PKP-026 Therapeutic drug monitoring of vancomycin and evolution of renal function in patients with first time prosthesis replacement

BackgroundJoint prosthesis infection is a growing public health problem. The infections occur during surgery or in the postoperative period, and more rarely through blood. According to the time of onset and clinical settings (Tsukayama classification), 60% of infections are caused by staphylococcus...

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Published in:European journal of hospital pharmacy. Science and practice 2016-03, Vol.23 (Suppl 1), p.A190-A190
Main Authors: Marín-Casino, M, Martínez, N Carballo, Cuscó, M De Antonio, Fernández, S Herrera, Palau, E Esteve, Redo, ML Sorli, Gallego, JP Horcajada, Verdie, L Puig, Fabrego, A Alier, Cerrato, S Grau
Format: Article
Language:English
Subjects:
Antibiotics
Drug dosages
Pharmacokinetics
Prostheses
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Summary:BackgroundJoint prosthesis infection is a growing public health problem. The infections occur during surgery or in the postoperative period, and more rarely through blood. According to the time of onset and clinical settings (Tsukayama classification), 60% of infections are caused by staphylococcus spp. Vancomycin is one of the antibiotics commonly used. Therapeutic drug monitoring (TDM) of vancomycin is recommended because of its narrow therapeutic range.PurposeTo assess the impact of implementation of a new dosage schedule for vancomycin on plasma concentrations of this antibiotic and on renal function in patients with first time replacement prosthesis.Material and methodsRetrospective cohort study from December 2013 to May 2015 performed in a 400 bed tertiary university hospital. Patients undergoing first time replacement prosthesis were included. Vancomycin dosage schedule: first day 1 g/8 h; second day 1 g/12 h and blood samples for TDM.Data collected: demographics, weight, treatment duration, vancomycin Cmin and AUC, recommended dose to achieve Cmin 20–25 µg/mL, initial and final renal function (serum creatinine (Scr), ClCr Cockroft-Gault) and nephrotoxicity defined by the RIFLE Scale for renal failure.Pharmacokinetic analysis: Bayesian estimation compartmental model (PKS System Abbott).Data are shown as median (Q1-Q3). Statistical analysis was performed using non-parametric tests.ResultsPatients included: 84 (42 male), 69.5 (57.2–78.0) years, 79.0 (68.5–94.0) kg.Treatment duration: 9 (7–13) days. Cmin 10.8 (6.3–15.9) µg/mL. AUC 463 (348–585) µg.h/ml. Increasing dose 71 (84.5%) patients, decreasing 8 (9.5%). Recommended dose 3 (2.4–4) g/day.Renal function: Scr initial 0.70 (0.56–0.87) mg/dL, Scr final 0.74 (0.60–0.88) mg/dL. ClCrCockroft-Gault initial 105 (72–147) ml/min, final 106 (77–148) mL/min. RIFLE 1–2––0-0. Nephrotoxicity 3.6%.ConclusionAlthough an increase in initial vancomycin dose was implemented, most patients did not achieve therapeutic trough levels. This situation may be explained by high ClCr values in the patients included. However, AUC values agreed with optimal pharmacokinetic concentrations against microorganisms, with MIC
ISSN:2047-9956
2047-9964
DOI:10.1136/ejhpharm-2016-000875.429