Retrospective evaluation of a vancomycin dosing bundle in paediatric intensive care

Area of Science:

• Pediatric Intensive Care
• Pharmacology
• Nephrology

Background:

• Vancomycin is crucial for treating serious Gram-positive infections in critically ill children.
• Vancomycin-associated nephrotoxicity (VAN) is a significant concern, potentially linked to dosing strategies.
• Optimizing vancomycin dosing is essential to balance efficacy and safety in pediatric intensive care units (PICUs).

Purpose of the Study:

• To evaluate the impact of a pharmacist-led vancomycin dosing bundle on VAN rates in a pediatric intensive care unit (PICU).
• To assess changes in vancomycin-associated nephrotoxicity (VAN) following the implementation of a multi-component dosing strategy.

Main Methods:

• A retrospective observational study analyzed 648 vancomycin courses in a tertiary PICU (2020-2022).
• Interventions included pharmacist integration, model-informed precision dosing (MIPD), and adjusted vancomycin dosing/target concentrations.
• VAN was defined by creatinine increase; area under the curve (AUC24) was calculated using MIPD software.

Main Results:

• Vancomycin-associated nephrotoxicity (VAN) occurred in 11.3% of courses, with rates remaining consistent annually.
• Severe VAN rates decreased from 8.6% in 2020 to 3.9% in 2022.
• Neither total nor severe VAN reductions achieved statistical significance (P=0.4 and P=0.16, respectively).

Conclusions:

• A staggered pharmacist-led vancomycin dosing bundle did not significantly reduce overall VAN rates in critically ill children.
• A notable decrease in severe VAN and associated AUC24 suggests potential benefits.
• Further prospective studies are recommended to confirm these findings in high-risk PICU populations.