174. Implementation of a Vancomycin Pharmacokinetic Service: Clinical Outcomes
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Background: A hospital wide Vancomycin (VAN) Pharmacokinetic Service (VPS) was initiated. Meaningful clinical outcomes data for such interventions and for high trough dosing of VAN are sparse in the literature. Methods: Retrospective study of 101 patients treated empirically with traditional VAN dosing practices from July 2007 March 2008 were compared to 101 patients treated empirically with high trough VAN therapy guided by a pharmacist managed VPS from July 2009 March 2010. All adult patients on intravenous VAN were included. Patients who received fewer than 4 doses of VAN, or for whom no troughs were drawn were excluded. Data was collected in the following categories: baseline patient characteristics, clinical outcomes, and pharmacologic monitoring. Primary outcome measures included time to clinical stability, in-hospital mortality, and development of VAN associated nephrotoxicity. Results: Baseline characteristics of both groups were similar. Mean time to target VAN trough was 121.7 hours in the traditionally dosed group and 60.6 hours in the VPS group (p<0.0001). Total length of VAN treatment was reduced from 187.3 hours in the traditionally dosed group to 143.6 hours in the VPS group (p=0.015). Primary outcome measures were no different between the groups or for the culture proven MRSA subset. In the pulmonary infection subset more patients in the VPS group met the definition of clinical stability (p=0.012). VAN associated nephrotoxicity was not frequently observed in either group. Conclusion: Compared to traditional dosing, high trough VAN therapy guided by a therapeutic drug monitoring program reduced the mean time to target trough and reduced duration of VAN therapy. In those with a pulmonary source of infection, more patients in the VPS group met the definition of clinical stability, which suggests that the VPS may have clinical benefit for this patient subset.

Subject Category: A. Antimicrobial agents and Resistance

Anthony Cardile, DO, Christopher Tan, PharmD and Gunther Hsue, MD, Tripler Army Medical Center, Honolulu, HI

Disclosures:

A. Cardile, None

C. Tan, None

G. Hsue, None

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