Boston, MA
| | - David E Leaf
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Meghan E Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
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Ghasemiyeh P, Vazin A, Mohammadi-Samani S. A Brief Review of Pharmacokinetic Assessments of Vancomycin in Special Groups of Patients with Altered Pharmacokinetic Parameters. Curr Drug Saf 2023; 18:425-439. [PMID: 35927907 DOI: 10.2174/1574886317666220801124718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/22/2022] [Accepted: 05/26/2022] [Indexed: 11/22/2022]
Abstract
Vancomycin is considered the drug of choice against many Gram-positive bacterial infections. Therapeutic drug monitoring (TDM) is essential to achieve an optimum clinical response and avoid vancomycin-induced adverse reactions including nephrotoxicity. Although different studies are available on vancomycin TDM, still there are controversies regarding the selection among different pharmacokinetic parameters including trough concentration, the area under the curve to minimum inhibitory concentration ratio (AUC24h/MIC), AUC of intervals, elimination constant, and vancomycin clearance. In this review, different pharmacokinetic parameters for vancomycin TDM have been discussed along with corresponding advantages and disadvantages. Also, vancomycin pharmacokinetic assessments are discussed in patients with altered pharmacokinetic parameters including those with renal and/or hepatic failure, critically ill patients, patients with burn injuries, intravenous drug users, obese and morbidly obese patients, those with cancer, patients undergoing organ transplantation, and vancomycin administration during pregnancy and lactation. An individualized dosing regimen is required to guarantee the optimum therapeutic responses and minimize adverse reactions including acute kidney injury in these special groups of patients. According to the pharmacoeconomic data on vancomycin TDM, pharmacokinetic assessments would be cost-effective in patients with altered pharmacokinetics and are associated with shorter hospitalization period, faster clinical stability status, and shorter courses of inpatient vancomycin administration.
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Affiliation(s)
- Parisa Ghasemiyeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
- Pharmaceutical Sciences Research Center, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afsaneh Vazin
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soliman Mohammadi-Samani
- Pharmaceutical Sciences Research Center, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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Ma Y, Geng Y, Jin L, Wang X, Liang C, Xie L, Lu W, Lv J. Serum vancomycin levels predict the short-term adverse outcomes of peritoneal dialysis-associated peritonitis. ARCH ESP UROL 2023; 43:37-44. [PMID: 35021905 DOI: 10.1177/08968608211064192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The role of monitoring serum vancomycin levels during treatment of peritoneal dialysis (PD)-associated peritonitis is controversial. Substantial inter-individual variability may result in suboptimal serum levels despite similar dosing of vancomycin. The published predictors of suboptimal serum vancomycin levels remain limited. METHODS Data were retrospectively collected from 541 patients on continuous ambulatory peritoneal dialysis between 1 January 2018 and 31 December 312019. For gram-positive cocci and culture-negative peritonitis, we adopted a vancomycin administration and monitoring protocol. Short-term adverse outcomes of PD-associated peritonitis, including transfer to haemodialysis, death, persistent infection beyond planned therapy duration and relapse, were observed. The association between trough serum vancomycin levels and short-term adverse outcomes was evaluated. RESULTS Intraperitoneal vancomycin was used in 61 gram-positive cocci or culture-negative peritonitis episodes in 56 patients. Fourteen episodes of short-term adverse outcomes occurred in 12 patients, whose average trough serum vancomycin levels on day 5 of treatment were significantly lower than those who didn't experience any adverse outcomes (8.4 ± 1.7 vs 12.5 ± 4.3 mg/L, p = 0.003). In gram-positive cocci or culture-negative peritonitis patients, those with higher day 5 trough serum vancomycin levels had a lower risk of short-term adverse outcomes (odds ratio: 0.6, 95% confidence interval: 0.4 to 0.9, p = 0.011). Receiver operating charecteristic curve (ROC) analyses showed that the day 5 trough serum vancomycin levels diagnostic threshold value for short-term adverse outcomes was 10.1 mg/L. After adjustments for gender, exchange volume and residual kidney function (RKF), baseline higher peritoneal transport was associated with a suboptimal (<10.1 mg/L) day 5 serum vancomycin level. CONCLUSIONS Serum vancomycin levels are correlated with short-term adverse outcomes of PD-associated peritonitis, and higher peritoneal solute transport status is associated with suboptimal trough serum vancomycin levels on day 5.
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Affiliation(s)
- Ying Ma
- Department of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yingzhou Geng
- Department of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Jin
- Department of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaopei Wang
- Department of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Changna Liang
- Department of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liyi Xie
- Department of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wanhong Lu
- Department of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jing Lv
- Department of Nephrology, Kidney Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Ogawa A, Hira D, Tsujimoto M, Nishiguchi K, Endo M, Ono T, Hatta T, Terada T, Morita SY. Optimal Sampling Strategy and Threshold of Serum Vancomycin Concentration in Elderly Japanese Patients Undergoing High-Flux Hemodialysis. Ther Drug Monit 2022; 44:396-403. [PMID: 34407000 DOI: 10.1097/ftd.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal sampling points and thresholds for initial serum vancomycin (VCM) concentrations have not been determined in hemodialysis (HD) patients. To clarify this, multiple blood tests were performed, and the correlations between VCM concentrations at several sampling points and the area under the concentration-time curve for 24 hours (AUC24h) were analyzed. METHODS A single-center, prospective observational study was conducted. Patients with end-stage renal failure who received VCM treatment while undergoing chronic maintenance HD were enrolled in this study. HD was performed using a high-flux membrane as the dialyzer. After VCM administration, 7 points were sampled between the first and second HD. The AUC24h after the end of the first HD (AUC0-24) and that before the end of the second HD (AUC24-48) were calculated using the linear trapezoidal method. Correlation analysis and simple regression analysis between AUC24h and serum concentrations were performed at each sampling point. RESULTS Nine patients were evaluated. Strong correlations were found between AUC24-48 and serum concentrations at 24 hours after the initiation of VCM treatment following the first HD (C24h, R = 0.983 and P < 0.001), between AUC0-24 and C24h (R = 0.967 and P < 0.001), and between AUC24-48 and serum concentration just before the second HD (Cpre(HD2), R = 0.965 and P < 0.001). Regression equations with high coefficients of determination (R2 > 0.9) were obtained, and a C24h of ≥18.0 mg/L and a Cpre(HD2) of ≥16.5 mg/L were required to achieve an AUC24-48 value of ≥400 mg·h/L. In addition, a C24h of ≤23.3 mg/L was estimated to satisfy the AUC0-24 range of ≤600 mg·h/L. CONCLUSIONS C24h and Cpre(HD2) are optimal sampling points for predicting VCM-AUC24h in HD patients.
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Affiliation(s)
- Akio Ogawa
- Department of Pharmacy, Omihachiman Community Medical Center, Omihachiman, Shiga, Japan. Dr. Hatta is now with the Hatta Medical Clinic, Kyoto, Japan
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan. Dr. Terada is now with the Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Daiki Hira
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan. Dr. Terada is now with the Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu, Shiga, Japan ; and
| | - Masayuki Tsujimoto
- Department of Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Kohshi Nishiguchi
- Department of Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Masanori Endo
- Department of Pharmacy, Omihachiman Community Medical Center, Omihachiman, Shiga, Japan. Dr. Hatta is now with the Hatta Medical Clinic, Kyoto, Japan
| | - Toshiaki Ono
- Department of Pharmacy, Omihachiman Community Medical Center, Omihachiman, Shiga, Japan. Dr. Hatta is now with the Hatta Medical Clinic, Kyoto, Japan
| | - Tsuguru Hatta
- Department of Pharmacy, Omihachiman Community Medical Center, Omihachiman, Shiga, Japan. Dr. Hatta is now with the Hatta Medical Clinic, Kyoto, Japan
| | - Tomohiro Terada
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan. Dr. Terada is now with the Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Shin-Ya Morita
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan. Dr. Terada is now with the Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
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Clinical Practice Guidelines for Therapeutic Drug Monitoring of Vancomycin in the Framework of Model-Informed Precision Dosing: A Consensus Review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. Pharmaceutics 2022; 14:pharmaceutics14030489. [PMID: 35335866 PMCID: PMC8955715 DOI: 10.3390/pharmaceutics14030489] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/08/2023] Open
Abstract
Background: To promote model-informed precision dosing (MIPD) for vancomycin (VCM), we developed statements for therapeutic drug monitoring (TDM). Methods: Ten clinical questions were selected. The committee conducted a systematic review and meta-analysis as well as clinical studies to establish recommendations for area under the concentration-time curve (AUC)-guided dosing. Results: AUC-guided dosing tended to more strongly decrease the risk of acute kidney injury (AKI) than trough-guided dosing, and a lower risk of treatment failure was demonstrated for higher AUC/minimum inhibitory concentration (MIC) ratios (cut-off of 400). Higher AUCs (cut-off of 600 μg·h/mL) significantly increased the risk of AKI. Although Bayesian estimation with two-point measurement was recommended, the trough concentration alone may be used in patients with mild infections in whom VCM was administered with q12h. To increase the concentration on days 1–2, the routine use of a loading dose is required. TDM on day 2 before steady state is reached should be considered to optimize the dose in patients with serious infections and a high risk of AKI. Conclusions: These VCM TDM guidelines provide recommendations based on MIPD to increase treatment response while preventing adverse effects.
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Matsuzaki T, Kato Y, Mizoguchi H, Yamada K. A machine learning model that emulates experts’ decision making in vancomycin initial dose planning. J Pharmacol Sci 2022; 148:358-363. [DOI: 10.1016/j.jphs.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/26/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022] Open
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Singhal T, Rodrigues C, Soman R, Wattal C, Swaminathan S, Nambi S, Talwar D, Singh RK, Todi S. Treatment of MRSA infections in India: Clinical insights from a Delphi analysis. Indian J Med Microbiol 2021; 40:35-45. [PMID: 34785281 DOI: 10.1016/j.ijmmb.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE International and Indian guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections are available, but the local guidelines are not MRSA-specific. This study aimed to provide clinical insights for the treatment of MRSA infections in India. METHODS We used a three-step modified Delphi method to obtain insights. Ten experts comprising infectious disease specialists, microbiologists, pulmonologists, and critical care experts agreed to participate in the analysis. In round 1, a total of 161 statements were circulated to the panel and the experts were asked to 'agree' or 'disagree' by responding 'yes' or 'no' to each statement and provide comments. The same process was used for 73 statements in round 2. Direct interaction with the experts was carried out in round 3 wherein 35 statements were discussed. At least 80% of the experts had to agree for a statement to reach concordance. RESULTS Eighty-eight statements in round 1, thirty-eight statements in round 2, and eight statements in round 3 reached concordance and were accepted without modification. The final document comprised 152 statements on the management of various syndromes associated with MRSA such as skin and soft tissue infections, bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system infections. CONCLUSIONS This analysis will assist clinicians in India to choose an appropriate course of action for MRSA infections.
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Affiliation(s)
- Tanu Singhal
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | - Chand Wattal
- Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Subramanian Swaminathan
- Infectious Diseases and Infection Control at Gleneagles Global Hospitals (Chennai, Bangalore, Hyderabad), India
| | | | - Deepak Talwar
- Metro Respiratory Center Pulmonology & Sleep Medicine, Metro Hospital, Noida, India
| | | | - Subhash Todi
- Critical Care Medicine, Department of Academics & Health Research, AMRI Hospitals, Kolkata, India.
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11
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Amerstorfer F, Schober M, Valentin T, Klim S, Leithner A, Fischerauer S, Glehr M. Risk of reinfection after two- or multiple-stage knee revision surgery using superficial vancomycin coating and conventional spacers. J Orthop Res 2021; 39:1700-1709. [PMID: 33118642 PMCID: PMC8451795 DOI: 10.1002/jor.24892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
This study investigates the effect of superficial vancomycin coating (SVC) in two- or more-stage exchange procedures of prosthetic knee joint infections. We hypothesized that spacer treatment with SVC result in lower reinfection rates than conventional spacers after prosthetic reimplantation. Our secondary aim was to determine the demographic and treatment factors associated with reinfection rates. This retrospective cohort study compromised 96 cases with prosthetic knee infections. Twenty-four cases were treated with a temporary SVC spacer and 72 cases with conventional spacers. Prosthetic reinfection occurred after a median observation period of 1.7 ± 4.0 years in 24 cases (25%). The prevalence of having a reinfection was not significantly different between the two treatment groups (13% [3 cases] in the SVC group vs. 29% [21 cases] in the conventional spacer group [p = .104]). In seven cases (7.3%), two in the SVC group (8.3%) and five (6.9%) in the conventional spacer group (p ≥ .999), histological, respectively microbiological evaluations from the intraoperative specimens revealed persistent infection at the second stage. Nevertheless, in all seven cases no significant higher risk of periprosthetic reinfection was observed during follow-up (p = .750). Our secondary investigation of cofactors revealed that spacers additionally stabilized by nails were significantly associated with a 3.9-fold higher hazard ratio of sustaining a reinfection of revision prosthesis (p = .005).
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Affiliation(s)
| | - Martina Schober
- Department of Orthopedics and TraumaHospital St. Josef BraunauBraunau am InnAustria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Sebastian Klim
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
| | - Andreas Leithner
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
| | - Stefan Fischerauer
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
| | - Mathias Glehr
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
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12
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Khurana M. Renal Impairment in Pediatric Patients: Current Approaches to Drug Dosing. J Clin Pharmacol 2021; 61 Suppl 1:S161-S164. [PMID: 34185911 DOI: 10.1002/jcph.1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/06/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Mona Khurana
- Division of Pediatrics and Maternal Health, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
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13
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Chung E, Tjon JA, Nemec RM, Nalli N, Harvey EA, Licht C, Seto W. Pharmacokinetics of Vancomycin in Pediatric Patients Receiving Intermittent Hemodialysis or Hemodiafiltration. Kidney Int Rep 2021; 6:1003-1014. [PMID: 33912750 PMCID: PMC8071675 DOI: 10.1016/j.ekir.2021.01.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/27/2020] [Accepted: 01/25/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Vancomycin is a common antibiotic used to treat hemodialysis (HD) or hemodiafiltration (HDF)-related infections in pediatric patients, but optimal dosing remains unknown. This is the first observational study to characterize the pharmacokinetics and evaluate dosing of vancomycin in this population. METHODS Eligible patients received IV vancomycin 10 mg/kg per dose postdialysis followed by a series of serum vancomycin concentrations collected before, immediately after, 1 hour after, and 4 hours after dialysis. The pharmacokinetic parameters were estimated using 1- and 2-compartment models and a nonlinear least-squares algorithm. RESULTS Among 42 vancomycin courses in 16 patients, 1 compartment model had the best fit for observed data. The net drug removal was 43 ± 13% (39% for HD and 50% for HDF) from an average 3-hour HD/HDF session. The mean elimination constant was 0.28 h-1 (standard deviation [SD], 0.11 h-1) during the intradialytic period compared with 0.0049 h-1 (SD, 0.004 h-1) when off dialysis. The mean volume of distribution was 0.65 (SD, 0.19) L/kg. Duration of dialysis session and mode of dialysis (HD vs. HDF) were significant predictors of vancomycin pharmacokinetic parameters. Half-life was shorter for HDF compared with HD (2.1 vs. 3.5 hours). CONCLUSIONS Based on the simulations, an initial vancomycin dose of 10 mg/kg per dose and redosing postdialysis was optimal to achieve a vancomycin concentration range of 5 to 12 mg/L at 4 hours postdialysis and 24-hour area under the curve over minimum inhibitory concentration of ≥400 hours. Therapeutic drug monitoring is necessary to account for residual variability in vancomycin elimination in pediatric patients receiving HD/HDF.
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Affiliation(s)
- Erin Chung
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - James A. Tjon
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Rosaleen M. Nemec
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Nephrology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Nadya Nalli
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth A. Harvey
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Nephrology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Winnie Seto
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluation Services, The Hospital for Sick Children, Toronto, Ontario, Canada
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14
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Chen C, Xu P, Xu T, Zhou K, Zhu S. Influence of cerebrospinal fluid drainage and other variables on the plasma vancomycin trough levels in postoperative neurosurgical patients. Br J Neurosurg 2020; 35:133-138. [PMID: 32456472 DOI: 10.1080/02688697.2020.1769023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) aims to minimise the clinical impact of vancomycin (VCM) pharmacokinetic variability. However, TDM data are limited among specific patient populations, including postoperative neurosurgical populations. The objective of this study was to retrospectively investigate the influence of cerebrospinal fluid (CSF) drainage and other factors on the serum trough concentrations of VCM. METHODS We analysed 154 patients who had been hospitalised in the neurosurgical ward and received intravenous infusions of VCM. We compared the daily doses of VCM, serum VCM concentrations, and serum concentration/dose ratio (C/D ratio) between patients who underwent CSF drainage (drainage group) and controls (nondrainage group). In addition, we also elucidated other factors affecting the attainment of target concentrations. RESULTS The patients in the drainage group showed a significantly lower trough concentration of VCM (6.2 ± 4.2 µg/mL) than that shown by the nondrainage group (8.5 ± 6.6 µg/mL, p = 0.03). Furthermore, the patients in the drainage group showed a significantly different trough C/D ratio (3.1 ± 2.1) than that shown by the nondrainage group (4.3 ± 3.4, p = 0.014). The Mann-Whitney U test demonstrated significantly lower VCM trough levels with concomitant use of diuretic than without (p = 0.004). Multivariable logistic regression demonstrated that coadministered diuretic independently predicted subtherapeutic trough levels of <10 µg/mL (p = 0.04). The concomitant use of albumin and other variables exerted no effects on VCM trough levels. CONCLUSIONS These data suggest that CSF drainage and diuretics have different effects, but it seems that both lower the VCM concentration in postoperative neurosurgical patients. Our findings strongly suggest that a high dose of VCM is required to maintain optimal serum concentrations of VCM in patients managed with CSF drainage or concomitant use of diuretic.
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Affiliation(s)
- Chunyan Chen
- Department of Pharmacy, Ningbo First Hospital, Ningbo, Zhejiang, P.R. China
| | - Ping Xu
- Department of Pharmacy, Ningbo First Hospital, Ningbo, Zhejiang, P.R. China
| | - Tao Xu
- Department of Pharmacy, Ningbo First Hospital, Ningbo, Zhejiang, P.R. China
| | - Keting Zhou
- Department of Pharmacy, Ningbo First Hospital, Ningbo, Zhejiang, P.R. China
| | - Suyan Zhu
- Department of Pharmacy, Ningbo First Hospital, Ningbo, Zhejiang, P.R. China
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15
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A Pharmacokinetic Study Comparing the Clearance of Vancomycin during Haemodialysis Using Medium Cut-Off Membrane (Theranova) and High-Flux Membranes (Revaclear). Toxins (Basel) 2020; 12:toxins12050317. [PMID: 32408589 PMCID: PMC7290329 DOI: 10.3390/toxins12050317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 12/30/2022] Open
Abstract
Medium cut-off membrane (MCO) dialysers have been shown to remove a range of middle molecules, which are associated with adverse outcomes in haemodialysis (HD) patients, more effectively than high-flux HD. Vancomycin is widely used in HD patients for treating a variety of infections. To avoid subtherapeutic trough concentrations, it is important to understand vancomycin clearance in patients undergoing HD with the MCO membrane. This open label single centre, cross-over clinical study compared the vancomycin pharmacokinetics in chronic HD patients using MCO membrane (Theranova) and high-flux membrane (Revaclear). Five patients established on chronic HD who were due to receive vancomycin were enrolled. The study used alternating Theranova and Revaclear dialysis membranes over six consecutive sessions. Vancomycin was administered over the last one to two hours of each HD session. The maintenance dose was adjusted based on pre-HD serum concentrations. Over the 210 study samples, vancomycin clearance was higher with MCO-HD compared to high-flux HD but not statistically significant. Median percentage of vancomycin removal at 120 min by MCO membrane was 39% (20.6-51.5%) compared with 34.1% (21.3-48.4%) with high-flux HD. MCO-HD removes a slightly higher percentage of vancomycin at 120 min into dialysis compared to high-flux membrane dialysis in HD patients with infections. Application of vancomycin during the last one to two hours of each dialysis is required to maintain therapeutic concentrations to minimise loss through the dialyser and maintain therapeutic levels.
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16
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Izumisawa T, Wakui N, Kaneko T, Soma M, Imai M, Saito D, Hasegawa H, Horino T, Takahashi N. Increased Vancomycin Clearance in Patients with Solid Malignancies. Biol Pharm Bull 2020; 43:1081-1087. [PMID: 32295975 DOI: 10.1248/bpb.b20-00083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vancomycin (VAN) is an anti-microbial agent used to treat a number of bacterial infections, which has a high incidence of nephrotoxicity. We examined the pharmacokinetics of VAN retrospectively based on trough concentrations at large scale and identified pharmacokinetic differences between Japanese patients having solid malignancy and non-malignancy patients. Data were analyzed from 162 solid malignancy patients and 261 non-malignancy patients, including the patient's background, VAN dose, and pharmacokinetics of VAN. We failed to detect differences in values for VAN clearance or shorter elimination half-lives between these two groups. In contrast, multiple regression analysis under adjusting for confounding factors by propensity score, showed that VAN clearance significantly increased in relation to solid malignancies in each stage. We conclude that VAN clearance in solid malignancy patients is increased and that the blood concentration of VAN becomes lower than expected. These results suggest that early monitoring of VAN levels in solid malignancy patients might be essential for maintaining desired effects without side-effects.
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Affiliation(s)
- Tomohiro Izumisawa
- Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University.,Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Nobuyuki Wakui
- Division of Applied Pharmaceutical Education and Research, Hoshi University
| | - Tomoyoshi Kaneko
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Masakazu Soma
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Masahiko Imai
- Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University
| | - Daisuke Saito
- Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University
| | - Hideo Hasegawa
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Tetsuya Horino
- Department of Infectious Diseases and Infection Control, Jikei University School of Medicine
| | - Noriko Takahashi
- Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University
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17
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Inage S, Nakamura S, Isoe Y, Okamoto S, Uetake S, Murakami M, Yamaguchi A, Morishima M, Nei T, Ise Y, Katayama S. Acute Kidney Injury in Non-Intensive Care and Intensive Care Patients Treated with Vancomycin and Piperacillin-Tazobactam. J NIPPON MED SCH 2019; 87:66-72. [PMID: 31611508 DOI: 10.1272/jnms.jnms.2020_87-203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We investigated the incidence of acute kidney injury (AKI) and risk factors associated with vancomycin (VAN) and piperacillin-tazobactam (TZP) combination therapy in non-intensive care unit (ICU) and ICU settings. METHODS In this single-center retrospective cohort study, adults who received VAN for ≥48 h during the period from 1 January 2016 through 31 December 2017 were included. The primary endpoint was incidence of AKI. RESULTS Data from 593 adults were analyzed. The incidence of AKI was 10.6% overall, 8.0% in the non-TZP group, and 19.8% in the TZP group. In univariate analysis, the odds ratio (OR) for AKI was higher in the TZP group than in the non-TZP group (2.84, 95% CI = 1.64-4.90). In both the non-ICU and ICU settings, the OR for AKI was higher in the TZP group than in the non-TZP group (non-ICU: OR = 3.04, 95% CI = 1.52-6.09; ICU: OR = 2.51, 95% CI = 1.03-6.08). Furthermore, in propensity score analysis, the OR for AKI was higher in the TZP group than in the non-TZP group (OR = 2.81, 95% CI = 1.52-5.17). In both the non-ICU and ICU settings, the OR for AKI was higher in the TZP group than in the non-TZP group (non-ICU: OR = 2.57, 95% CI = 1.17-5.64; ICU: OR = 3.51, 95% CI = 1.05-11.6). CONCLUSIONS Combined use of TZP in patients receiving VAN increased AKI incidence in non-ICU and ICU settings.
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Affiliation(s)
- Shunsuke Inage
- Section of Pharmaceutical Services, Nippon Medical School Hospital
| | - Shotaro Nakamura
- Section of Pharmaceutical Services, Nippon Medical School Hospital
| | - Yuto Isoe
- Section of Pharmaceutical Services, Nippon Medical School Hospital
| | - Saori Okamoto
- Section of Pharmaceutical Services, Nippon Medical School Hospital
| | - Sho Uetake
- Section of Pharmaceutical Services, Nippon Medical School Hospital
| | - Misato Murakami
- Section of Pharmaceutical Services, Nippon Medical School Hospital
| | - Ayaka Yamaguchi
- Section of Pharmaceutical Services, Nippon Medical School Hospital
| | - Masayo Morishima
- Department of Infection Control and Prevention, Nippon Medical School Hospital
| | - Takahito Nei
- Department of Infection Control and Prevention, Nippon Medical School Hospital
| | - Yuya Ise
- Section of Pharmaceutical Services, Nippon Medical School Hospital
| | - Shiro Katayama
- Section of Pharmaceutical Services, Nippon Medical School Hospital
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18
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Izumisawa T, Kaneko T, Soma M, Imai M, Wakui N, Hasegawa H, Horino T, Takahashi N. Augmented Renal Clearance of Vancomycin in Hematologic Malignancy Patients. Biol Pharm Bull 2019; 42:2089-2094. [PMID: 31534058 DOI: 10.1248/bpb.b19-00652] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The pharmacokinetics of vancomycin (VAN) was retrospectively examined based on trough concentrations at large scale to identify pharmacokinetic differences between Japanese hematologic malignancy and non-malignancy patients. Data from 261 hematologic malignancy patients and 261 non-malignancy patients, including the patient's background, VAN dose, and pharmacokinetics of VAN estimated by an empirical Bayesian method, were collected and analyzed. Our results showed significantly higher values for VAN clearance and shorter elimination half-lives in patients with hematologic malignancies than non-malignancy patients. In addition, multiple regression analysis under adjusting for confounding factors by propensity score, showed that VAN clearance significantly increased in relation to hematologic malignancies. In conclusion, since in hematologic cancer patients VAN clearance is increased, the blood concentration of VAN becomes lower than expected and this may contribute to the survival of resistant bacteria when VAN is administered at low doses. These results suggest that early monitoring of VAN levels in hematologic cancer patients might be recommended to maintain desired effects without side-effects.
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Affiliation(s)
- Tomohiro Izumisawa
- Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University.,Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Tomoyoshi Kaneko
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Masakazu Soma
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Masahiko Imai
- Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University
| | - Nobuyuki Wakui
- Division of Applied Pharmaceutical Education and Research, Hoshi University
| | - Hideo Hasegawa
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Tetsuya Horino
- Department of Infectious Diseases and Infection Control, Jikei University School of Medicine
| | - Noriko Takahashi
- Laboratory of Physiological Chemistry, Institute of Medicinal Chemistry, Hoshi University
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19
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El Nekidy WS, El‐Masri MM, Ghazi IM, Soong D. Factors predicting vancomycin therapy outcomes in hemodialysis outpatients and the role of the nephrology stewardship pharmacist. Hemodial Int 2019; 23:449-457. [DOI: 10.1111/hdi.12775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Islam M. Ghazi
- Philadelphia College of Pharmacy at University of the Sciences Philadelphia Pennsylvania USA
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20
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Ponce D, Zamoner W, Freitas FM, Balbi A, Awdishu L. Vancomycin Removal During High-Volume Peritoneal Dialysis in Acute Kidney Injury Patients. ARCH ESP UROL 2019; 39:183-187. [PMID: 30858287 DOI: 10.3747/pdi.2018.00092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies on vancomycin pharmacokinetics in acute kidney injury (AKI) patients on high-volume peritoneal dialysis (HVPD) are lacking. We studied the pharmacokinetics of intravenous (IV) vancomycin in AKI patients treated by HVPD who received a prescribed single IV dose of vancomycin (15 - 20 mg/kg total body weight) to determine the extent of vancomycin removal and to establish vancomycin dosing guidelines for the empirical treatment of AKI patients receiving HVPD. The application of 18 mg/kg vancomycin every 48 - 72 hours in AKI patients undergoing HVPD was required to maintain therapeutic concentrations.
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Affiliation(s)
- Daniela Ponce
- São Paulo State University - UNESP, Botucatu, São Paulo, Brazil .,Bauru Course of Medicine - USP, Botucatu, São Paulo, Brazil
| | - Welder Zamoner
- São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
| | | | - André Balbi
- São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
| | - Linda Awdishu
- UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of San Diego, California, USA
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21
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Joseph C, Robineau O, Titecat M, Putman S, Blondiaux N, Loiez C, Valette M, Schmit JL, Beltrand E, Dézeque H, Nguyen S, Migaud H, Senneville E. Daptomycin versus Vancomycin as Post-Operative Empirical Antibiotic Treatment for Prosthetic Joint Infections: A Case-Control Study. J Bone Jt Infect 2019; 4:72-75. [PMID: 31011511 PMCID: PMC6470651 DOI: 10.7150/jbji.22118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 06/16/2018] [Indexed: 12/31/2022] Open
Abstract
Purpose: To compare safety and efficacy of Vancomycin (Van) versus Daptomycin (Dap) as post-operative empirical antibiotic treatment (PEAT) in patients with periprosthetic joint infections (PJIs). Methods: Medical charts of patients treated empirically with Van or Dap in the post-operative period of total hip/knee prosthesis septic revision until the results of intra-operative culture were reviewed. Cefotaxime, cefepime or aztreonam were used in combination with Dap or Van. Results: Twenty Dap patients were matched with 20 other Van patients according to the age and type of prosthesis. The ASA score and the distribution of the pathogens was similar in the two groups especially regarding the number of methicillin-resistant staphylococci. The mean duration of the PEAT was 6.07 ± 0.85 days. A total of 17 episodes of adverse events (AE) in 10 patients (25%) were recorded during the PEAT which led to discontinue the treatment in 5 patients, all of them treated with Van (P=0.02). At the end of a mean post-treatment follow-up of 618 +/- 219 days, 36 patients remained in remission of infection; 2 patients failed in each group. Conclusions: Our observations suggest that PEAT with Van for septic revision of PJIs is associated with a higher discontinuation rate due to AE but with a similar outcome than it is with Dap.
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Affiliation(s)
- C Joseph
- Infectious Diseases Department, University Hospital of Amiens, France
| | - O Robineau
- Infectious Diseases Department, Gustave Dron Hospital of Tourcoing, France.,Faculty of Medicine of Lille, Lille University 2
| | - M Titecat
- Faculty of Medicine of Lille, Lille University 2.,Laboratory of Microbiology, University Hospital of Lille, France
| | - S Putman
- Orthopaedic Surgery Unit, University Hospital of Lille, France
| | - N Blondiaux
- Laboratory of Microbiology, Gustave Dron Hospital of Tourcoing, France
| | - C Loiez
- Laboratory of Microbiology, University Hospital of Lille, France
| | - M Valette
- Infectious Diseases Department, Gustave Dron Hospital of Tourcoing, France
| | - J L Schmit
- Infectious Diseases Department, University Hospital of Amiens, France
| | - E Beltrand
- Orthopedic Surgery Unit, Gustave Dron Hospital, France
| | - H Dézeque
- Orthopaedic Surgery Unit, University Hospital of Lille, France
| | | | - H Migaud
- Faculty of Medicine of Lille, Lille University 2.,Orthopaedic Surgery Unit, University Hospital of Lille, France
| | - E Senneville
- Infectious Diseases Department, Gustave Dron Hospital of Tourcoing, France.,Faculty of Medicine of Lille, Lille University 2.,Orthopaedic Surgery Unit, University Hospital of Lille, France
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22
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Mesoporous silica nanoparticles carrying multiple antibiotics provide enhanced synergistic effect and improved biocompatibility. Colloids Surf B Biointerfaces 2019; 175:498-508. [DOI: 10.1016/j.colsurfb.2018.12.035] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/13/2022]
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23
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Chen QY, Wan J, Yang JH, Lin M, Chen Y. Vancomycin-induced severe thrombocytopenia in a young infant. Rev Soc Bras Med Trop 2019; 51:873-875. [PMID: 30517547 DOI: 10.1590/0037-8682-0150-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/05/2018] [Indexed: 01/12/2023] Open
Abstract
Vancomycin is a first-line drug for treating methicillin-resistant Staphylococcus aureus. Thrombocytopenia is a rare adverse reaction to vancomycin treatment, and there are no reports of vancomycin-induced thrombocytopenia (VIT) in infants. We describe the case of a 3-month-old girl who was diagnosed with purulent meningitis. After 13 days of treatment with vancomycin, her platelet count reduced to 8 × 109/L. Vancomycin was discontinued, and intravenous methylprednisolone was administered. The platelet count returned to normal after 4 days. Patients, especially young children, receiving vancomycin for a long clinical course should undergo careful monitoring of laboratory indicators and blood tests.
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Affiliation(s)
- Quan-Yao Chen
- Department of Pharmacy, Xiamen Maternity and Child Care Hospital, Xiamen, Fujian, China
| | - Jun Wan
- Department of Pharmacy, Xiamen Maternity and Child Care Hospital, Xiamen, Fujian, China
| | - Jian-Hui Yang
- Department of Pharmacy, Xiamen Maternity and Child Care Hospital, Xiamen, Fujian, China
| | - Min Lin
- Department of Pharmacy, Xiamen Maternity and Child Care Hospital, Xiamen, Fujian, China
| | - Yao Chen
- Department of Pharmacy, Xiamen Maternity and Child Care Hospital, Xiamen, Fujian, China
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Low Serum Trough Concentrations and High Vancomycin Minimum Inhibitory Concentration in Methicillin-Sensitive Staphylococcus aureus From Hemodialysis Patients in Brazil. Ther Drug Monit 2019; 41:38-43. [DOI: 10.1097/ftd.0000000000000581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effect of Extracorporeal Membrane Oxygenation on the New Vancomycin Dosing Regimen in Critically Ill Patients Receiving Continuous Venovenous Hemofiltration. Ther Drug Monit 2019; 40:310-314. [PMID: 29746432 DOI: 10.1097/ftd.0000000000000495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The optimal dosing regimen of vancomycin for critically ill patients receiving continuous venovenous hemofiltration (CVVH) remains controversial, not to mention those with concurrent use of extracorporeal membrane oxygenation (ECMO). We aimed to determine if a new dosing regimen can achieve the target vancomycin trough concentration (Ctrough) of 10-20 mcg/mL in patients receiving CVVH with or without ECMO. METHODS We conducted a retrospective study by enrolling patients who received vancomycin while undergoing CVVH. The vancomycin dosing regimen was 15-20 mg/kg as the loading dose and 7.5 mg/kg every 12 hours as the maintenance doses. Serum concentration was determined after at least 4 doses of vancomycin were given. RESULTS A total of 38 patients were enrolled, of which 21 were also on ECMO. The ultrafiltration rate of CVVH was 30.6 ± 5.5 mL·kg·h with the Ctrough of 14.7 ± 3.5 mcg/mL. Ctrough was within the target range in 82% of patients. All CVVH-only patients achieved the target concentration, whereas only 76.2% of those with concurrent ECMO did (P = 0.031). CONCLUSIONS All patients receiving CVVH achieved the target Ctrough with this new dosing regimen, but those with concurrent ECMO did not. Ctrough must be more closely monitored in patients using ECMO simultaneously.
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Rodríguez N, Gómez M, Rico N, María Campistol J, Maduell F. Vancomycin hemodialysis: Clearance differences between high‐flux hemodialysis and on‐line hemodiafiltration. Artif Organs 2018; 43:261-269. [DOI: 10.1111/aor.13368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/03/2018] [Accepted: 10/02/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Néstor Rodríguez
- Nephrology and Renal Transplantation Department Hospital Clinic Barcelona Barcelona Spain
| | - Miquel Gómez
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació Clínic per a la Recerca Biomèdica (FCRB) Hospital Clínic de Barcelona Barcelona Spain
| | - Naira Rico
- Nephrology and Renal Transplantation Department Hospital Clinic Barcelona Barcelona Spain
| | - Josep María Campistol
- Nephrology and Renal Transplantation Department Hospital Clinic Barcelona Barcelona Spain
| | - Francisco Maduell
- Nephrology and Renal Transplantation Department Hospital Clinic Barcelona Barcelona Spain
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Ponce D, Zamoner W, Freitas FM, Balbi A, Awdishu L. Vancomycin Removal During High-Volume Peritoneal Dialysis in Acute Kidney Injury Patients: A Prospective Cohort Clinical Study. Kidney Int Rep 2018; 4:112-118. [PMID: 30596174 PMCID: PMC6308823 DOI: 10.1016/j.ekir.2018.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/01/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Vancomycin pharmacokinetic data in patients with acute kidney injury (AKI) on high-volume peritoneal dialysis (HVPD) are lacking. The aims were to study the pharmacokinetics of i.v. vancomycin in patients with AKI treated by HVPD who received an i.v. dose of vancomycin (15–20 mg/kg), to determine the vancomycin removal, and to establish vancomycin dosing and evaluation pharmacokinetics target attainment achievement for the empirical treatment of patients with AKI treated by HVPD. Methods Vancomycin was administered 1 hour before dialysis start. Samples of all dialysate were collected for a 24-hour period. Blood samples were collected after 1, 2, 4, and 24 hours of therapy. Vancomycin concentrations were determined using a liquid chromatographic (high-performance liquid chromatography)–fluorescence method. Pharmacokinetic calculations were completed assuming a 1-compartment model. Results Ten patients completed the study. The mean vancomycin dose administered was 18.0 ± 2.95 mg/kg (14.7–21.8 mg/kg) on the day of study (first day) and the mean percentage of vancomycin removal by HVPD was 21.7% ± 2.2% (16%–29%). Peritoneal clearance was 8.1 ± 2.2 ml/min (5.3–12 ml/min). The serum vancomycin half-life was 71.2 ± 24.7 hours (42–110 hours) during HVPD session, the maximum serum concentration was 26.2 ± 3.5 mg/l, which occurred 1 hour after vancomycin administration and HVPD start. Area under the curve (AUC)0–24/minimum inhibitory concentration (MIC) ratio ≥400 was achieved in all patients when MIC = 1 mg/l was considered. Conclusion HVPD removes considerable amounts of vancomycin in septic patients with AKI. Administration of 18 mg/kg vancomycin each 48 to 72 hours in patients with AKI undergoing HVPD was required to reach and maintain therapeutic concentrations.
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Affiliation(s)
- Daniela Ponce
- São Paulo State University-UNESP, Rubião Junior District, without number Botucatu, São Paulo, Brazil.,University of Sao Paulo-USP, Bauru School of Medicine, Bauru, Sao Paulo, Brazil
| | - Welder Zamoner
- São Paulo State University-UNESP, Rubião Junior District, without number Botucatu, São Paulo, Brazil
| | - Fernanda Moreira Freitas
- São Paulo State University-UNESP, Rubião Junior District, without number Botucatu, São Paulo, Brazil
| | - André Balbi
- São Paulo State University-UNESP, Rubião Junior District, without number Botucatu, São Paulo, Brazil
| | - Linda Awdishu
- UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of San Diego, California, USA
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Duronville JV, Diamantidis CJ. Medical safety in the care of the person with end-stage kidney disease. Semin Dial 2018; 31:140-148. [PMID: 29315834 PMCID: PMC5839985 DOI: 10.1111/sdi.12672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Much is written about medical safety as it pertains to patients with chronic kidney disease, yet the transition to end-stage kidney disease and processes inherent to the receipt of dialysis present unique safety challenges in this population. Educational efforts in medical safety need to focus on the areas of greatest threat and where intervention can provide the greatest benefit. This study addresses such safety topics in the dialysis population and identifies potential strategies that may aid in harm reduction.
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Affiliation(s)
| | - Clarissa J. Diamantidis
- Division of Nephrology, Duke University School of Medicine, Durham, NC
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
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Imai T. [Evaluation of Pharmacotherapy on Emergency and Intensive Care Medicine: The Influence of Intensity and Duration of Invasion]. YAKUGAKU ZASSHI 2018; 137:1427-1430. [PMID: 29199252 DOI: 10.1248/yakushi.17-00139-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Critically ill patients who receive high-level invasion show physiological changes different from those under more normal conditions, along with variable therapeutic effects and pharmacokinetics. The concept of systemic inflammatory response syndrome (SIRS) has been introduced to describe the clinical state resulting from invasive actions taken under acute circumstances, resulting in an acute-phase systemic response. In particular, dosages of vancomycin (VCM) and phenytoin (PHT) need to be adjusted by therapeutic drug monitoring (TDM) because of their narrow therapeutic concentration windows. However, there are few reports on the pharmacokinetics of VCM and PHT in patients with SIRS. We performed a retrospective cohort study of patients treated with VCM and PHT. These studies suggest that the pharmacokinetics of VCM are affected by SIRS score and duration. Furthermore, the concentration of PHT was also shown to be higher in SIRS patients compared with non-SIRS patients. These findings suggest that the pharmacokinetics of VCM and PHT may be affected by the pathology of SIRS, rather than by other patient characteristics. Modifying dosing according to SIRS will improve the prediction accuracy of drug concentration based on TDM. In this review, I introduce work conducted by pharmacists in the clinical study of critically ill patients, and will be discussing the evaluation of pharmacotherapy in emergency and intensive care medicine.
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Affiliation(s)
- Toru Imai
- Department of Pharmacy, Nihon University Itabashi Hospital
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Herrero P, Rawson TM, Philip A, Moore LSP, Holmes AH, Georgiou P. Closed-Loop Control for Precision Antimicrobial Delivery: An In Silico Proof-of-Concept. IEEE Trans Biomed Eng 2017; 65:2231-2236. [PMID: 29989937 DOI: 10.1109/tbme.2017.2787423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Inappropriate dosing of patients with antibiotics is a driver of antimicrobial resistance, toxicity, and poor outcomes of therapy. In this paper, we investigate, in silico, the hypothesis that the use of a closed-loop control system could improve the attainment of pharmacokinetic-pharmacodynamic targets for antimicrobial therapy, where wide variations in target attainment have been reported. This includes patients in critical care, patients with renal disease, and patients with obesity. METHODS The presented in silico study focuses on vancomycin delivery, a first line therapy for Methicillin-resistant Staphylococcus aureus (MRSA) that has serious side effects, including nephrotoxicity. For this purpose, an in silico platform for the simulation of pharmacokinetics of vancomycin agents was developed including 24 virtual noncritically ill-adult subjects obtained from routinely collected data from two prospective audits of vancomycin therapy. Intraday variability on renal clearance, sensor error, and infusion constraints were taken into account. Proportional integral derivative (PID) controller was chosen because of its simplicity of implementation and satisfactory performance. RESULTS Even though significant intraday variability and sensor error were considered in the simulations, by assuming a minimum inhibitory concentration of 1 mg/l for MRSA, the proposed controller was able to reach the well-established therapeutic target of 24-h area under curve to minimum inhibitory concentration ratio equal to 400 $\text{mg} \cdot \text{h}\text{/}\text{l}$ for all the studied subjects, while staying significantly below toxic levels. CONCLUSION A PID controller has the potential to precisely deliver a vancomycin therapy in a noncritically ill-adult population. SIGNIFICANCE Closed-loop control for precision Vancomycin delivery can potentially reduce toxicity and poor therapeutic outcomes, as well as reduce antimicrobial resistance.
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Mohammadi M, Jahangard-Rafsanjani Z, Sarayani A, Hadjibabaei M, Taghizadeh-Ghehi M. Vancomycin-Induced Thrombocytopenia: A Narrative Review. Drug Saf 2017; 40:49-59. [PMID: 27848200 DOI: 10.1007/s40264-016-0469-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Thrombocytopenia has been reported as an adverse reaction of numerous drugs. Vancomycin is often overlooked as a culprit but has been associated with several cases of thrombocytopenia that were not well described in the literature. A literature search was conducted to find reports of thrombocytopenia induced by vancomycin. Biomedical databases including 'PubMed', 'Scopus', and 'Web of Science' were searched using terms 'vancomycin', 'platelet', 'pancytopenia', 'thrombocytopenia', and 'bleeding'. English language articles published before July 2015 were included. Thirty-nine papers including 29 case reports (30 cases), five observational studies, two clinical trials, two letters, and one case series remained for final analysis. The main route of administration was intravenous infusion. This adverse reaction seems to be duration dependent with the mean time to platelet nadir count of 8 days in reported cases. The interval may be significantly shorter in re-exposure to the drug. Platelet nadir counts ranged from 2000 to 100,000/mL in patients who experienced bleeding. Vancomycin-specific antibodies were detected in 13 of 17 patients who were tested in the case reports. Based on the Naranjo Adverse Drug Reaction Probability Scale, reaction was 'definite', 'probable', and 'possible' in 1, 15, and 14 patients, respectively. Among 30 cases, vancomycin was discontinued in 29 patients and platelets returned to normal counts within 5-6 days in 17 of them; in one patient, vancomycin was not discontinued, but platelet count recovered 11 days after the nadir time. Transfusion might be recommended if severe thrombocytopenia and bleeding occurs. Intravenous immunoglobulins, corticosteroids, rituximab, and plasma exchange should be reserved for patients with resistant thrombocytopenia and severe bleeding as mentioned in a number of reports.
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Affiliation(s)
- Mehdi Mohammadi
- Faculty of Pharmacy, Tehran University of Medical Sciences, Pour Sina St, District 6, Tehran, Iran
| | | | - Amir Sarayani
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, 4th Floor, No. 92, Karimkhan Zand Avenue, Hafte Tir Square, Tehran, Iran
| | - Molouk Hadjibabaei
- Faculty of Pharmacy, Tehran University of Medical Sciences, Pour Sina St, District 6, Tehran, Iran.,Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, 4th Floor, No. 92, Karimkhan Zand Avenue, Hafte Tir Square, Tehran, Iran
| | - Maryam Taghizadeh-Ghehi
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, 4th Floor, No. 92, Karimkhan Zand Avenue, Hafte Tir Square, Tehran, Iran.
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Amerstorfer F, Fischerauer S, Sadoghi P, Schwantzer G, Kuehn KD, Leithner A, Glehr M. Superficial Vancomycin Coating of Bone Cement in Orthopedic Revision Surgery: A Safe Technique to Enhance Local Antibiotic Concentrations. J Arthroplasty 2017; 32:1618-1624. [PMID: 28111125 DOI: 10.1016/j.arth.2016.11.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 11/08/2016] [Accepted: 11/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The use of antibiotic-loaded cement has become a well-accepted method to develop high local antibiotic concentrations in revision surgery of infected arthroplasty. A new surgical technique has been established to further increase the local antibiotic concentration and thereby minimizes the risk of reinfection. Our study aim was to investigate the safety of additional superficial vancomycin coating (SVC) by analyzing postoperative joint and serum vancomycin concentrations, as well as the creatinine levels of patients with orthopedic revision surgery. METHODS A longitudinal case series was performed by reviewing collected data of patients who were treated by SVC during revision surgery (1- or 2-stage exchange) because of prosthetic joint infections. Vancomycin levels were obtained, local from drains and systemic from blood samples, on postoperative days 1 to 5. Furthermore, preoperative and postoperative serum creatinine levels were analyzed. RESULTS Highest median local vancomycin levels were documented on postoperative day 1 with 546.8 μg/mL (range, 44.4-1485 μg/mL) in the reimplantation group and 408.7 μg/mL (range, 24.7-1650 μg/mL) in the spacer group. Median serum vancomycin level was 4.4 μg/mL (range, <2.0-11.7 μg/mL) on the first postoperative day in the reimplantation group and <2.0 μg/mL (range, <2.0-3.9 μg/mL) in the spacer group, and lower than 2.0 μg/mL (range, <2.0-7.5 μg/mL) from postoperative day 2 to 5 in both groups. Neither an anaphylactic reaction nor other side effects to SVC were observed. CONCLUSION Our data showed that SVC of bone cement is an effective technique to enhance local concentrations of vancomycin without leading to systemic side effects.
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Affiliation(s)
| | | | - Patrick Sadoghi
- Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria
| | - Gerold Schwantzer
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Klaus Dieter Kuehn
- Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria
| | - Mathias Glehr
- Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria
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Araújo LK, Ueno YA, Gentil T, Soeiro EM, Castro I, Laranja SM, Pereira BJ. Laboratory correlation between vancomycin levels and serum creatinine in the nephrotoxicity of vancomycin. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1217971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Luiza K.R.P. Araújo
- Nephrology Service of Hospital do Servidor Público Estadual, São Paulo/SP, Brazil
| | - Yule A. Ueno
- Universidade Nove de Julho, São Paulo/SP, Brazil
| | - Thais Gentil
- Nephrology Service of Hospital do Servidor Público Estadual, São Paulo/SP, Brazil
| | | | - Isac Castro
- Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Sandra M. Laranja
- Nephrology Service of Hospital do Servidor Público Estadual, São Paulo/SP, Brazil
| | - Benedito Jorge Pereira
- Nephrology Service of Hospital do Servidor Público Estadual, São Paulo/SP, Brazil
- Universidade Nove de Julho, São Paulo/SP, Brazil
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El Nekidy WS, El-Masri MM, Umstead GS, Dehoorne-Smith M. Predicting Maintenance Doses of Vancomycin for Hospitalized Patients Undergoing Hemodialysis. Can J Hosp Pharm 2016; 69:341-347. [PMID: 27826151 DOI: 10.4212/cjhp.v69i5.1588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus is a leading cause of death in patients undergoing hemodialysis. However, controversy exists about the optimal dose of vancomycin that will yield the recommended pre-hemodialysis serum concentration of 15-20 mg/L. OBJECTIVE To develop a data-driven model to optimize the accuracy of maintenance dosing of vancomycin for patients undergoing hemodialysis. METHODS A prospective observational cohort study was performed with 164 observations obtained from a convenience sample of 63 patients undergoing hemodialysis. All vancomycin doses were given on the floor after completion of a hemodialysis session. Multivariate linear generalized estimating equation analysis was used to examine independent predictors of pre-hemodialysis serum vancomycin concentration. RESULTS Pre-hemodialysis serum vancomycin concentration was independently associated with maintenance dose (B = 0.658, p < 0.001), baseline pre-hemodialysis serum concentration of the drug (B = 0.492, p < 0.001), and interdialytic interval (B = -2.133, p < 0.001). According to the best of 4 models that were developed, the maintenance dose of vancomycin required to achieve a pre-hemodialysis serum concentration of 15-20 mg/L, if the baseline serum concentration of the drug was also 15-20 mg/L, was 5.9 mg/kg with interdialytic interval of 48 h and 7.1 mg/kg with interdialytic interval of 72 h. However, if the baseline pre-hemodialysis serum concentration was 10-14.99 mg/L, the required dose increased to 9.2 mg/kg with an interdialytic interval of 48 h and 10.0 mg/kg with an interdialytic interval of 72 h. CONCLUSIONS The maintenance dose of vancomycin varied according to baseline pre-hemodialysis serum concentration of the drug and interdialytic interval. The current practice of targeting a pre-hemodialysis concentration of 15-20 mg/L may be difficult to achieve for the majority of patients undergoing hemodialysis.
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Affiliation(s)
- Wasim S El Nekidy
- PharmD, BCPS, BCACP, was, at the time of this study, a Resident at St John Hospital and Medical Center in Detroit, Michigan. At the time of submission, he was a Clinical Pharmacy Specialist with the Departments of Pharmacy and Nephrology, Windsor Regional Hospital, Windsor, Ontario, and he is now a Senior Pharmacotherapy Specialist - Nephrology with the Department of Pharmacy, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Maher M El-Masri
- PhD, RN, is Professor and Research Leadership Chair, Faculty of Nursing, University of Windsor, Windsor, Ontario
| | - Greg S Umstead
- PharmD, is a Clinical Pharmacy Specialist, St John Hospital and Medical Center, Detroit, Michigan
| | - Michelle Dehoorne-Smith
- PharmD, is Manager of Patient Care Services, St John Hospital and Medical Center, Detroit, Michigan
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Maxson R, Pate J, Starr J. Evaluation of weight-based vancomycin dosing for hospitalized hemodialysis patients. Ren Fail 2016; 38:1677-1682. [DOI: 10.1080/0886022x.2016.1229992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Rebecca Maxson
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Birmingham, AL, USA
| | - Julia Pate
- Department of Pharmacy, Centennial Medical Center, Nashville, TN, USA
| | - Jessica Starr
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Birmingham, AL, USA
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Crew P, Heintz SJ, Heintz BH. Vancomycin dosing and monitoring for patients with end-stage renal disease receiving intermittent hemodialysis. Am J Health Syst Pharm 2016; 72:1856-64. [PMID: 26490819 DOI: 10.2146/ajhp150051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Vancomycin dosing and monitoring algorithms for patients with end-stage renal disease (ESRD) receiving intermittent hemodialysis are reviewed. SUMMARY Vancomycin is one of the most commonly administered antimicrobial agents in adult patients with ESRD receiving intermittent hemodialysis. However, despite the availability of many published studies, the single best method of vancomycin administration in this population remains unclear. Many studies evaluating vancomycin dosing in adult patients with ESRD receiving intermittent hemodialysis were limited by a small sample size, inappropriate therapeutic targets, older hemodialysis modalities (e.g., low-flux intermittent hemodialysis), and inconsistencies in the timing of dosing or therapeutic drug monitoring. Pharmacokinetic variables that must be accounted for include a prolonged distribution phase, a redistribution phase and rebound effect after completion of hemodialysis, patient weight, residual renal function, and nonrenal clearance. Optimal vancomycin dosing recommendations are needed, but clinicians should always consider patient-specific variables, the timing of vancomycin administration, the timing of serum vancomycin concentrations, and technical aspects of the dialysis procedure when creating a dosing regimen. CONCLUSION Individualized vancomycin dosing regimens and therapeutic drug monitoring are necessary for patients with ESRD receiving intermittent hemodialysis to ensure that goal serum vancomycin levels are reached to adequately treat an infection.
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Affiliation(s)
- Page Crew
- Page Crew, Pharm.D., M.P.H., is Postgraduate Year 1 Pharmacy Resident, Froedtert and the Medical College of Wisconsin, Milwaukee. Shannon J. Heintz, Pharm.D., BCPS, is Assistant Professor of Clinical Pharmacy, University of Iowa College of Pharmacy, Iowa City, and Pharmacy Specialist, Critical Care/Surgery, Department of Pharmaceutical Services, Iowa City Veterans Affairs Healthcare System, Iowa City. Brett H. Heintz, Pharm.D., BCPS (AQ-ID), AAHIVE, is Associate Professor of Clinical Pharmacy, University of Iowa College of Pharmacy, and Pharmacy Specialist, Internal Medicine and Infectious Diseases, Department of Pharmaceutical Services, Iowa City Veterans Affairs Healthcare System
| | - Shannon J Heintz
- Page Crew, Pharm.D., M.P.H., is Postgraduate Year 1 Pharmacy Resident, Froedtert and the Medical College of Wisconsin, Milwaukee. Shannon J. Heintz, Pharm.D., BCPS, is Assistant Professor of Clinical Pharmacy, University of Iowa College of Pharmacy, Iowa City, and Pharmacy Specialist, Critical Care/Surgery, Department of Pharmaceutical Services, Iowa City Veterans Affairs Healthcare System, Iowa City. Brett H. Heintz, Pharm.D., BCPS (AQ-ID), AAHIVE, is Associate Professor of Clinical Pharmacy, University of Iowa College of Pharmacy, and Pharmacy Specialist, Internal Medicine and Infectious Diseases, Department of Pharmaceutical Services, Iowa City Veterans Affairs Healthcare System
| | - Brett H Heintz
- Page Crew, Pharm.D., M.P.H., is Postgraduate Year 1 Pharmacy Resident, Froedtert and the Medical College of Wisconsin, Milwaukee. Shannon J. Heintz, Pharm.D., BCPS, is Assistant Professor of Clinical Pharmacy, University of Iowa College of Pharmacy, Iowa City, and Pharmacy Specialist, Critical Care/Surgery, Department of Pharmaceutical Services, Iowa City Veterans Affairs Healthcare System, Iowa City. Brett H. Heintz, Pharm.D., BCPS (AQ-ID), AAHIVE, is Associate Professor of Clinical Pharmacy, University of Iowa College of Pharmacy, and Pharmacy Specialist, Internal Medicine and Infectious Diseases, Department of Pharmaceutical Services, Iowa City Veterans Affairs Healthcare System.
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Mizokami F, Mizuno T. Acute kidney injury induced by antimicrobial agents in the elderly: awareness and mitigation strategies. Drugs Aging 2016; 32:1-12. [PMID: 25491560 DOI: 10.1007/s40266-014-0232-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The use of antimicrobial agents has increased in recent years as treatments have diversified and resistant bacteria have appeared. With increased use of antimicrobial agents, elderly patients are prone to adverse drug reactions (ADRs) as a result of factors such as drug-drug interactions, polypharmacy, long-term use, and over- or under-dosage. In particular, elderly patients using antimicrobials are at increased risk to develop drug-induced acute kidney injury (AKI), which is the most common severe ADR in such patients. AKI is a serious problem that is associated with mortality amongst hospitalized patients. Antimicrobial-induced AKI can be classified into three different types: acute tubular necrosis (ATN), acute interstitial nephritis (AIN), and renal tubule lumen obstruction. AKI can generally be prevented by proper maintenance of fluid balance. To design dosage regimens that ensure efficient drug excretion via the kidney, it is necessary to accurately estimate renal function; however, the kidney undergoes age-dependent structural and functional alterations over time. Therefore, proper management of antimicrobial agents by an antimicrobial stewardship team may lead to decreased incidence of AKI. This article reviews antimicrobial-induced AKI and discusses potential strategies for increasing awareness of AKI and mitigating its clinical effects.
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Affiliation(s)
- Fumihiro Mizokami
- Department of Pharmacy, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8511, Japan,
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Descombes E, Martins F, Hemett OM, Erard V, Chuard C. Three-times-weekly, post-dialysis cefepime therapy in patients on maintenance hemodialysis: a retrospective study. BMC Pharmacol Toxicol 2016; 17:4. [PMID: 26846675 PMCID: PMC4743204 DOI: 10.1186/s40360-016-0048-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/27/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In hemodialysis patients, post-dialysis treatment with intravenous antibiotics permits even severe infections to be managed on an outpatient basis. Cefepime is a fourth-generation cephalosporin with a broad spectrum of action in monotherapy. We report on the pharmacokinetics of cefepime in post-dialysis therapy. METHODS Since June 2012, twelve infections were treated with post-dialysis cefepime in 9 patients on high-flux hemodialysis. The initial post-dialysis dose of cefepime was approximately 15 mg/kg. The following doses were adapted according to the trough serum levels obtained before the subsequent dialysis in order to be above the EUCAST breakpoints for susceptible organisms and above the MIC90. Residual plasma concentrations were determined before (n = 30) and after (n = 17) dialysis by liquid chromatography-mass spectrometry. RESULTS Overall, the mean ± SD dose of cefepime was 920 ± 270 mg (14.5 ± 5.1 mg/kg), but it was significantly lower before the 48 h interval (775 ± 210 mg or 12.7 ± 4.5 mg/kg) compared to the 72 h interval (1125 ± 225 mg or 17.2 ± 4.9 mg/kg) (p < 0.05). The mean trough pre-dialysis concentrations were 10.7 ± 3.9 mg/l and 11.3 ± 5.6 mg/l at 48 and 72 h, respectively. These levels always largely exceeded the EUCAST susceptibility breakpoints for all the targeted bacteria (>1 mg/l) with the exception of Pseudomonas aeruginosa (>8 mg/l). Cefepime concentrations were higher in anuric patients compared to those with preserved diuresis (15.6 ± 3.5 vs 9.25 ± 3.6 mg/l; p < 0.001) and decreased on average by 81 % during dialysis (from 10.5 ± 3.7 to 1.96 ± 1.2 mg/l; p < 0.001). The clinical outcome of all patients was good. CONCLUSIONS Outpatient treatment with cefepime administered post-dialysis three-times-weekly was effective and well-tolerated in our patients. According to our data, in patients infected by highly susceptible pathogens a fixed dose of cefepime of 1 g before every 48-h interval and of 1.5 g before every 72-h interval should be recommended, without need of routine monitoring of the cefepime blood levels. In patients having an infection with less susceptibles pathogens as P. aeruginosa, and particularly in those among them exhibiting residual renal function, higher initial doses are necessary (1.5 g before a 48-h interval and 2.0 g before a 72-h interval) with adaption according to the subsequent pre-dialysis trough serum levels.
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Affiliation(s)
- Eric Descombes
- Service of Nephrology, Department of Internal Medicine, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
| | - Filipe Martins
- Service of Nephrology, Department of Internal Medicine, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
| | - Ould Maouloud Hemett
- Service of Nephrology, Department of Internal Medicine, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
| | - Veronique Erard
- Service of Infectious Diseases, Department of Internal Medicine, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
| | - Christian Chuard
- Service of Infectious Diseases, Department of Internal Medicine, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
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Li ZL, Zhou SF. A SILAC-Based Approach Elicits the Proteomic Responses to Vancomycin-Associated Nephrotoxicity in Human Proximal Tubule Epithelial HK-2 Cells. Molecules 2016; 21:148. [PMID: 26840285 PMCID: PMC6273696 DOI: 10.3390/molecules21020148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 11/16/2022] Open
Abstract
Vancomycin, a widely used antibiotic, often induces nephrotoxicity, however, the molecular targets and underlying mechanisms of this side effect remain unclear. The present study aimed to examine molecular interactome and analyze the signaling pathways related to the vancomycin-induced nephrotoxicity in human proximal tubule epithelial HK-2 cells using the stable isotope labeling by amino acids in cell culture (SILAC) approach. The quantitative proteomic study revealed that there were at least 492 proteins interacting with vancomycin and there were 290 signaling pathways and cellular functions potentially regulated by vancomycin in HK-2 cells. These proteins and pathways played a critical role in the regulation of cell cycle, apoptosis, autophagy, EMT, and ROS generation. These findings suggest that vancomycin-induced proteomic responses in HK-2 cells involvefunctional proteins and pathways that regulate cell cycle, apoptosis, autophagy, and redox homeostasis. This is the first systemic study revealed the networks of signaling pathways and proteomic responses to vancomycin treatment in HK-2 cells, and the data may be used to discriminate the molecular and clinical subtypes and to identify new targets and biomarkers for vancomycin-induced nephrotoxic effect. Further studies are warranted to explore the potential of quantitative proteomic analysis in the identification of new targets and biomarkers for drug-induced renal toxicity.
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Affiliation(s)
- Zhi-Ling Li
- Department of Pharmacy, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200040, China.
| | - Shu-Feng Zhou
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL 33612, USA.
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Cardile AP, Tan C, Lustik MB, Stratton AN, Madar CS, Elegino J, Hsue G. Optimization of time to initial vancomycin target trough improves clinical outcomes. SPRINGERPLUS 2015. [PMID: 26203410 PMCID: PMC4506278 DOI: 10.1186/s40064-015-1146-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Outcomes data for the efficacy of interventions designed to decrease the time to initial target vancomycin troughs are sparse. OBJECTIVE A vancomycin therapeutic drug monitoring (TDM) program was initiated to reduce the time to initial target troughs and to examine the impact on clinical outcomes. METHODS Single-center, pre- and post-intervention observational study in a 250 bed teaching facility. Adult inpatients treated with physician-guided, vancomycin therapy (historical control, CTRL) were compared to high trough, pharmacist-guided vancomycin therapy (TDM). Nephrotoxicity analyses were conducted to the ensure safety of the TDM. Clinical outcome analysis was limited to patients with normal renal function and culture-confirmed gram positive infections and a pre-defined MRSA subset. RESULTS 340 patients met initial inclusion criteria for the nephrotoxicity analysis (TDM, n = 173; CTRL, n = 167). Acute kidney injury occurrence was similar between the CTRL (n = 20) and TDM (n = 23) groups (p = 0.7). Further exclusions yielded 145 patients with gram positive infections for clinical outcomes evaluation (TDM, n = 66; CTRL, n = 75). The time to initial target trough was shorter in the TDM group (3 vs. 5 days, p < 0.001). Patients in the TDM group discharged from the hospital more rapidly, 7 vs. 14 days (Hazards Ratio (HR), 1.41; 95% Confidence Interval [CI] 1.08-1.83; p = 0.01), reached clinical stability faster, 4 vs. 8 days (HR, 1.51; 95% CI 1.08-2.11; p = 0.02), and had shorter courses of vancomycin, 4 vs. 7 days (HR, 1.5; 95% CI 1.15-1.95; p = 0.003). In the MRSA infection subset (TDM, n = 36; CTRL, n = 35), patients in the TDM group discharged from the hospital more rapidly, 7 vs. 16 days (HR, 1.89; 95% CI 1.08-3.3; p = 0.03), reached clinical stability faster, 4 vs. 6 days (HR, 2.69; 95% CI 1.27-5.7; p = 0.01), and had shorter courses of vancomycin, 5 vs. 8 days (HR, 2.52; 95% CI 1.38-4.6; p = 0.003). Attaining initial target troughs in <5 days versus ≥5 days was associated with improved clinical outcomes. All cause in-hospital mortality, and vancomycin treatment failure occurred at comparable rates between groups. CONCLUSIONS Interventions designed to decrease the time to reach initial target vancomycin troughs can improve clinical outcomes in gram positive infections, and in particular MRSA infections.
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Affiliation(s)
- Anthony P Cardile
- Department of Medicine, Tripler Army Medical Center, 1 Jarrett White Roadm, Honolulu, HI 96859 USA
| | - Christopher Tan
- Department of Pharmacy, Tripler Army Medical Center, 1 Jarrett White Roadm, Honolulu, HI 96859 USA
| | - Michael B Lustik
- Department of Clinical Investigation, Tripler Army Medical Center, 1 Jarrett White Roadm, Honolulu, HI 96859 USA
| | - Amy N Stratton
- Department of Medicine, Tripler Army Medical Center, 1 Jarrett White Roadm, Honolulu, HI 96859 USA
| | - Cristian S Madar
- Department of Medicine, Tripler Army Medical Center, 1 Jarrett White Roadm, Honolulu, HI 96859 USA
| | - Jun Elegino
- Department of Medicine, Tripler Army Medical Center, 1 Jarrett White Roadm, Honolulu, HI 96859 USA
| | - Günther Hsue
- Department of Medicine, Tripler Army Medical Center, 1 Jarrett White Roadm, Honolulu, HI 96859 USA ; Department of Infectious Diseases, Tripler Army Medical Center, 1 Jarrett White Roadm, Honolulu, HI 96859 USA
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Application of Intrawound Vancomycin Powder during Spine Surgery in a Patient with Dialysis-Dependent Renal Failure. Case Rep Surg 2015; 2015:321682. [PMID: 26185703 PMCID: PMC4491571 DOI: 10.1155/2015/321682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/15/2015] [Indexed: 11/29/2022] Open
Abstract
Surgical site infections (SSIs) after spinal surgery are a serious complication that can be minimized with prophylaxis. Vancomycin is a common agent used in the prevention of SSI. Given that vancomycin is renally cleared, its use requires careful observation in dialysis-dependent patients due to toxicity at supratherapeutic levels. Since minimum inhibitory concentrations (MICs) for vancomycin have increased due to the emergence of resistant pathogens, the use of vancomycin in such patients is further complicated. Local instillation of vancomycin powder is thought to provide additional protection against SSI and have lower systemic absorption. We present a patient with end-stage renal disease that developed progressively debilitating cervical spondylotic myelopathy necessitating multilevel laminectomy and instrumented fusion. Prior to closure, 1 gram of vancomycin powder was sprinkled into the surgical incision. Postoperative serum vancomycin levels were well below those associated with nephrotoxicity and ototoxicity. Based on this experience, we reviewed the relevant guidelines that were designed to prevent postoperative infections in such dialysis-dependent patients. Intrawound application of vancomycin may be a legitimate and safe option for SSI prophylaxis in patients with renal failure on dialysis.
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Spadaro S, Berselli A, Fogagnolo A, Capuzzo M, Ragazzi R, Marangoni E, Bertacchini S, Volta CA. Evaluation of a protocol for vancomycin administration in critically patients with and without kidney dysfunction. BMC Anesthesiol 2015; 15:95. [PMID: 26116239 PMCID: PMC4483208 DOI: 10.1186/s12871-015-0065-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 05/27/2015] [Indexed: 12/03/2022] Open
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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Affiliation(s)
- Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy.
| | - Angela Berselli
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy.
| | - Alberto Fogagnolo
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy.
| | - Maurizia Capuzzo
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy.
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy.
| | - Elisabetta Marangoni
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy.
| | - Sara Bertacchini
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy.
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy.
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Pharmacokinetic analysis of antibiotic adsorption (vancomycin and teicoplanin) by the Lixelle extracorporeal unit. Int J Artif Organs 2015; 38:8-12. [PMID: 25651463 DOI: 10.5301/ijao.5000383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE The pharmacokinetic properties of vancomycin (VAN) and teicoplanin (TEC) may be affected by adsorption during hemofiltration as well as hemoperfusion therapies. The aim of this in vitro study was to investigate VAN and TEC removal adsorption kinetics with mass balance analysis by direct hemoperfusion (DHP) with the Lixelle S-35 cartridge (Lixelle, Kaneka Corporation, Tokyo). METHODS Mock DHP was performed for 120 min using VAN and TEC solutions (46.08 ± 0.81 and 74.79 ± 1.24 mg/l per N = 6). Clinical plasma antibiotic concentrations were circulated in a closed circuit simulating DHP using an adsorption column (Lixelle S-35) at flow rate of 250 ml/min. Samples were collected at 10, 60, and 120 min through both arterial and venous ports; drug levels were measured with particle enhanced turbidimetric inhibition immunoassay and fluorescence polarization immunoassay. All tests were performed in triplicate. RESULTS Results subsequent to DHP at the primary assessment interval for VAN mass was 49.06 ± 1.47 mg, indicating a significant reduction of the starting mass (94.74 ± 1.63 mg). The observed reduction of TEC levels greatly exceeded that of VAN at the first interval (10 min). At 120 min of DHP, the estimated mass adsorption of VAN was 45.68 ± 2.26 mg, while the mesured total TEC mass adsorbed was 126.86 ± 0.91 mg. CONCLUSIONS A VAN adsorption plateau indicating the VAN loading dose may be required in patients receiving DHP with the Lixelle S-35. The total TEC mass was adsorbed subsequent to 60 min of circulation, so the loading dose should be closely considered. In addition, the Lixelle S-35 may represent an option as a rescue therapy in accidental overdose of TEC.
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De Vriese AS, Vandecasteele SJ. Vancomycin: the tale of the vanquisher and the pyrrhic victory. Perit Dial Int 2015; 34:154-61. [PMID: 24676741 DOI: 10.3747/pdi.2014.00001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Vancomycin has been the antibiotic of choice in the treatment of methicillin-resistant Staphylococcus aureus infections for decades. But relatively recently, vancomycin-intermediate-susceptible S. aureus (VISA) have been reported. Phenotypically, VISA are characterized by thicker cell walls, requiring higher concentrations of vancomycin for inhibition of bacterial cell growth. Vancomycin-intermediate-susceptible S. aureus represent just the tip of the iceberg of an insidious loss of vancomycin susceptibility in staphylococci. Increasing proportions of S. aureus isolates have higher minimum inhibitory concentrations that are still within the officially susceptible range, a characteristic that is associated with treatment failure. The most important risk factor for decreased vancomycin susceptibility is in vivo selection pressure. To prevent the development of VISA, prolonged or inappropriate use of vancomycin and suboptimal vancomycin levels should be avoided. Trough serum vancomycin concentrations of 15 - 20 mg/L for intermittent dosing and plateau serum vancomycin concentrations of 20 - 25 mg/L for continuous infusions are therefore currently recommended. The widespread clinical application of these intensive dosing regimens has resulted in an increasing awareness of vancomycin-induced nephrotoxicity, which is especially relevant in patients whose renal function is already compromised. This narrow therapeutic-toxic window reinforces the use of rigorous dosing protocols. In hemodialysis, the use of a vancomycin dose calculator permits achievement of target concentrations in most patients. In peritoneal dialysis (PD), intermittent vancomycin dosing regimens often lead to low end-of-dwell concentrations. On the other hand, a continuous vancomycin dosing regimen after a loading dose offers the desired combination of high local levels without toxic systemic levels.
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Affiliation(s)
- An S De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge, Brugge, Belgium
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Chaijamorn W, Wanakamanee U. Pharmacokinetics of vancomycin in critically ill patients undergoing continuous venovenous haemodialysis. Int J Antimicrob Agents 2014; 44:367-8. [PMID: 25127656 DOI: 10.1016/j.ijantimicag.2014.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 11/19/2022]
Affiliation(s)
| | - Usanee Wanakamanee
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
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Ren W, Pan H, Wang P, Lan L, Chen W, Wang Y, Ni L, Peng L. Clinical analysis of pulmonary infection in hemodialysis patients. Exp Ther Med 2014; 7:1713-1717. [PMID: 24926372 PMCID: PMC4043622 DOI: 10.3892/etm.2014.1646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 01/07/2014] [Indexed: 12/13/2022] Open
Abstract
The present study aimed to investigate the pathogen distribution and drug resistance of lung infections in hemodialysis to guide clinical empirical pharmacy. The clinical data of 116 hemodialysis patients with pulmonary infection were analyzed. The majority of the 82 pathogens isolated from the sputa of patients were Gram-negative bacteria (accounting for 71.95%). The results of the drug sensitivity test suggested that Gram-negative bacilli had low resistance rates to piperacillin and tazobactam, imipenem and amikacin, while Gram-positive cocci had a low resistance rate to vancomycin. All resistance rates of the pathogens to other common antimicrobials were >50%. The pathogens resulting in lung infections in hemodialysis patients were mainly Gram-negative bacteria and were significantly resistant to various antibacterials. Results of the this study demonstrate that pathological examination should be performed as early as possible and effective antimicrobial agents should be chosen according to drug sensitivity test results.
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Affiliation(s)
- Wei Ren
- Department of Nephrology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Huixuan Pan
- Department of Nephrology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Peng Wang
- Department of Nephrology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Lei Lan
- Department of Nephrology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Wei Chen
- Department of Nephrology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Yan Wang
- Department of Nephrology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Lijun Ni
- Department of Nephrology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - Li Peng
- Department of Nephrology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, P.R. China
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Stevenson S, Tang W, Cho Y, Mudge DW, Hawley CM, Badve SV, Johnson DW. The role of monitoring vancomycin levels in patients with peritoneal dialysis-associated peritonitis. Perit Dial Int 2014; 35:222-8. [PMID: 24584597 DOI: 10.3747/pdi.2013.00156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/03/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is limited available evidence regarding the role of monitoring serum vancomycin concentrations during treatment of peritoneal dialysis (PD)-associated peritonitis. METHODS A total of 150 PD patients experiencing 256 episodes of either gram-positive or culture-negative peritonitis were included to investigate the relationship between measured serum vancomycin within the first week and clinical outcomes of cure, relapse, repeat or recurrence of peritonitis, catheter removal, temporary or permanent transfer to hemodialysis, hospitalization and death. RESULTS Vancomycin was used as an initial empiric antibiotic in 54 gram-positive or culture-negative peritonitis episodes among 34 patients. The median number of serum vancomycin level measurements in the first week was 3 (interquartile range; IQR 1 - 4). The mean day-2 vancomycin level, measured in 34 (63%) episodes, was 17.5 ± 5.2 mg/L. Hospitalized patients were more likely to have serum vancomycin levels measured on day 2 and ≥ 3 measurements in the first week. The peritonitis cure rates were similar between patients with < 3 and ≥ 3 measurements in the first week (77% vs 57%, p = 0.12) and if day-2 vancomycin levels were measured or not (68% vs 65%, p = 0.84). The average day-2 (18.0 ± 5.9 vs 16.6 ± 3.2, p = 0.5), first-week average (18.6 ± 5.1 vs 18.6 ± 4.3, p = 0.9) and nadir (14.5 ± 4.1 vs 13.6 ± 4.2, p = 0.5) vancomycin levels were comparable in patients who did or did not achieve peritonitis cure. Similar results were observed for all other clinical outcomes. CONCLUSION The clinical outcomes of gram-positive and culture-negative peritonitis episodes are not associated with either the frequency or levels of serum vancomycin measurements in the first week of treatment when vancomycin is dosed according to International Society for Peritoneal Dialysis (ISPD) Guidelines.
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Affiliation(s)
- Sarah Stevenson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Wen Tang
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Division of Nephrology, Peking University Third Hospital, Beijing, China
| | - Yeoungjee Cho
- Division of Nephrology, Peking University Third Hospital, Beijing, China
| | - David W Mudge
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Carmel M Hawley
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Sunil V Badve
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
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Lomaestro BM. Vancomycin dosing and monitoring 2 years after the guidelines. Expert Rev Anti Infect Ther 2014; 9:657-67. [DOI: 10.1586/eri.11.46] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Fullmer A, McCue D, Feng C. Retrospective review of vancomycin-induced nephrotoxicity in patients with leukemia. J Oncol Pharm Pract 2013; 20:403-8. [DOI: 10.1177/1078155213509847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background The occurrence of nephrotoxicity with vancomycin is approximately 17%, but can increase to 35% when combined with other nephrotoxic agents. Patients with hematologic malignancies may be at greater risk for vancomycin-induced nephrotoxicity due to nephrotoxic chemotherapy and tumor lysis syndrome. Objective The primary objective of this study was to determine the occurrence of nephrotoxicity in adult patients with leukemia receiving vancomycin. Methods A retrospective review approved by the Institutional Review Board was conducted on adult patients with leukemia who received at least one dose of vancomycin during hospital admission between 1 January 2009 and 30 April 2009. Results Forty patients had an occurrence of nephrotoxicity (16%) while 210 patients did not have an occurrence of nephrotoxicity. In multivariate analysis, variables significantly associated with development of nephrotoxicity included active disease status (odds ratio, 4.38 [95% CI 1.1–29.4], p = 0.0291), concomitant intravenous acyclovir administration (odds ratio, 3.83 [95% CI, 1.6–8.9]; p = 0.0022), and concomitant amphotericin administration (odds ratio, 4.26 [95% CI, 1.9–9.4]; p = 0.0004). Conclusion The occurrence of nephrotoxicity in patients with leukemia treated with vancomycin was 16% in our study, similar to previously published reports. Active disease status and concomitant use of intravenous acyclovir and amphotericin were identified as significant risk factors for development of nephrotoxicity. The presence of risk factors for vancomycin nephrotoxicity should be evaluated prior to initiation of therapy to determine appropriateness of use.
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Affiliation(s)
- Amber Fullmer
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah McCue
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chun Feng
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Eldemiry EMB, Sabry NA, Abbassi MM, Abdel Shafy SS, Mokhtar MS, Abdel Bary A. A specially tailored vancomycin continuous infusion regimen for renally impaired critically ill patients. SAGE Open Med 2013; 1:2050312113507921. [PMID: 26770686 PMCID: PMC4687768 DOI: 10.1177/2050312113507921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Vancomycin remains the gold standard for treatment of methicillin-resistant Staphylococcus aureus. Specially designed continuous infusion of vancomycin leads to better therapy. Methodology: A total of 40 critically ill patients who suffered from pneumonia susceptible to vancomycin, had serum creatinine >1.4 mg%, and oliguria <0.5 mL/kg/h for 6 h were included in the study with respiratory culture sensitivity to vancomycin ≤2 mg/L. Patients’ clinical, microbiological, and biological data were obtained by retrospective analysis of the corresponding medical files before and after vancomycin treatment. Patients with serum creatinine level ≥4 mg% and patients who received renal replacement therapy during the treatment period were excluded. The patients were divided into two groups—group 1 (intermittent dosing) and group 2 (continuous infusion) based on the following formula: rate of vancomycin continuous infusion (g/day) = [0.0205 creatinine clearance (mL/min) + 3.47] × [target vancomycin concentration at steady state (µg/mL)] × (24/1000). Trough vancomycin serum levels were also assessed using high-performance liquid chromatographic technique. Patients’ outcomes such as clinical improvement, adverse events, and 15-day mortality were reported. Results: Group 2 showed significant reduction in blood urea nitrogen, creatinine serum levels, white blood cells, partial carbon dioxide pressure, body temperature, and Sequential Organ Failure Assessment score, while significant increase in partial oxygen pressure and saturated oxygen was also observed. A significantly shorter duration of treatment with a comparable vancomycin serum levels was also reported with group 2. Conclusion: After treatment, comparison in patients’ criteria supports the superiority of using continuous infusion of vancomycin according to this equation in renally impaired patients.
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Affiliation(s)
| | | | | | | | - Mohamed S Mokhtar
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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