2025. Continuous Infusion of Vancomycin in children with Invasive Methicillin-Resistant Staphylococcus aureus Infections
Session: Poster Abstract Session: Antimicrobial Resistant Infections: Treatment
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • IDWeek MRSA vanc poster Chatterjee.pdf (104.2 kB)
  • Background: Despite the introduction of newer agents, vancomycin is the antimicrobial of choice for invasive MRSA infections in children. A few studies have suggested potential pharmacokinetic advantages with administration of vancomycin by continuous infusion over intermittent dosing. However, reported experience with the use of continuous infusion of vancomycin (CIV) in the treatment of disseminated MRSA infections in children is limited.

    Methods: We studied CIV in 3 pediatric patients with invasive MRSA infections presenting to Sanford Children's Hospital, Sioux Falls, SD between 1/1/14-7/1/15. Retrospective chart review was conducted to obtain demographic, clinical, laboratory, and pharmacokinetic data including duration of CIV and time to defervescence and clearance of bacteremia, as well as associated diagnoses (defined by ICD-9).

    Results: All of the children were diagnosed with MRSA bacteremia and septic shock (100%) and had osteomyelitis (n=3); 2/3 had pneumonia/pulmonary emboli. The children were aged between 2 and 15 years. All required ICU admission, mechanical ventilation and vasopressor support. CIV was initiated after lack of clinical improvement on intermittent vancomycin therapy, drainage of infectious foci as well as acceptable vancomycin MIC values (<1). The patients failed to achieve target trough serum concentrations on intermittent vancomycin dosing, despite frequent dose adjustments. CIV was initiated after a median of 7 days (range 6-9 days) of intermittent vancomycin. Desired serum concentrations were achieved within 24-48 hours after CIV initiation in all patients. Only 33% (6/18) of trough serum concentrations were in the targeted range (15-20 mcg/mL) on intermittent vancomycin compared to 82% of random serum concentrations within the targeted range (15-25 mcg/mL) on CIV (p<0.0007). CIV was continued for 6-13 days. The median duration for defervescence was 3 days (1-4 days) and for clearance of bacteremia was 2 days (1-4 days) after CIV initiation. CIV was not associated with any adverse effects or mortalities.

    Conclusion: This report provides evidence to support the use of vancomycin as a first line agent for invasive MRSA in children, with potential benefit of CIV in patients with vancomycin-susceptible MRSA isolates, unable to attain target serum concentrations on intermittent dosing.

    Archana Chatterjee, MD, PhD, FIDSA, FPIDS, Department of Pediatrics, University of South Dakota Sanford School of Medicine/Sanford Children's Specialty Clinic, Sioux Falls, SD, Ashlesha Kaushik, MD, Pediatric Infectious Disease, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, Amy Heiberger, Pharm.D., Pharmacy Practice, Sanford Children's Hospital and South Dakota State University College of Pharmacy, Sioux Falls, SD, Vishnu Kanala, MD, sanford childrens hospital, sioux falls, SD, Elizabeth Rubin-Peck, MD, Pediatrics, Sanford Children's Hospital and Specialty Clinics, Sioux Falls, SD and Cassie Wagner, CNP, Pediatric Infectious Diseases, Sanford Children's Specialty Clinic, Sioux Falls, SD

    Disclosures:

    A. Chatterjee, None

    A. Kaushik, None

    A. Heiberger, None

    V. Kanala, None

    E. Rubin-Peck, None

    C. Wagner, None

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