Augmented renal clearance in septic patients and implications for vancomycin optimisation.

Area of Science:

• Pharmacokinetics and Pharmacodynamics
• Critical Care Medicine
• Nephrology

Background:

• Augmented renal clearance (ARC) is common in critically ill patients.
• Subtherapeutic vancomycin concentrations can lead to treatment failure.
• Optimizing vancomycin dosing is crucial for effective sepsis management.

Purpose of the Study:

• To investigate the impact of ARC on vancomycin serum concentrations.
• To determine if ARC is associated with subtherapeutic vancomycin levels in septic patients.
• To inform vancomycin dosing strategies in critically ill populations.

Main Methods:

• Prospective, observational cohort study of 93 critically ill septic patients.
• Continuous infusion vancomycin therapy was administered.
• ARC defined as 24-h creatinine clearance (CL(Cr)) > 130 mL/min/1.73 m(2).
• Vancomycin levels assessed on days 1, 2, and 3.

Main Results:

• Patients with ARC (Group B) had significantly lower vancomycin serum concentrations compared to those without (Group A) on all assessed days (P<0.05).
• A strong negative correlation was observed between CL(Cr) and vancomycin levels on day 1 (r=-0.57, P<0.001).
• ARC was strongly associated with subtherapeutic vancomycin concentrations during the initial 3 days of treatment.

Conclusions:

• Augmented renal clearance is linked to subtherapeutic vancomycin serum concentrations in critically ill septic patients.
• Current vancomycin dosing may be inadequate for patients with ARC.
• Further research is needed to optimize vancomycin dosing regimens in this population.