1019. Effectiveness of a pharmacist managed vancomycin dosing protocol in achieving therapeutic levels in a Community Medical Center
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • Patel IDSA Vanc.pdf (209.5 kB)
  • Background: Vancomycin is commonly used for severe gram-positive infections.  Previous studies have shown that subtherapetic dosing of vancomycin is common.  The objective of this study was to evaluate whether the implementation of a pharmacist-managed protocol increased the attainment of therapeutic levels without compromising patient safety.

    Methods: The hospital database was used to identify inpatients that received vancomycin through standard care (STA) versus protocol (PRO). Patients in the PRO group received an initial dose based on the institutional nomogram with subsequent dose adjustments based on patient specific pharmacokinetic parameters.  Patients were included if they were 18 years of age or older, had a creatinine clearance greater than 40 mL/min at baseline, and had a vancomycin trough level drawn near steady state. Patients with one-time orders, on hemodialysis, pregnant, or on surgical prophylaxis were excluded. The primary outcome was achievement of therapeutic trough levels, defined as 10-20 µg/mL. Secondary outcomes included acute renal failure (ARF, defined as an increase in sCr of 0.5 mg/dL or more on two consecutive days) and thrombocytopenia. Data were analyzed using descriptive and inferential statistics.

    Results: A total of 465 patients (164 STA and 301 PRO) were included in the analysis. Baseline characteristics were similar. The source of infection and distribution of bacteria cultured was similar between groups.  Therapeutic trough levels were more likely to be reached in the PRO group (71% vs. 34%, P < 0.0001) with a mean initial trough concentration of 9.44 +/- 4.2 µg/mL in the STA group and 15.78 +/- 6.6 µg/mL in PRO group (P < 0.0001).  The incidence of ARF was similar in both groups (3.7% STA and 4.0 PRO; p=0.86) as was the development of thrombocytopenia (13.4% STA and 9.6%; p=0.33).

    Conclusion: A pharmacist-managed vancomycin protocol increases the likelihood of attaining therapeutic vancomycin levels without compromising patient safety.  Additional analyses are required to evaluate the impact of protocol dosing on patient outcomes.

    Sweta Patel1, Luigi Brunetti, PharmD, MPH1,2, Robert Segal, MD2,3, Julie Kalabalik, PharmD, BCPS1,2 and Ronald Nahass, MD, FIDSA, FSHEA2,3, (1)Rutgers, The State University of New Jersey, Piscataway, NJ, (2)Somerset Medical Center, Somerville, NJ, (3)ID Care, Inc., Hillsborough, NJ


    S. Patel, None

    L. Brunetti, None

    R. Segal, None

    J. Kalabalik, None

    R. Nahass, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.