Mari Koyanagi1, Rebecca Anning1, Mark Loewenthal1,2, Jennifer H Martin1,2. 1. John Hunter Hospital, Lookout Road New Lambton, New South Wales, 2305, Australia. 2. School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, New South Wales, 2305, Australia.
Abstract
AIMS: Vancomycin dosing and monitoring recommendations are poorly adhered to in many institutions internationally, with concerns of treatment failure and propelling antibiotic resistance. The primary aim of this study was to audit the rate of adherence to American guidelines, with particular interest in loading dose administration. The secondary aims were (i) to determine whether or not guideline adherence results in therapeutic concentrations across body mass index (BMI) groups and (ii) to determine whether or not this was in turn associated with morbidity and hospital mortality. METHOD: Data were collected in a single tertiary hospital on all patients who had two or more serum vancomycin concentrations measured. RESULT: In total, 107 patients met the inclusion criteria. Overall, 38.3% of patients were commenced on guideline adherent vancomycin doses, and 28.3% of overweight patients received an adherent first dose compared to 51.1% of non-overweight people (difference 23%, 95% CI 4% to 41%, P = 0.024). Overweight patients were more frequently underdosed compared to non-overweight patients (P = 0.039). The frequency and proportion of underdosing increased with BMI. Overweight patients spent a smaller fraction of their course within the therapeutic range, although the difference was not statistically significant (difference 7.7%; 95% CI 4% to 19.4%; P = 0.195). The overweight group had longer hospital length of stay (LOS), higher mortality and more treatment failures. CONCLUSION: Adherence to guideline-based prescription is poor, particularly in overweight patients. Patients who are initially underdosed have fewer therapeutic vancomycin days, regardless of BMI. Overweight patients have increased hospital LOS, hospital mortality and treatment failure.
AIMS: Vancomycin dosing and monitoring recommendations are poorly adhered to in many institutions internationally, with concerns of treatment failure and propelling antibiotic resistance. The primary aim of this study was to audit the rate of adherence to American guidelines, with particular interest in loading dose administration. The secondary aims were (i) to determine whether or not guideline adherence results in therapeutic concentrations across body mass index (BMI) groups and (ii) to determine whether or not this was in turn associated with morbidity and hospital mortality. METHOD: Data were collected in a single tertiary hospital on all patients who had two or more serum vancomycin concentrations measured. RESULT: In total, 107 patients met the inclusion criteria. Overall, 38.3% of patients were commenced on guideline adherent vancomycin doses, and 28.3% of overweightpatients received an adherent first dose compared to 51.1% of non-overweightpeople (difference 23%, 95% CI 4% to 41%, P = 0.024). Overweightpatients were more frequently underdosed compared to non-overweightpatients (P = 0.039). The frequency and proportion of underdosing increased with BMI. Overweightpatients spent a smaller fraction of their course within the therapeutic range, although the difference was not statistically significant (difference 7.7%; 95% CI 4% to 19.4%; P = 0.195). The overweight group had longer hospital length of stay (LOS), higher mortality and more treatment failures. CONCLUSION: Adherence to guideline-based prescription is poor, particularly in overweightpatients. Patients who are initially underdosed have fewer therapeutic vancomycin days, regardless of BMI. Overweightpatients have increased hospital LOS, hospital mortality and treatment failure.
Authors: Joanne Oi Sze Chan; Melissa Therese Baysari; Jane Ellen Carland; Indy Sandaradura; Maria Moran; Richard Osborne Day Journal: Eur J Clin Pharmacol Date: 2018-07-28 Impact factor: 2.953
Authors: Aileen P Morrison; Stacy E F Melanson; Marcy G Carty; David W Bates; Paul M Szumita; Milenko J Tanasijevic Journal: Am J Clin Pathol Date: 2012-03 Impact factor: 2.493
Authors: Cameron J Phillips; Alice J Wisdom; Ross A McKinnon; Richard J Woodman; David L Gordon Journal: Infect Drug Resist Date: 2018-10-31 Impact factor: 4.003