Background: Administration of vancomycin in critically ill patients needs close regulation. While subtherapeutical\nvancomycin serum concentration (VSC) is associated with increased mortality, accumulation is responsible for\nnephrotoxicity. Our study aimed to estimate the efficacy of a vancomycin-dosing protocol in reaching appropriate\nserum concentration in patients with and without kidney dysfunction.\nMethods: This was a retrospective study in critically ill patients treated with continuous infusion of vancomycin.\nPatients with creatinine clearance >50 ml/min (Group A) were compared to those with creatinine clearance\n?50 ml/min (Group B).\nResults: 348 patients were enrolled (210 in Group A, 138 in Group B). At first determination, patients with kidney\ndysfunction (Group B) had a statistically higher percentage of vancomycin in target range, while the percentage of\npatients with a VSC under the range was almost equal. These percentages differed at the subsequent\nmeasurements. The number of patients with low vancomycin concentration progressively decreased, except in\nthose with augmented renal clearance; the percentage of patients with VSC over 30 mg/L was about 28 %,\nirrespective of the presence or absence of kidney dysfunction. Patients who reached a subtherapeutic level at the\nfirst VSC measurement had a significant correlation with in-hospital mortality.\nConclusions: Our protocol seems to allow a rapid achievement of a target VSC particularly in patients with kidney\ndysfunction. In order to avoid subtherapeutical VSC, our algorithm should be implemented by the estimation of the\npresence of an augmented renal clearance.
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