• Peter Thomas Scully, Weng Man Lam, Alvaro Jose Coronado Munoz, and Vinai Modini Modem.
• Division of Pediatric Critical Care, Department of Pediatrics, McGovern Medical School, Houston, TX.
• Pediatr Crit Care Me. 2022 Jun 1; 23 (6): 444452444-452.

ObjectivesTo identify associations between augmented renal clearance (ARC) in pediatric patients treated for suspected sepsis and vancomycin pharmacokinetics. ARC has been associated with lower serum drug levels in both adult and pediatric cohorts for multiple drugs. We hypothesize that presence of ARC is associated with subtherapeutic initial vancomycin trough level (VTL).DesignRetrospective study, with patients divided into two groups based on the presence of ARC (estimated glomerular filtration rate [eGFR] above 130 mL/min/1.73 m2) in comparison with VTL. Multivariable logistic regression analysis was performed to evaluate the association between eGFR and subtherapeutic VTL.SettingTertiary children's hospital.PatientsHospitalized children (0-18 yr) initiated on empiric vancomycin therapy for suspected sepsis.InterventionsRetrospective measurement of VTL, eGFR, and clinical variables.Measurements And Main ResultsSeventy-three patients were treated with empiric vancomycin for sepsis. ARC was present in 32 patients (44%). Subtherapeutic first VTL was present in 40 patients (55%). Higher eGFR was independently associated with subtherapeutic VTL in the multivariable logistic regression analysis.ConclusionsSubtherapeutic VTL is associated with ARC in our single-center retrospective cohort of children with suspected sepsis. This problem may present a potential risk of treatment failure in Gram-positive sepsis or longer time to clinical response. Prospective studies to investigate the clinical significance and effect of optimizing vancomycin dose in patients with ARC are recommended.Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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