Continuous Vancomycin Infusion versus Intermittent Infusion in Critically Ill Patients

Abstract

Background

Vancomycin is the best-choice medication for methicillin-resistant staphylococcal and enterococcal infections, which are major problems in intensive care units (ICUs). Intermittent infusion is standard for vancomycin, although delayed therapeutic target achievement and supra- and subtherapeutic levels are concerns. A recently proposed alternative with superior therapeutic target achievement is continuous infusion.

Objective

To compare the benefits of continuous (CVI) and intermittent (IVI) vancomycin infusion.

Methods

This quasi-experimental study used propensity score-matched historical controls and adult patients in medical and surgical ICUs for whom vancomycin was indicated. The experimental group received CVI for ≥ 48 hours. Data on patients receiving IVI between January 2018 and October 2020 were reviewed. Capability to achieve serum vancomycin therapeutic targets (48 and 96 hours), episodes of supra- and subtherapeutic levels, treatment success, mortality, and incidence of acute kidney injury (AKI) were analyzed before and after one-to-two propensity score matching.

Results

The CVI group had 31 patients, while the unmatched IVI group had 125. More CVI patients achieved the therapeutic target within 48 hours (54.8% vs 25.6%; P=0.002). CVI patients had a higher median number of supratherapeutic episodes (2 vs 1; P=0.007) but a lower median for subtherapeutic episodes (0 vs 1; P=0.003). Other outcomes demonstrated no differences. After propensity score matching, target achievement within 48 hours (54.8% vs 22.6%; P=0.002) and fewer subtherapeutic episodes (0 vs 1; P=0.014) remained significant.

Conclusion

CVI’s rapid therapeutic target achievement and fewer subtherapeutic episodes make it superior to IVI. No differences in treatment success, mortality, or AKI are evident.

Keywords:

• continuous infusion
• intensive care units
• pharmacokinetics
• therapeutic drug monitoring
• vancomycin

Data Sharing Statement

The dataset supporting this study’s findings will be available from the corresponding author 1 year after publication for a period of 1 year upon a reasonable request.

Acknowledgments

The authors express their gratitude to Dr Visanu Thamlikitkul and Dr Pornpan Koomanachai for their invaluable study design and methodological advice and gratefully acknowledge Khemajira Karaketklang for assistance with the statistical analyses. The authors are also indebted to Mr David Park for the English-language editing of this paper.

Disclosure

The authors have no conflicts of interest to disclose.

Additional information

Funding

This research project was supported by the Siriraj Research Fund (grant number [IO] R016431031), Faculty of Medicine Siriraj Hospital, Mahidol University. The study funders were not involved in the study design, recruitment, management, analysis, interpretation of data, writing of the report, or the decision to submit the report for publication.