Objectives: Critically ill patients routinely receive vancomycin as empiric antibiotic therapy. A continuous infusion administration strategy may be superior to intermittent infusion by minimizing peak concentrations and variability thereby optimizing safety. We performed a systematic review and meta-analysis to investigate the impact of vancomycin infusion strategy on acute kidney injury in critically ill adults.
Data sources: A systematic search of MEDLINE, CINAHL, Web of Science, International Pharmaceutical Abstracts, and Google Scholar was undertaken.
Study selection: We included randomized controlled trials and observational studies evaluating acute kidney injury in critically ill adults comparing vancomycin administered by intermittent and continuous infusion. Secondary outcomes included mortality and pharmacokinetic target attainment.
Data extraction: Eleven studies were identified for analysis with baseline demographics, endpoints, protocol definitions, and outcomes extracted.
Data synthesis: When compared with intermittent infusion, continuous infusion was associated with a reduction in acute kidney injury in critically ill adults (odds ratio, 0.47; 95% CI, 0.34-0.65) and a 2.6 greater odds of pharmacokinetic target attainment (odds ratio, 2.63; 95% CI, 1.52-4.57). No difference in mortality was observed (odds ratio, 1.04; 95% CI, 0.80-1.35).
Conclusions: When administered via a continuous infusion, vancomycin is associated with a 53% reduction in the odds of acute kidney injury and a 2.6-fold higher odds of pharmacokinetic target attainment when compared with intermittent infusion without influencing overall mortality.
Vancomycin Plus Piperacillin-Tazobactam and Acute Kidney Injury in Adults: A Systematic Review and Meta-Analysis.Crit Care Med. 2018 Jan;46(1):12-20. doi: 10.1097/CCM.0000000000002769. Crit Care Med. 2018. PMID: 29088001 Review.
Switching From Intermittent to Continuous Infusion of Vancomycin in Critically Ill Patients: Toward a More Robust Exposure.Ther Drug Monit. 2016 Jun;38(3):398-401. doi: 10.1097/FTD.0000000000000295. Ther Drug Monit. 2016. PMID: 26926670 Clinical Trial.
Vancomycin-associated nephrotoxicity in the critically ill: a retrospective multivariate regression analysis*.Crit Care Med. 2014 Dec;42(12):2527-36. doi: 10.1097/CCM.0000000000000514. Crit Care Med. 2014. PMID: 25083977
Review of continuous-infusion vancomycin.Ann Pharmacother. 2013 Feb;47(2):219-27. doi: 10.1345/aph.1R420. Epub 2013 Feb 5. Ann Pharmacother. 2013. PMID: 23386074 Review.
Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis. A Meta-analysis of Individual Patient Data from Randomized Trials.Am J Respir Crit Care Med. 2016 Sep 15;194(6):681-91. doi: 10.1164/rccm.201601-0024OC. Am J Respir Crit Care Med. 2016. PMID: 26974879