Continuous infusion versus intermittent administration of vancomycin in critically ill patients with Gram-positive infections resistant to beta-lactam antibiotics
Authors:
Štěpán Martin 1; Chytra Ivan 1; Pelnář Petr 2; Bergerová Tamara 2; Kasal Eduard 1
Authors‘ workplace:
Anesteziologicko-resuscitační klinika, Fakultní nemocnice v Plzni, Univerzita Karlova v Praze, Lékařská fakulta v Plzni
1; Ústav mikrobiologie, Fakultní nemocnice v Plzni
2
Published in:
Anest. intenziv. Med., 20, 2009, č. 6, s. 309-316
Category:
Intensive Care Medicine - Original Paper
Overview
Objective:
The aim of study was to compare the clinical and microbiological efficacy of continuous infusion versus intermittent administration of vancomycin in critically ill patients with Gram-positive infections resistant to beta-lactam antibiotics. The second goal was to evaluate the safety of both the vancomycin administration modes in relation to renal function.
Design:
Prospective randomized controlled study.
Setting:
Interdisciplinary intensive care unit of a University teaching hospital.
Materials and methods:
Patients admitted to the interdisciplinary ICU suffering from Gram-positive infection indicated for vancomycin administration were randomized to receive either continuous infusion or intermittent administration of vancomycin according to defined protocols. In addition to the basic variables, parameters allowing evaluation of efficacy and safety of the continuous and intermittent administration of vancomycin were assessed. Paired and unpaired t-test, Mann-Whitney test, Wilcoxon test, chi-square test and Fisher’s exact test were used accordingly; p < 0.05 was considered statistically significant.
Results:
A total of 65 patients were enrolled and randomized to the continuous (n = 32) or intermittent (n = 33) groups. No significant differences between the groups were found in the clinical (69% vs. 64%; p = 0.58) and microbiological (59% vs. 76%; p = 0.23) efficacy, in the length of ICU stay, in ICU mortality, in the length of vancomycin therapy and in the total dose of vancomycin. No changes in serum creatinine concentration and glomerular filtration rate were detected during the period of vancomycin administration.
Conclusion:
Continuous infusion and intermittent administration of vancomycin in critically ill patients provided an equivalent clinical and microbiological outcome. Neither continuous nor intermittent administration of vancomycin was associated with deterioration of the renal function.
The intermittent mode of application required more frequent assessment of the serum vancomycin concentration.
Keywords:
vancomycin – continuous infusion – clinical efficacy – microbiological efficacy – nefrotoxicity
Sources
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2009 Issue 6
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