PT  - JOURNAL ARTICLE
AU  - Petejova, Nadezda
AU  - Martinek, Arnost
AU  - Zahalkova, Jana
AU  - Duricova, Jana
AU  - Brozmannova, Hana
AU  - Urbanek, Karel
AU  - Grundmann, Milan
AU  - Plasek, Jiri
AU  - Kacirova, Ivana
TI  - Vancomycin pharmacokinetics during high-volume continuous venovenous hemofiltration in critically ill septic patients
DP  - 2014 Apr 1
TA  - Biomedical papers
PG  - 065--072
VI  - 158
IP  - 1
AID - 10.5507/bp.2012.092
IS  - 12138118
AB  - Aims: To assess the influence of continuous venovenous hemofiltration (CVVH) at a filtration rate of 45 mL/kg/h on vancomycin pharmacokinetics in critically ill septic patients with acute kidney injury (AKI).
Methods: Seventeen adult septic patients with acute kidney injury treated with CVVH and vancomycin were included. All patients received first dose of 1.0 g intravenously followed by 1.0 g/12 h if not adjusted. In sixteen patients vancomycin was introduced on the day of the start of CRRT therapy. Blood samples and ultrafiltrates were obtained before and 0.5, 1, 6 and 12 h after vancomycin administration.
Results: On the first day, the median total vancomycin clearance (Cl<sub>tot</sub>) was 0.89 mL/min/kg (range 0.31 - 2.16). CRRT clearance accounted for around 50-60% of the total clearance of vancomycin found in a population with normal renal function (0.97 mL/min/kg). Vancomycin serum concentrations after the first dose were below the required target of 10 mg/L as early as 6 h in 10 patients, AUC<sub>0-24</sub>/MIC ≥ 400 ratio was achieved in 10 patients on the first day.
Conclusions: CVVH at a filtration rate of 45 mL/kg/h leads to high and rapid extracorporeal removal of vancomycin in critically ill patients. Due to the rapid change in patient clinical status it was impossible to predict a fixed dosage regimen. We recommend blood sampling as early as 6 h after first vancomycin dose with maintenance dose based on vancomycin serum level monitoring.