Continuous Versus Intermittent Infusion of Vancomycin and the Risk of Acute Kidney Injury in Critically Ill Adults: A Systematic Review and Meta-Analysis.

Abstract:

OBJECTIVES:Critically 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 SOURCES:A systematic search of MEDLINE, CINAHL, Web of Science, International Pharmaceutical Abstracts, and Google Scholar was undertaken. STUDY SELECTION:We 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 EXTRACTION:Eleven studies were identified for analysis with baseline demographics, endpoints, protocol definitions, and outcomes extracted. DATA SYNTHESIS:When 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). CONCLUSIONS:When 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.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Flannery AH,Bissell BD,Bastin MT,Morris PE,Neyra JA

doi

10.1097/CCM.0000000000004326

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

912-918

issue

6

eissn

0090-3493

issn

1530-0293

journal_volume

48

pub_type

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