Infection and Drug Resistance (Dec 2022)
Continuous Vancomycin Infusion versus Intermittent Infusion in Critically Ill Patients
Abstract
Chailat Maluangnon, Surat Tongyoo, Chairat Permpikul Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Chairat Permpikul, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2, Wanglang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand, Tel +66 81 408 1676, Fax +66 2 419 8597, Email [email protected]: Vancomycin is the best-choice medication for methicillin-resistant staphylococcal and enterococcal infections, which are major problems in intensive care units (ICUs). Intermittent infusion is standard for vancomycin, although delayed therapeutic target achievement and supra- and subtherapeutic levels are concerns. A recently proposed alternative with superior therapeutic target achievement is continuous infusion.Objective: To compare the benefits of continuous (CVI) and intermittent (IVI) vancomycin infusion.Methods: This quasi-experimental study used propensity score-matched historical controls and adult patients in medical and surgical ICUs for whom vancomycin was indicated. The experimental group received CVI for ≥ 48 hours. Data on patients receiving IVI between January 2018 and October 2020 were reviewed. Capability to achieve serum vancomycin therapeutic targets (48 and 96 hours), episodes of supra- and subtherapeutic levels, treatment success, mortality, and incidence of acute kidney injury (AKI) were analyzed before and after one-to-two propensity score matching.Results: The CVI group had 31 patients, while the unmatched IVI group had 125. More CVI patients achieved the therapeutic target within 48 hours (54.8% vs 25.6%; P=0.002). CVI patients had a higher median number of supratherapeutic episodes (2 vs 1; P=0.007) but a lower median for subtherapeutic episodes (0 vs 1; P=0.003). Other outcomes demonstrated no differences. After propensity score matching, target achievement within 48 hours (54.8% vs 22.6%; P=0.002) and fewer subtherapeutic episodes (0 vs 1; P=0.014) remained significant.Conclusion: CVI’s rapid therapeutic target achievement and fewer subtherapeutic episodes make it superior to IVI. No differences in treatment success, mortality, or AKI are evident.Keywords: continuous infusion, intensive care units, pharmacokinetics, therapeutic drug monitoring, vancomycin
