Timothy Rice, PharmD (he/him/his)
Clinical Pharmacy Specialist - Critical Care
University of Cincinnati Medical Center
Independence, Kentucky
Disclosure information not submitted.
Chris Droege, PharmD, BCCCP, FCCM
UC Health/University of Cincinnati Medical Center
Cincinnati
Disclosure information not submitted.
Molly Droege, PharmD
Clinical Pharmacy Specialist
UC Health/University of Cincinnati Medical Center
Cincinnati, Ohio, United States
Disclosure information not submitted.
Eric Mueller, PharmD, FCCP, FCCM
Clinical Pharmacy Specialist
University of Cincinnati Medical Center
Cincinnati, Ohio, United States
Disclosure information not submitted.
Neil Ernst, PharmD
Clinical Pharmacy Specialist
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Siyun Liao, PharmD, PhD, BCPS, BCIDP
Clinical Pharmacy Specialist
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Michael Goodman, MD, FACS
Acute Care/Trauma Surgeon
Department of Surgery, University of Cincinnati College of Medicine, United States
Disclosure information not submitted.
Title: The Impact of Augmented Renal Clearance on Vancomycin Therapy in Critically Ill Trauma Patients
Introduction: Augmented renal clearance (ARC) can present a clinical challenge due to reduced exposure to renally eliminated medications. Subtherapeutic serum vancomycin concentrations due to ARC may result in treatment failure. This study evaluated ARC impact on vancomycin pharmacokinetics in critically ill trauma patients.
Methods: This single center, retrospective cohort study compared adult patients with and without ARC admitted to the trauma service at an urban, academic, level-I trauma center. ARC was defined as an Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) score ≥6. Patients were included if vancomycin was prescribed for at least 48 hours within 10 days of hospital admission. The primary endpoint was percent-time therapy was at goal vancomycin trough (VT) defined as time in hours on doses associated with a VT within clinician defined goal range. Secondary endpoints were dose required to attain therapeutic VT, percent-time in hours on doses associated with subtherapeutic VT, and risk factors associated with delayed goal VT attainment defined as goal trough not achieved prior to 5th dose of initial vancomycin regimen.
Results: A total of 165 patients (66 [40%] ARC; 99 [60%] no ARC) were included. Demographics were similar between groups. The median time receiving vancomycin therapy did not differ significantly between groups (ARC, 100.4 hours [IQR 68.6-158.3] vs 89.9 hours [IQR 67.0-161.5], p=0.77). No difference in median percent-time at goal VT (ARC, 0% [IQR 0-38.4] vs no ARC, 0% [IQR 0-56.6]; p=0.096) was observed. The ARC group had more time at subtherapeutic VT (100% [IQR 50.4-100] vs 73.7% [IQR 31.2-100], p=0.04). For those with goal VT attainment, there was no difference in the vancomycin dose required to attain goal trough (ARC, 58.1 mg/kg/day [IQR 45.5-70.8] vs 49.4 mg/kg/day [IQR 40.1-62.7], p=0.09). Age, body mass index, ARCTIC Score, creatinine clearance, and Injury Severity Score were found to be associated with delayed goal trough attainment. No independent risk factors were identified.
Conclusions: Low attainment of time at goal VT was seen in patients with and without ARC. Patients with ARC experienced longer periods with subtherapeutic concentrations. Larger studies are necessary to determine optimal vancomycin dosing and ARC influence on clinical infectious endpoints.