1924. Optimizing Vancomycin Prescribing Through A Pharmacist Driven Monitoring Intervention At A Children’s Hospital
Session: Poster Abstract Session: Antibiotic Stewardship: Pediatrics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Vanco ID week poster.eatreview.2.pdf (479.8 kB)
  • Background: Therapeutic drug monitoring for vancomycin is essential to optimize therapeutic efficacy and monitor for risk of nephrotoxicity. Ensuring optimal exposure requires calculating AUC24. However, because the majority of patients receiving vancomycin have treatment discontinued at 72 hours, obtaining drug levels for all patients is unnecessary. We designed a pharmacy driven vancomycin dosing intervention to (1) optimize AUC24 ≥400 attainment and (2) reduce the number of levels ordered among children treated for <72 hours.

    Methods: This was a retrospective study that evaluated vancomycin use at a 290 bed freestanding children’s hospital. During the pre-intervention period (6/2013-5/2014), physicians were responsible for vancomycin dosing and targeted troughs of 15-20 mg/L. During the intervention period (6/2014-5/2015), pharmacists ordered and modified vancomycin dosing regimens to target an AUC24 ≥400, defer level obtainment for up to 72 hours, and monitor renal function. The primary outcomes included attainment of AUC24 ≥400 (calculated using a midpoint and a trough), the percentage of patients receiving <72 hours of therapy with ≥1 vancomycin concentration, and the percentage of patients that experienced acute kidney injury (defined as doubling serum creatinine up to 72 hours after receiving vancomycin).

    Results: We evaluated 1629 courses of vancomycin therapy (852 pre-intervention and 777 intervention). The duration of vancomycin was <72 hours for 68% (1114/1629) of patients and did not differ between the periods (p = 0.18). For patients receiving vancomycin for ≥72 hours, 78% achieved an AUC≥400 during the intervention period. Of patients receiving <72 hours of vancomycin, the percentage with concentrations monitored declined from 64% (362/570) to 23% (128/544) during the intervention period (p < 0.01). The percentage of patients that experienced nephrotoxicity did not change between the two periods (2.9% pre-intervention vs 3.9% intervention; p = 0.30).

    Conclusion: A pharmacist driven intervention that redesigned vancomycin dosing and monitoring was successful in achieving the target AUC24 for the majority of patients, reduced unnecessary vancomycin monitoring, and did not change the risk for nephrotoxicity.

    Jared Olson, PharmD1, Chris Stockmann, PhD, MSc2, Adam L. Hersh, MD, PhD3, Collin Anderson, PharmD PhD1, Jeffery Zobell, PharmD1 and Emily Thorell, MD, MSCI2, (1)Primary Children's Hospital, Salt Lake City, UT, (2)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (3)University of Utah School of Medicine, Salt Lake City, UT

    Disclosures:

    J. Olson, None

    C. Stockmann, None

    A. L. Hersh, Merck: Grant Investigator , Research grant

    C. Anderson, None

    J. Zobell, None

    E. Thorell, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.