• Alexander H Flannery, Brittany D Bissell, Melissa Thompson Bastin, Peter E Morris, and Javier A Neyra.
• Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY.
• Crit. Care Med. 2020 Jun 1; 48 (6): 912-918.

ObjectivesCritically ill patients routinely receive vancomycin as empiric antibiotic therapy. A continuous infusion administration strategy may be superior to intermittent infusion by minimizing peak concentrations and variability thereby optimizing safety. We performed a systematic review and meta-analysis to investigate the impact of vancomycin infusion strategy on acute kidney injury in critically ill adults.Data SourcesA systematic search of MEDLINE, CINAHL, Web of Science, International Pharmaceutical Abstracts, and Google Scholar was undertaken.Study SelectionWe included randomized controlled trials and observational studies evaluating acute kidney injury in critically ill adults comparing vancomycin administered by intermittent and continuous infusion. Secondary outcomes included mortality and pharmacokinetic target attainment.Data ExtractionEleven studies were identified for analysis with baseline demographics, endpoints, protocol definitions, and outcomes extracted.Data SynthesisWhen compared with intermittent infusion, continuous infusion was associated with a reduction in acute kidney injury in critically ill adults (odds ratio, 0.47; 95% CI, 0.34-0.65) and a 2.6 greater odds of pharmacokinetic target attainment (odds ratio, 2.63; 95% CI, 1.52-4.57). No difference in mortality was observed (odds ratio, 1.04; 95% CI, 0.80-1.35).ConclusionsWhen administered via a continuous infusion, vancomycin is associated with a 53% reduction in the odds of acute kidney injury and a 2.6-fold higher odds of pharmacokinetic target attainment when compared with intermittent infusion without influencing overall mortality.

19 keywords...

hide…