Continuous infusion of vancomycin improved therapeutic levels in term and preterm infants.
Journal
Journal of perinatology : official journal of the California Perinatal Association
ISSN: 1476-5543
Titre abrégé: J Perinatol
Pays: United States
ID NLM: 8501884
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
27
07
2020
accepted:
01
12
2020
revised:
26
10
2020
pubmed:
21
1
2021
medline:
9
10
2021
entrez:
20
1
2021
Statut:
ppublish
Résumé
Growing evidence suggests that continuous infusion of vancomycin (CIV) is superior to intermittent infusion of vancomycin (IIV) in neonates. This quality improvement (QI) project aimed to transition from IIV to CIV with earlier and improved attainment of therapeutic vancomycin levels. The Model for Improvement framework with Plan Do Study Act cycles was used. Prospective data were collected during three phases: IIV, CIV-1 and CIV-2. A QI team developed a CIV drug monograph and a multidisciplinary education package. Using IIV, 36% (9/25) of first vancomycin levels were within target range. CIV achieved therapeutic levels twice as quickly as IIV (p < 0.05) with improved first vancomycin target levels (IIV 36%, 9/25; CIV-1 55%, 16/29; CIV-2 61%, 14/23) and total therapeutic levels (IIV 44%, 37/84; CIV-1 56%, 55/98; CIV-2 69%, 79/114). This QI project demonstrated a successful transition from IIV to CIV with reduced time to achieve target vancomycin and an increased proportion of therapeutic levels.
Sections du résumé
BACKGROUND
Growing evidence suggests that continuous infusion of vancomycin (CIV) is superior to intermittent infusion of vancomycin (IIV) in neonates. This quality improvement (QI) project aimed to transition from IIV to CIV with earlier and improved attainment of therapeutic vancomycin levels.
METHODS
The Model for Improvement framework with Plan Do Study Act cycles was used. Prospective data were collected during three phases: IIV, CIV-1 and CIV-2.
INTERVENTIONS
A QI team developed a CIV drug monograph and a multidisciplinary education package.
RESULTS
Using IIV, 36% (9/25) of first vancomycin levels were within target range. CIV achieved therapeutic levels twice as quickly as IIV (p < 0.05) with improved first vancomycin target levels (IIV 36%, 9/25; CIV-1 55%, 16/29; CIV-2 61%, 14/23) and total therapeutic levels (IIV 44%, 37/84; CIV-1 56%, 55/98; CIV-2 69%, 79/114).
CONCLUSIONS
This QI project demonstrated a successful transition from IIV to CIV with reduced time to achieve target vancomycin and an increased proportion of therapeutic levels.
Identifiants
pubmed: 33469164
doi: 10.1038/s41372-020-00909-3
pii: 10.1038/s41372-020-00909-3
doi:
Substances chimiques
Vancomycin
6Q205EH1VU
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1459-1466Références
Cailes B, Kortsalioudaki C, Buttery J, Pattnayak S, Greenough A, Matthes J, et al. Epidemiology of UK neonatal infections: the neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed. 2018;103:F547-F553.
doi: 10.1136/archdischild-2017-313203
NICE. Neonatal infection (early onset): antibiotics for prevention and treatment. 2012. https://www.nice.org.uk/guidance/CG149 .
Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed. 2015;100:F257-63.
doi: 10.1136/archdischild-2014-306213
De Hoog M, Mouton JW, Van Den Anker JN. Vancomycin: Pharmacokinetics and administration regimens in neonates. Clin Pharmacokinet. 2004;43:417–40.
doi: 10.2165/00003088-200443070-00001
Moise-Broder PA, Forrest A, Birmingham MC, Schentag JJ. Pharmacodynamics of vancomycin and other antimicrobials in patients with Staphylococcus aureus lower respiratory tract infections. Clin Pharmacokinet. 2004;43:925–42.
doi: 10.2165/00003088-200443130-00005
British National Formulary for Children. Vancomycin. 2020. https://bnfc.nice.org.uk/drug/vancomycin.html .
Wysocki M, Delatour F, Faurisson F, Rauss A, Pean Y, Misset B, et al. Continuous versus intermittent infusion of vancomycin in severe staphylococcal infections: Prospective multicenter randomized study. Antimicrob Agents Chemother. 2001;45:2460–7.
doi: 10.1128/AAC.45.9.2460-2467.2001
Cataldo MA, Tacconelli E, Grilli E, Pea F, Petrosillo N. Continuous versus intermittent infusion of vancomycin for the treatment of gram-positive infections: systematic review and meta-analysis. J Antimicrob Chemother. 2012;67:17–24.
doi: 10.1093/jac/dkr442
Patel AD, Anand D, Lucas C, Thomson AH. Continuous infusion of vancomycin in neonates. Arch Dis Child. 2013;98:478–9.
doi: 10.1136/archdischild-2012-303197
Gwee A, Cranswick N, McMullan B, Perkins E, Bolisetty S, Gardiner K, et al. Continuous versus intermittent vancomycin infusions in infants: a randomized controlled trial. Pediatrics. 2019;143:e20182179.
doi: 10.1542/peds.2018-2179
Kim J, Walker SAN, Iaboni DC, Walker SE, Elligsen M, Dunn MS, et al. Determination of vancomycin pharmacokinetics in neonates to develop practical initial dosing recommendations. Antimicrob Agents Chemother. 2014;58:2830–40.
doi: 10.1128/AAC.01718-13
Gwee A, Cranswick N, Metz D, Coghlan B, Daley AJ, Bryant PA, et al. Neonatal vancomycin continuous infusion: still a confusion? Pediatr Infect Dis J. 2014;33:600–5.
doi: 10.1097/INF.0000000000000243
Ward RM, Allegaert K, De Groot R, Van Den Anker JN. Commentary: continuous infusion of vancomycin in neonates: to use or not to use remains the question. Pediatr Infect Dis J. 2014;33:606–7.
doi: 10.1097/INF.0000000000000244
Zhao W, Lopez E, Biran V, Durrmeyer X, Fakhoury M, Jacqz-Aigrain E. Vancomycin continuous infusion in neonates: dosing optimisation and therapeutic drug monitoring. Arch Dis Child. 2013;98:449–53.
doi: 10.1136/archdischild-2012-302765
Mahieu LM, De Dooy JJ, Lenaerts AE, Ieven MM, De Muynck AO. Catheter manipulations and the risk of catheter-associated bloodstream infection in Neonatal Intensive Care Unit patients. J Hosp Infect. 2001;48:20–6.
doi: 10.1053/jhin.2000.0930
Pacifici GM, Allegaert K. Clinical pharmacokinetics of vancomycin in the neonate: a review. Clinics. 2012;67:831–7.
doi: 10.6061/clinics/2012(07)21
Rybak M, Lomaestro B, Rotschafer JC, Moellering R, Craig W, Billeter M, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2009;66:82–98.
doi: 10.2146/ajhp080434
Rasigade JP, Raulin O, Picaud JC, Tellini C, Bes M, Grando J, et al. Methicillin-resistant Staphylococcus capitis with reduced vancomycin susceptibility causes late-onset sepsis in intensive care neonates. PLoS ONE. 2012;7:e31548.
doi: 10.1371/journal.pone.0031548
Butin M, Martins-Simões P, Picaud JC, Kearns A, Claris O, Vandenesch F, et al. Adaptation to vancomycin pressure of multiresistant Staphylococcus capitis NRCS—a involved in neonatal sepsis. J Antimicrob Chemother. 2015;70:3027–31.
doi: 10.1093/jac/dkv217
Butin M, Martins-Simões P, Rasigade JP, Picaud JC, Laurent F. Worldwide endemicity of a multidrug-resistant Staphylococcus capitis clone involved in neonatal sepsis. Emerg Infect Dis. 2017;23:538–9.
doi: 10.3201/eid2303.160833
Frymoyer A, Hersh AL, El-Komy MH, Gaskari S, Su F, Drover DR, et al. Association between vancomycin trough concentration and area under the concentration-time curve in neonates. Antimicrob Agents Chemother. 2014;58:6454–61.
doi: 10.1128/AAC.03620-14
University Hospitals of Leicester NHS Trust. The Leicester neonatal service. https://www.leicestershospitals.nhs.uk/aboutus/departments-services/neonatal-service/ (2020).