Assessment of Empiric Vancomycin Regimen in the Neonatal Intensive Care Unit

Area of Science:

• Neonatal pharmacotherapy
• Pediatric infectious diseases
• Clinical pharmacology

Background:

• Vancomycin is crucial for treating serious gram-positive infections in neonates.
• Current guidelines lack consensus on optimal empiric dosing and target trough vancomycin levels for neonates.
• The Fraser Health regimen (since 2010) aims for trough levels of 5–15 mg/L.

Purpose of the Study:

• Evaluate the efficacy of the Fraser Health empiric vancomycin dosing regimen in neonates.
• Determine the percentage of neonates achieving target trough vancomycin levels (5–15 mg/L).
• Assess time to culture negativity and clinical resolution, and the incidence of nephrotoxicity.

Main Methods:

• Retrospective chart review of neonates receiving vancomycin between June 2012 and May 2017.
• Inclusion criteria: neonatal intensive care unit setting and at least one interpretable vancomycin level.
• Data collected from Surrey Memorial Hospital and Royal Columbian Hospital.

Main Results:

• 75% of 87 vancomycin encounters achieved target trough levels (5–15 mg/L).
• Mean time to negative culture was 5 days; mean time to clinical resolution was 6 days.
• Nephrotoxicity occurred in 22% of cases with trough levels exceeding 15 mg/L.

Conclusions:

• The Fraser Health empiric vancomycin dosing regimen successfully achieved target trough levels in the majority of neonates studied.
• Lowering target trough levels below 15 mg/L, when clinically appropriate, may mitigate vancomycin-associated nephrotoxicity in neonates.
• Further investigation is required to understand the clinical implications of varying vancomycin levels in neonatal populations.