Vancomycin dosing in critically ill trauma patients: The VANCTIC Study.

Area of Science:

• Pharmacology
• Critical Care Medicine
• Infectious Diseases

Background:

• Current guidelines recommend vancomycin troughs of 15-20 mg/L for serious MRSA infections.
• Vancomycin pharmacokinetics are altered in critically ill patients, often leading to suboptimal serum levels.
• Previous studies reported initial therapeutic trough rates of 17.6%-33% with intermittent infusions in critically ill trauma patients.

Purpose of the Study:

• To evaluate a vancomycin dosing protocol in critically ill trauma patients.
• To determine if aggressive loading doses could achieve higher rates of initial therapeutic troughs.
• To assess the incidence of initial therapeutic vancomycin troughs in this patient population.

Main Methods:

• Retrospective study of critically ill trauma patients with suspected serious infections treated with vancomycin.
• Inclusion criteria: Level I trauma ICU admission, empiric vancomycin use, and steady-state trough level measurement.
• Primary outcome: Rate of initial therapeutic troughs (14.5-20.5 mg/L).

Main Results:

• Seventy patients met inclusion criteria; median age 47.5 years, median Injury Severity Score 28.
• Augmented renal clearance was common (median creatinine clearance 159.1 mL/min).
• Only 15.71% achieved initial therapeutic troughs; 42.86% were <10 mg/L, 8.57% were >20.5 mg/L. Acute kidney injury occurred in 10-11.4%.

Conclusions:

• The study's incidence of initial therapeutic troughs was lower than anticipated and reported in similar studies.
• Guideline-adherent intermittent vancomycin dosing appears insufficient to achieve target troughs (15-20 mg/L) in critically ill trauma patients.
• Further optimization of vancomycin dosing strategies is needed for this population.