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Retrospective review of intermittent and continuous infusion vancomycin for methicillin-resistant Staphylococcus aureus bacteremia

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Abstract

Purpose

Vancomycin is commonly administered as an intermittent infusion (IIV), although vancomycin’s stability at room temperature permits administration continuously over 24 h (CIV). At our institution, CIV has been the preferred infusion method for over 20 years due to ease of administration and simplicity of therapeutic drug monitoring. The purpose of this study was to examine the outcomes associated with IIV compared to CIV.

Methods

This was a retrospective study of patients who received vancomycin for MRSA bacteremia. The primary outcomes were the time to therapeutic goal and frequency of adverse drug reactions on IIV compared to CIV. Secondary outcomes evaluated all-cause readmission, relapse, and mortality 30 days after completion of therapy.

Results

Sixty-three patients were included. Significantly fewer patients were able to achieve a therapeutic goal on IIV compared to CIV (52.4% vs. 82.5%, p < 0.01). Patients on IIV took 3.6 days, on average, to reach the target goal, compared to 1.9 days when patients were switched to CIV (95% confidence interval, 0.48–3.04, p < 0.01). Six patients experienced adverse events on IIV, and 15 patients experienced adverse events on CIV (IIV 9.5%, CIV 23.8%, p = 0.035). One patient experienced relapse of infection, and six patients (9.5%) were readmitted 30 days after completion of therapy. There were no deaths in the cohort.

Conclusion

For MRSA bacteremia, CIV enabled patients to achieve the AUC/MIC goal significantly faster than when patients received IIV. Furthermore, patients who were unable to achieve a therapeutic trough on IIV became therapeutic once switched to CIV.

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Authors and Affiliations

  1. Department of Pharmacy, University of New Mexico Hospitals, 2211 Lomas Blvd NE, Albuquerque, NM, 87106, USA

    Diari Gilliam & Carla Walraven

  2. Department of Pharmacy, Presbyterian Healthcare Services, Albuquerque, NM, 87106, USA

    Dominic Acosta

  3. Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA

    Martha L. Carvour

Authors
  1. Diari Gilliam
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  2. Dominic Acosta
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  3. Martha L. Carvour
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  4. Carla Walraven
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Contributions

D.G., M.C., C.W., and D.A contributed to the design and implementation of the research. D.G., M.C., and C.W. wrote the main manuscript text and prepared all figures and tables. All authors reviewed the manuscript.

Corresponding author

Correspondence to Diari Gilliam.

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Ethics approval

This protocol was approved by the Institutional Review Board (STUDY00005330), and the requirement for patient consent was waived.

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The authors declare no competing interests.

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Gilliam, D., Acosta, D., Carvour, M.L. et al. Retrospective review of intermittent and continuous infusion vancomycin for methicillin-resistant Staphylococcus aureus bacteremia. Eur J Clin Pharmacol 80, 75–81 (2024). https://doi.org/10.1007/s00228-023-03585-2

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  • DOI: https://doi.org/10.1007/s00228-023-03585-2

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