[Continuous infusion of vancomycin in pediatric critical care]

Area of Science:

• Pediatric Intensive Care Medicine
• Infectious Diseases
• Pharmacokinetics

Background:

• Vancomycin is crucial for treating methicillin-resistant Staphylococcus aureus (MRSA) infections.
• Achieving adequate vancomycin plasma levels can be challenging in critically ill pediatric patients.
• Limited literature exists on continuous vancomycin infusion in pediatric critical care.

Observation:

• Six pediatric patients (2 months–7 years) with MRSA sepsis in the ICU received vancomycin via intermittent dosing.
• Patients exhibited poor outcomes, persistent fever, positive cultures, and inadequate vancomycin plasma levels.
• Continuous vancomycin infusion at 50 mg/kg/day was initiated for these patients.

Findings:

• All patients achieved target vancomycin plasma levels (10–25 ug/ml) with continuous infusion.
• Clinical outcomes were favorable, with negative cultures and resolution of fever.
• No signs of nephrotoxicity were observed during treatment (9–18 days).

Implications:

• Continuous vancomycin infusion is an effective strategy for pediatric MRSA sepsis when intermittent dosing fails.
• This regimen can achieve therapeutic drug concentrations safely, avoiding nephrotoxicity.
• Further research into continuous vancomycin infusion is warranted for pediatric critical care settings.