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.
A. L. Hersh, Merck: Grant Investigator , Research grant
C. Anderson, None
J. Zobell, None
E. Thorell, None