Vancomycin Pharmacokinetics in Obese Patients with Sepsis or Septic Shock

• DOI: 10.1002/phar.2367
• Publication Date: 2020-01-20T04:25:35Z
• Authors: Anne M. Masich; Shamir N. Kalaria; Jeffrey P. Gonzales; Emily L. Heil; Asha L. Tata; Kimberly C. Claeys; Devang Patel; Mathangi Gopalakr...
• Keywords: Adult; Male; 2. Zero hunger; Middle Aged; Shock, Septic; Anti-Bacterial Agents; Obesity, Morbid; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Vancomycin; Area Under Curve; Sepsis; Humans; Female; Prospective Studies; Infusions, Intravenous; Aged

Obese patients with sepsis or septic shock may have altered vancomycin pharmacokinetics compared the general population that result in improper dosing inadequate drug concentrations. The objective of this study was to characterize obese shock, and develop a novel pharmacokinetic model based on pharmacokinetic-pharmacodynamic target requirements.Prospective observational study.Large quaternary academic medical center.Sixteen (body mass index [BMI] 30 kg/m2 higher) adults either gram-positive bacteremia requiring vasopressor support (septic shock), who were receiving between November 2016 June 2018, included. Patients excluded if they renal replacement therapy extracorporeal membrane oxygenation, treatment for central nervous system infections, pregnant, surgical prophylaxis.Four blood samples per patient collected following single dose vancomycin: one peak serum level (within 1-2 hrs infusion completion), two random levels during interval, trough 30-60 min next dose) measured.A developed describe concentrations over time. Simulations determine optimal performed using different ranges creatinine clearance (Clcr ) daily doses. Median age 62 years; median BMI 36.1 , Acute Physiology Chronic Health Evaluation II score 26, Sequential Organ Failure Assessment 11. Eleven (69%) had an acute kidney injury. initial 15 mg/kg; concentration 17 mg/L. A one-compartment best characterized shock. Volume distribution slightly increased (0.8 L/kg) (0.7 L/kg). Only Clcr effect found be significant (decrease function value by 16.4 points), confirming it is strong predictor clearance.To our knowledge, provides first population-based nomograms generated from provide simplified approach population.