Optimize Vancomycin Dose in Surgical Ward Patients with Augmented Renal Clearance Determined by Chronic Kidney Disease Epidemiology Collaboration Equation.
Journal
Infection and drug resistance
Journal Volume
17
Start Page
4195
End Page
4203
ISSN
1178-6973
Date Issued
2024
Author(s)
Chen, Li-Yu
Wang, Chen-Yu
Lin, Chi-Ying
Shen, Wei-Hsun
Li, Pei-Jhih
Liao, Lin-Chu
Wu, Chien-Chih
Abstract
Background: In the field of postoperative care, infections caused by Gram-positive bacteria pose a major clinical challenge. Vancomycin is a key therapeutic agent whose efficacy is greatly influenced by renal function, particularly by augmented renal clearance (ARC). The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) is an easy and commonly used method to predict ARC; however, it is not well studied to determine vancomycin dose. In this study, we examined the effectiveness of the CKD-EPI equation in determining ARC and optimizing the dose of vancomycin for surgical ward patients. Methodology: A retrospective observational study was conducted to examine 158 surgical ward patients receiving vancomycin. Data on demographics, medical history, and vancomycin dosing were collected. Renal function was evaluated using the CKD-EPI equation, with ARC defined as eGFR ≥ 96.5 mL/min/1.73 m2. Vancomycin pharmacokinetics were calculated using the ClinCalc tool. Results: ARC was in 54% of the patients. Compared with patients without ARC, those with ARC were younger and had lower serum creatinine levels. They also required higher vancomycin doses but had lower trough concentrations and 24-hour area-under-the-curve values. A significant correlation was observed between eGFR and vancomycin clearance, with eGFR > 96.5 mL/min/1.73 m2 necessitating higher vancomycin doses (>45 mg/kg/day) to achieve the desired area under the curve to minimum inhibitory concentration ratio. Conclusion: For surgical ward patients with CKD-EPI eGFR ≥ 96.5 mL/min/1.73 m2, a vancomycin dosage of >45 mg/kg/day may be recommended to reach effective therapeutic levels. Overall, this study emphasizes the importance of tailoring vancomycin therapy depending on renal function to ensure efficacy and mitigate the risk of antimicrobial resistance in surgical ward patients.
Subjects
augmented renal clearance
surgery
vancomycin
SDGs
Type
journal article