Appropriate vancomycin dosing is important to ensure adequate bactericidal activity.
Evaluate the impact of a CPOE on the achievement of early therapeutic vancomycin trough levels and clinical outcomes among adult patients admitted to surgical/medical wards and critical care units at the University of Arkansas for Medical Sciences who received treatment for at least 2 days.
A pre- and post-interventional study was conducted following the introduction of CPOE for vancomycin dosing. Demographic, clinical, laboratory and treatment characteristics were retrospectively collected. The primary outcome was the proportion of patients achieving therapeutic early trough levels (15-20 mg/dl measured before fourth dose). The secondary outcomes were time to achieve therapeutic levels, development of acute kidney injury (AKI) and 30-day readmission rate. The protocol was reviewed and approved by the UAMS Institutional Review Board.
A total of 337 subjects (186 pre-intervention and 151 post-intervention) were analyzed. Mean age was 52 years; 60% were white and 29% African-American. Most common infections treated were lower respiratory tract infection (37%) and skin and soft tissue infections (19%). Duration of therapy was 7.5±0.3 days. Troughs were collected in 99% cases. Early troughs were obtained in 50%, 24% of them were therapeutic. Improvement of infection was reported in 77% and 84% pre-intervention and post-intervention groups, respectively. Only 35% in both groups received a loading dose ≥15 mg/kg. Regression analysis showed significant differences between therapeutic early levels and age (OR 0.97; p=0.02) but not with gender, renal function, service, level of care, severity and type of infection. A composite outcome of both AKI and 30-day readmission rate was significantly associated to both early therapeutic trough (p= 0.02) and the use of a CPOE (p<0.01). The use of a CPOE did not improve the proportion of patients achieving therapeutic early trough nor time to achieve therapeutic levels.
Achieving early therapeutic levels and the use of a CPOE for dosing was associated to improved clinical outcomes in patients treated with vancomycin.
S. Parajuli, None
K. Walker, None
J. Jo-Kamimoto, None
K. Ayoub, None
M. Saylors, None
J. Bariola, None