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• W4313271879 abstract "Introduction: Augmented renal clearance (ARC) leads to supraphysiologic drug clearance and reduced exposure to renally eliminated medications such as vancomycin. This study assessed vancomycin pharmacokinetic (PK) changes in critically ill trauma patients with ARC. Methods: This prospective, single center, PK study included 6 critically ill trauma patients with ARC (defined as a creatinine clearance [CrCl] >120 mL/min) admitted to a level-1 trauma, academic medical center. Adult patients admitted to an ICU for trauma on vancomycin within 10 days of injury were screened. Five serum samples were collected within 72 hours after the 2nd vancomycin dose at 1, 2, 3, and 4 hours after infusion initiation with a final sample prior to the next scheduled dose. 24-hour urine samples were assayed for creatinine for measured CrCl. Preliminary data were evaluated with a single-compartment model. Finalized PK models will be performed with Monte Carlo simulations (MCS) to guide optimal dosing, probability of target attainment, and cumulative fraction of response. Results: Preliminary analysis with 6 patients (4 male; 2 female) were included. A median age of 38 (25.3-46) years and serum creatinine of 0.58 (0.46-0.68) mg/dL were observed. Patients received a median of 4 (2-5) doses prior to sampling. Median PK values calculated included a volume of distribution (Vd) of 0.6 (0.5-0.7) L/kg and an elimination half-life (t½) of 4.3 (3.9-5.4) hours. Median serum trough concentrations were 9.8 (7.9-11.5) mg/L with a total daily dose 24 hours prior to sampling of 4000 (3125-4125) mg, or 45.2 (37.3-49.1) mg/kg. Calculated and measured CrCl (calculated, 161.6±31.4 vs measured, 180.9±63.0 mL/min; p=0.52) were similar. Conclusions: Preliminary data displayed routinely subtherapeutic vancomycin concentrations in critically ill trauma patients with ARC despite appropriate total daily dosing. Observed Vd were comparable to vancomycin reference range while t½ were on the low end of normal. Variability was appreciated between measured and calculated CrCl, but was not significant. Formal PD analyses with MCS will provide insight on the therapeutic strategies for these patients where guidance is lacking for patients with a CrCl >90-100 mL/min." @default.
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• W4313271879 date "2022-12-15" @default.
• W4313271879 modified "2023-09-26" @default.
• W4313271879 title "1286: IMPACT OF AUGMENTED RENAL CLEARANCE ON VANCOMYCIN IN CRITICALLY ILL TRAUMA PATIENTS" @default.
• W4313271879 doi "https://doi.org/10.1097/01.ccm.0000910880.97506.4f" @default.
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