Patient safety outcomes for continuous infusion vancomycin as outpatient parenteral antimicrobial therapy.
home infusion therapy
patient safety
vancomycin
Journal
Pharmacotherapy
ISSN: 1875-9114
Titre abrégé: Pharmacotherapy
Pays: United States
ID NLM: 8111305
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
revised:
09
04
2023
received:
08
02
2023
accepted:
10
04
2023
medline:
14
9
2023
pubmed:
30
5
2023
entrez:
29
5
2023
Statut:
ppublish
Résumé
Administration of vancomycin as a continuous infusion has been associated with reduced nephrotoxicity. Given limited published experience with continuous infusion vancomycin in outpatient parenteral antimicrobial therapy (OPAT) programs, we reviewed outcomes from our center. This was a retrospective, single-center study of adult patients receiving vancomycin OPAT as continuous or intermittent infusion for an intended treatment duration of at least 7 days. The primary outcome was time to nephrotoxicity with continuous versus intermittent infusion vancomycin while on OPAT; additional outcomes included time to any vancomycin-associated adverse event, time to 60-day death or readmission, and time to 60-day emergency department encounter. Proportional hazards modeling was used to identify variables independently associated with outcomes, as well as assess the strength of association of continuous infusion with each outcome. Four-hundred ninety-two patients were included: 118 treated with continuous and 374 with intermittent vancomycin infusion. Continuous infusion was not associated with lower rates of nephrotoxicity compared to intermittent infusion (adjusted hazard ratio (aHR) 0.72, 95% CI: 0.35-1.50). There were no advantages of continuous over intermittent infusion in the rates of any adverse event (aHR 0.93, 95% CI: 0.56-1.53), 60-day death or readmission (aHR 1.04, 95% CI: 0.68-1.61), or 60-day emergency department encounter (aHR 1.17, 95% CI: 0.68-1.99). Vancomycin area under the concentration-time curve (AUC) at discharge was the only modifiable factor identified that was independently associated with patient safety outcomes. There was no appreciable benefit of continuous infusion vancomycin on outpatient safety outcomes. AUC-centered dosing approaches warrant further investigation as strategies to improve vancomycin safety in OPAT programs.
Sections du résumé
BACKGROUND
Administration of vancomycin as a continuous infusion has been associated with reduced nephrotoxicity. Given limited published experience with continuous infusion vancomycin in outpatient parenteral antimicrobial therapy (OPAT) programs, we reviewed outcomes from our center.
METHODS
This was a retrospective, single-center study of adult patients receiving vancomycin OPAT as continuous or intermittent infusion for an intended treatment duration of at least 7 days. The primary outcome was time to nephrotoxicity with continuous versus intermittent infusion vancomycin while on OPAT; additional outcomes included time to any vancomycin-associated adverse event, time to 60-day death or readmission, and time to 60-day emergency department encounter. Proportional hazards modeling was used to identify variables independently associated with outcomes, as well as assess the strength of association of continuous infusion with each outcome.
RESULTS
Four-hundred ninety-two patients were included: 118 treated with continuous and 374 with intermittent vancomycin infusion. Continuous infusion was not associated with lower rates of nephrotoxicity compared to intermittent infusion (adjusted hazard ratio (aHR) 0.72, 95% CI: 0.35-1.50). There were no advantages of continuous over intermittent infusion in the rates of any adverse event (aHR 0.93, 95% CI: 0.56-1.53), 60-day death or readmission (aHR 1.04, 95% CI: 0.68-1.61), or 60-day emergency department encounter (aHR 1.17, 95% CI: 0.68-1.99). Vancomycin area under the concentration-time curve (AUC) at discharge was the only modifiable factor identified that was independently associated with patient safety outcomes.
CONCLUSION
There was no appreciable benefit of continuous infusion vancomycin on outpatient safety outcomes. AUC-centered dosing approaches warrant further investigation as strategies to improve vancomycin safety in OPAT programs.
Substances chimiques
Vancomycin
6Q205EH1VU
Anti-Bacterial Agents
0
Anti-Infective Agents
0
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
894-903Informations de copyright
© 2023 Pharmacotherapy Publications, Inc.
Références
Keller SC, Williams D, Gavgani M, et al. Rates of and risk factors for adverse drug events in outpatient parenteral antimicrobial therapy. Clin Infect Dis. 2018;66(1):11-19.
Schrank GM, Wright SB, Branch-Elliman W, LaSalvia MT. A retrospective analysis of adverse events among patients receiving daptomycin versus vancomycin during outpatient parenteral antimicrobial therapy. Infect Control Hosp Epidemiol. 2018;39(8):947-954.
Shrestha NK, Mason P, Gordon SM, et al. Adverse events, healthcare interventions and healthcare utilization during home infusion therapy with daptomycin and vancomycin: a propensity score-matched cohort study. J Antimicrob Chemother. 2014;69(5):1407-1415.
Keller SC, Wang NY, Salinas A, Williams D, Townsend J, Cosgrove SE. Which patients discharged to home-based outpatient parenteral antimicrobial therapy are at high risk of adverse outcomes? Open forum. Infect Dis. 2020;7(6):ofaa178.
Krueger KM, LaCloche L, Buros Stein A, Kates R, Murray M, Angarone MP. Risk factors associated with nephrotoxicity during outpatient intravenous vancomycin administration. J Pharm Technol. 2022;38(1):10-17.
Gallagher C, Benefield RJ, Certain L. 232. Safety and effectiveness of intravenous to oral de-escalation compared to continued vancomycin therapy in orthopedic infections. Open Forum Infect Dis. 2021;8(Suppl 1):S225-S226.
Huck D, Ginsberg JP, Gordon SM, Nowacki AS, Rehm SJ, Shrestha NK. Association of laboratory test result availability and rehospitalizations in an outpatient parenteral antimicrobial therapy programme. J Antimicrob Chemother. 2014;69(1):228-233.
Norris AH, Shrestha NK, Allison GM, et al. 2018 infectious diseases society of America clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. Clin Infect Dis. 2019;68(1):e1-e35.
Douiyeb S, de la Court JR, Tuinte B, et al. Risk factors for readmission among patients receiving outpatient parenteral antimicrobial therapy: a retrospective cohort study. Int J Clin Pharmacol. 2022;44(2):557-563.
Shakeraneh P, Fazili T, Wang D, et al. Nephrotoxicity risk and clinical effectiveness of continuous versus intermittent infusion vancomycin among patients in an outpatient parenteral antimicrobial therapy program. Pharmacotherapy. 2020;40(4):357-362.
Ingram PR, Lye DC, Fisher DA, Goh WP, Tam VH. Nephrotoxicity of continuous versus intermittent infusion of vancomycin in outpatient parenteral antimicrobial therapy. Int J Antimicrob Agents. 2009;34(6):570-574.
Vuagnat A, Stern R, Lotthe A, et al. High dose vancomycin for osteomyelitis: continuous vs. intermittent infusion. J Clin Pharm Ther. 2004;29(4):351-357.
Hao JJ, Chen H, Zhou JX. Continuous versus intermittent infusion of vancomycin in adult patients: a systematic review and meta-analysis. Int J Antimicrob Agents. 2016;47(1):28-35.
Avedissian SN, Pais G, Liu J, et al. The Pharmacodynamic-Toxicodynamic relationship of AUC and C(max) in vancomycin-induced kidney injury in an animal model. Antimicrob Agents Chemother. 2021;65(3), e01945-20.
Konishi H, Morita Y, Mizumura M, Iga I, Nagai K. Difference in nephrotoxicity of vancomycin administered once daily and twice daily in rats. J Chemother. 2013;25(5):273-278.
Rybak MJ, Le J, Lodise TP, et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2020;77(11):835-864.
Deryke CA, Alexander DP. Optimizing vancomycin dosing through Pharmacodynamic assessment targeting area under the concentration-time curve/minimum inhibitory concentration. Hosp Pharm. 2009;44(9):751-765.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41.
Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147(8):W163-W194.
Uno H. Pages. 2017. https://cran.r-project.org/web/packages/survRM2/vignettes/survRM2-vignette3-2.html
Norton K, Ingram PR, Heath CH, Manning L. Risk factors for nephrotoxicity in patients receiving outpatient continuous infusions of vancomycin in an Australian tertiary hospital. J Antimicrob Chemother. 2014;69(3):805-808.
Lodise TP, Rosenkranz SL, Finnemeyer M, et al. The Emperor's new clothes: PRospective observational evaluation of the association between initial VancomycIn exposure and failure rates among ADult HospitalizEd patients with methicillin-resistant Staphylococcus aureus bloodstream infections (PROVIDE). Clin Infect Dis. 2020;70(8):1536-1545.
Lodise TP, Scheetz M, Carreno JJ, Chambers H, Fowler V Jr, Holland TL. Associations between vancomycin exposure and acute kidney injury within the recommended area under the curve therapeutic exposure range among patients with methicillin-resistant Staphylococcus aureus bloodstream infections. Open Forum Infect Dis. 2022;9(2):ofab651.
Rees MR, Carr DR, Trienski T, Buchanan C, White K, Bremmer DN. Outpatient vancomycin therapy: acute kidney injury in individualized AUC-based goal trough ranges versus traditional trough dosing. J Am Pharm Assoc. 2022;62(3):706-710.
Neely MN, Kato L, Youn G, et al. Prospective trial on the use of trough concentration versus area under the curve to determine therapeutic vancomycin dosing. Antimicrob Agents Chemother. 2018;62(2):e02042-17.
Finch NA, Zasowski EJ, Murray KP, et al. A quasi-experiment to study the impact of vancomycin area under the concentration-time curve-guided dosing on vancomycin-associated nephrotoxicity. Antimicrob Agents Chemother. 2017;61(12):e01293-17.
Shi Y, Alexander BT, Avedissian S, Bergman SJ, Cortés-Penfield N. In outpatients receiving parenteral vancomycin, dosing adjustments produced by area under the curve-based and trough-based monitoring differ only at the extremes of the therapeutic trough range. Open Forum Infect Dis. 2023;10(2):ofac696.
Li HK, Rombach I, Zambellas R, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med. 2019;380(5):425-436.
Waikar SS, Betensky RA, Emerson SC, Bonventre JV. Imperfect gold standards for kidney injury biomarker evaluation. J Am Soc Nephrol. 2012;23(1):13-21.