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Impact of the Implementation of a Vancomycin Protocol on Trough Serum Vancomycin Concentrations in a Pediatric Intensive Care Unit

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Abstract

Background

Vancomycin is an antibiotic that is widely used in pediatric intensive care, but the safe and effective use of this drug is challenging.

Objective

This study aimed to assess the impact of a vancomycin protocol on trough serum concentrations.

Methods

We conducted a retrospective quasiexperimental study in patients aged ≤ 18 years in intensive care who received vancomycin for at least 5 days. Patients were divided into two groups: before and after a protocol implemented in 2017 that suggested an initial vancomycin dose of 60 mg/kg/day, target serum levels of 15–20 μg/mL, and dose adjustments. We compared patient characteristics, target serum level achievement, and vancomycin levels over time.

Results

Each group contained 65 patients; most were male infants with heart disease as the main reason for hospitalization. Only 29.2% of the patients had pretreatment cultures for bacteria identification recorded, with 1.5% identified as methicillin-resistant Staphylococcus aureus. For the first serum levels, 10.8% of patients in the pre-protocol group and 21.5% in the post-protocol group achieved the 15–20 μg/mL target (p = 0.153); during the first 5 days of treatment, this proportion significantly increased from 52.3 to 73.8% (p = 0.018). We observed a difference between the first and fifth levels: 8.9 μg/mL (95% confidence interval [CI] − 3.1 to 21) pre-protocol and 0.4 μg/mL (95% CI − 6.1 to 6.9) post-protocol (p = 0.175).

Conclusions

Reaching adequate trough vancomycin concentrations in critically ill pediatric patients remains a challenge, and clinical practice protocols allow better dose adjustment and control even when monitoring technologies are unavailable.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Avenida Independência, 155, Porto Alegre, RS, CEP 90035-074, Brazil

    Raíssa Queiroz Rezende & Claudia Pires Ricachinevsky

  2. Department of Basic Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil

    Cícero Armídio Gomes Dias

  3. Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil

    João Paulo de Lucena Capelari

Authors
  1. Raíssa Queiroz Rezende
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  2. Cícero Armídio Gomes Dias
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  3. Claudia Pires Ricachinevsky
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Correspondence to Raíssa Queiroz Rezende.

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Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

Raíssa Queiroz Rezende, Cícero Armídio Gomes Dias, Claudia Pires Ricachinevsky, and João Paulo de Lucena Capelari have no conflicts of interest that are directly relevant to the content of this article.

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Author contributions

All authors contributed to the study conception and design.

Ethics approval

This study was approved by the Ethics and Research Committee of Hospital da Criança Santo Antônio under No. 2971369.

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Rezende, R.Q., Dias, C.A.G., Ricachinevsky, C.P. et al. Impact of the Implementation of a Vancomycin Protocol on Trough Serum Vancomycin Concentrations in a Pediatric Intensive Care Unit. Pediatr Drugs 23, 299–305 (2021). https://doi.org/10.1007/s40272-021-00445-3

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