Korean J Physiol Pharmacol.  2024 Mar;28(2):121-127. 10.4196/kjpp.2024.28.2.121.

Development of a model to predict vancomycin serum concentration during continuous infusion of vancomycin in critically ill pediatric patients

• Han YJ
• Jang W
• Kim JS
• Kim HJ
• Suh SY
• Cho YS
• Park JD
• Lee B

• KMID: 2553524
• DOI: http://doi.org/10.4196/kjpp.2024.28.2.121

Abstract

Vancomycin is a frequently used antibiotic in intensive care units, and the patient’s renal clearance affects the pharmacokinetic characteristics of vancomycin. Several advantages have been reported for vancomycin continuous intravenous infusion, but studies on continuous dosing regimens based on patients’ renal clearance are insufficient. The aim of this study was to develop a vancomycin serum concentration prediction model by factoring in a patient’s renal clearance. Children admitted to our institution between July 1, 2021, and July 31, 2022 with records of continuous infusion of vancomycin were included in the study. Sex, age, height, weight, vancomycin dose by weight, interval from the start of vancomycin administration to the time of therapeutic drug monitoring sampling, and vancomycin serum concentrations were analyzed with the linear regression analysis of the mixed effect model. Univariable regression analysis was performed using the vancomycin serum concentration as a dependent variable. It showed that vancomycin dose (p < 0.001) and serum creatinine (p = 0.007) were factors that had the most impact on vancomycin serum concentration. Vancomycin serum concentration was affected by vancomycin dose (p < 0.001) and serum creatinine (p = 0.001) with statistical significance, and a multivariable regression model was obtained as follows: Vancomycin serum concentration (mg/l) = –1.296 + 0.281 × vancomycin dose (mg/kg) + 20.458 × serum creatinine (mg/dl) (adjusted coefficient of determination, R² = 0.66). This prediction model is expected to contribute to establishing an optimal continuous infusion regimen for vancomycin.

Keyword

Intravenous infusions; Pediatric intensive care units; Pharmacokinetics; Vancomycin

Figure

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  Fig. 1 Patient selection. IIV, intermittent intravenous; CIV, continuous intravenous; SCr, serum creatinine; TDM, therapeutic drug monitoring; CRRT, continuous renal replacement therapy; ECMO, extracorporeal membrane oxygenation.

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  Fig. 2 Plot of observed vancomycin serum concentration vs. model-predicted vancomycin serum concentration. The median value of the predicted vancomycin serum concentrations for the study population was 21.2 (17.1–25.1) mg/l, comparable to the observed vancomycin serum concentration of 22.1 (18.3–24.6) mg/l. IQR, interquartile range.

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