Continuous Versus Intermittent Infusion of Vancomycin and the Risk of Acute Kidney Injury in Critically Ill Adults: A Systematic Review and Meta-Analysis*. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Flannery, Alexander H.; Bissell, Brittany D.; Bastin, Melissa Thompson; Morris, Peter E.; Neyra, Javier A.
• Is Part Of: Critical care medicine. Volume 48:Issue 6(2020)
• Publication Date: 2020-06
• Subjects: acute kidney injury -- continuous infusion -- critical care -- nephrotoxicity -- vancomycin; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000004326
• Languages: English
• ISSNs: 0090-3493

Abstract

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. Abstract : Supplemental Digital Content is available in the text.