Vancomycine als continue infusie bij obese IC-patiënten: evaluatie van het huidige doseerprotocol (VANCOBESE)

Vancomycin as continuous infusion in obese ICU patients: evaluation of the current dosing protocol Background Vancomycin is frequently used in the intensive care unit (ICU). Inadequate and late vancomycin target attainment may negatively affect outcomes. Obesity and critical illness are both associated with pathophysiological changes, which can lead to altered vancomycin pharmacokinetics and possibly suboptimal exposure. There is a lack of evidence for the optimal vancomycin loading and maintenance dose in obese critically ill patients. Objective To evaluate the efficacy of the current vancomycin dosing protocol in achieving early (< 24 hours) adequate vancomycin concentrations in adult obese (BMI > 30 kg/m2) ICU patients. Design Retrospective observational study, conducted at the ICU of the UMCG. Methods Adult obese ICU patients treated with vancomycin continuous infusion were included. Demographic and clinical data were extracted from the hospital's electronic database. The current vancomycin dosing protocol consists of a single loading dose of 20 mg/kg of total body weight (TBW), followed by a continuous infusion (10, 20 or 30 mg/kg TBW over 24 hours depending on renal function). Vancomycin concentrations were measured routinely within 24 hours after start of treatment, with a target of 20-25 mg/L. Results We included 104 patients, 43 patients (41%) were treated according to the protocol. Adequate vancomycin concentrations were obtained in 21.2%, within 12-24 hours after start of treatment. When treated according to the protocol, 30.2% met the target. Patients on continuous veno-venous hemofiltration had significantly more often sub- than supratherapeutic vancomycin concentrations (P-value 0.004). Conclusion With the current vancomycin dosing protocol, early adequate vancomycin concentrations are achieved only in a small proportion of adult obese ICU patients. Groningen (UMCG). Volwassen (> 18 jaar) obese (BMI > 30 kg/m2) patienten die in de periode januari 2018 tot januari 2022 werden behandeld met vancomycine werden geincludeerd. Hierbij moesten de eenmalige oplaaddosering en de onderhoudsdosering als continue infusie zijn gestart op de IC. Ook moest 12-24 uur na start een vancomycinespiegel bepaald zijn. Patienten die in de voorgaande 72 uur vancomycine hadden ontvangen, werden geexcludeerd. Demografische en klinische patientgegevens werden verzameld uit het elektronisch patientdossier. De Medisch Ethische Toetsingscommissie van het UMCG heeft dit onderzoek als niet-WMO-plichtig bestempeld.