Feasibility of serum Cystatin C for predicting Vancomycin concentration in abdominal cancer patients with severe infectious disease

2019 ◽  
Author(s):  
Xiaowu Zhang ◽  
Donghao Wang
Keyword(s):  
Infectious Disease ◽  
Mechanical Ventilation ◽  
Cancer Patients ◽  
Trough Concentration ◽  
Impact Indicator ◽  
Vasoactive Agent ◽  
Standard Dosage ◽  
Vancomycin Trough ◽  
Delayed Group ◽  
Trough Concentrations

Abstract Background: This study was designed to investigate the population pharmacokinetics and impact indicator of vancomycin in abdominal cancer patients complicated with severe infectious disease. Methods: A total of 78 patients abdominal cancer patients complicated with severe infectious disease were included. Vancomycin serum trough concentrations were measured using the fluorescence polarization immunoassay (FPIA) method. The patients were divided into early and delayed groups based on whether they achieve the target concentration. And clinical factors were compared between two groups.Results: The average initial therapeutic dose of vancomycin was 15.18±3.29 mg/kg (q12h). The research revealed that the abdominal cancer patients complicated with severe infectious disease had significantly lower initial vancomycin trough concentrations (median [IQR]: 6.90[5.28-11.20] mg/L). Multiple regression analysis revealed that Cys-C was the most important variable for vancomycin target trough achievement. The duration of mechanical ventilation in Early group was considerably shorter compared with group Delayed group (χ2=4.532; p < 0.05; Fig 1E). Propensity score weighting further confirmed that the duration of mechanical ventilation (χ2=6.607; p < 0.05; Fig 1F) and vasoactive agent (χ2=6.106; p < 0.05; Fig 1D) was considerably shorter compared with group Delayed group. Conclusions: The steady-state initial vancomycin trough concentration was significantly reduced in abdominal cancer patients complicated with severe infectious disease. The baseline Cys-C level measured prior to administration of vancomycin is suggested to be the most suitable parameter to predict whether vancomycin trough concentration is up to standard dosage.

scholarly journals Therapeutic Drug Monitoring and Impact Indicator of Vancomycin Pharmacokinetics in Abdominal Cancer Patients complicated with Severe Infectious Disease

2019 ◽  
Author(s):  
Xiaowu Zhang ◽  
Yang Lyu ◽  
Donghao Wang
Keyword(s):  
Infectious Disease ◽  
Mechanical Ventilation ◽  
Cancer Patients ◽  
Trough Concentration ◽  
Therapeutic Drug ◽  
Target Concentration ◽  
Impact Indicator ◽  
Vancomycin Trough ◽  
Delayed Group ◽  
Trough Concentrations

Abstract Abstract Objective: This study was designed to investigate effectiveness of therapeutic drug monitoring (TDM) and impact indicator of vancomycin pharmacokinetics in abdominal cancer patients complicated with severe infectious disease. Methods: A total of 78 patients abdominal cancer patients complicated with severe infectious disease were included. Vancomycin serum trough concentrations were measured using the fluorescence polarization immunoassay (FPIA) method. The patients were divided into early and delayed groups based on whether they achieve the target concentration. And clinical factors were compared between two groups. Results: The average initial therapeutic dose of vancomycin was 15.18±3.29 mg/kg (q12h). Ultimately, we collected 78 patient‘s trough concentrations data. The research revealed that the abdominal cancer patients complicated with severe infectious disease had significantly lower initial vancomycin trough concentrations (median [IQR]: 6.90[5.28-11.20] mg/L) compared with the recommended standard goal vancomycin trough concentration (10-15 or 15-20 mg/L). Multiple regression analysis revealed that Cys-C was the most important variable for vancomycin target trough achievement. We divided patients into early and delayed groups based on whether the initial trough concentration achieved standard goal trough concentration. Although the clinical outcomes were similar between two groups, the duration of mechanical ventilation in Early group was considerably shorter compared with group Delayed group (χ2=4.532; p < 0.05; Fig 1E). Propensity score weighting further confirmed that the duration of mechanical ventilation (χ2=6.607; p < 0.05; Fig 1F) and vasoactive agent (χ2=6.106; p < 0.05; Fig 1D) was considerably shorter compared with group Delayed group. Conclusions: The steady-state initial vancomycin trough concentration was significantly reduced in abdominal cancer patients complicated with severe infectious disease. Higher initial dosage regimen is needed to ensure clinical effectiveness. The baseline Cys-C level measured prior to administration of vancomycin is suggested to be the most suitable parameter to predict whether vancomycin trough concentration is up to standard dosage. Early attainment of target concentration significantly improved hemodynamic stability and reduced duration of mechanical ventilation.

scholarly journals Evaluating the Relationship between Vancomycin Trough Concentration and 24-Hour Area under the Concentration-Time Curve in Neonates

2018 ◽  
Vol 62 (4) ◽  
pp. e01647-17 ◽  
Author(s):  
Sheng-Hsuan Tseng ◽  
Chuan Poh Lim ◽  
Qi Chen ◽  
Cheng Cai Tang ◽  
Sing Teang Kong ◽  
...  
Keyword(s):  
Steady State ◽  
Trough Concentration ◽  
Therapeutic Drug ◽  
Population Pharmacokinetic ◽  
Time Curve ◽  
Content Type ◽  
Concentration Time ◽  
Vancomycin Trough ◽  
Trough Concentrations ◽  
The Relationship

ABSTRACT Bacterial sepsis is a major cause of morbidity and mortality in neonates, especially those involving methicillin-resistant Staphylococcus aureus (MRSA). Guidelines by the Infectious Diseases Society of America recommend the vancomycin 24-h area under the concentration-time curve to MIC ratio (AUC24/MIC) of >400 as the best predictor of successful treatment against MRSA infections when the MIC is ≤1 mg/liter. The relationship between steady-state vancomycin trough concentrations and AUC24 values (mg·h/liter) has not been studied in an Asian neonatal population. We conducted a retrospective chart review in Singapore hospitals and collected patient characteristics and therapeutic drug monitoring data from neonates on vancomycin therapy over a 5-year period. A one-compartment population pharmacokinetic model was built from the collected data, internally validated, and then used to assess the relationship between steady-state trough concentrations and AUC24. A Monte Carlo simulation sensitivity analysis was also conducted. A total of 76 neonates with 429 vancomycin concentrations were included for analysis. Median (interquartile range) was 30 weeks (28 to 36 weeks) for postmenstrual age (PMA) and 1,043 g (811 to 1,919 g) for weight at the initiation of treatment. Vancomycin clearance was predicted by weight, PMA, and serum creatinine. For MRSA isolates with a vancomycin MIC of ≤1, our major finding was that the minimum steady-state trough concentration range predictive of achieving an AUC24/MIC of >400 was 8 to 8.9 mg/liter. Steady-state troughs within 15 to 20 mg/liter are unlikely to be necessary to achieve an AUC24/MIC of >400, whereas troughs within 10 to 14.9 mg/liter may be more appropriate.

scholarly journals Are Vancomycin Trough Concentrations Adequate for Optimal Dosing?

2013 ◽  
Vol 58 (1) ◽  
pp. 309-316 ◽  
Author(s):  
Michael N. Neely ◽  
Gilmer Youn ◽  
Brenda Jones ◽  
Roger W. Jelliffe ◽  
George L. Drusano ◽  
...  
Keyword(s):  
Renal Function ◽  
Trough Concentration ◽  
Pharmacokinetic Data ◽  
Full Model ◽  
Full Data ◽  
Time Curve ◽  
Data Set ◽  
Content Type ◽  
Vancomycin Trough ◽  
Trough Concentrations

ABSTRACTThe current vancomycin therapeutic guidelines recommend the use of only trough concentrations to manage the dosing of adults withStaphylococcus aureusinfections. Both vancomycin efficacy and toxicity are likely to be related to the area under the plasma concentration-time curve (AUC). We assembled richly sampled vancomycin pharmacokinetic data from three studies comprising 47 adults with various levels of renal function. With Pmetrics, the nonparametric population modeling package for R, we compared AUCs estimated from models derived from trough-only and peak-trough depleted versions of the full data set and characterized the relationship between the vancomycin trough concentration and AUC. The trough-only and peak-trough depleted data sets underestimated the true AUCs compared to the full model by a mean (95% confidence interval) of 23% (11 to 33%;P= 0.0001) and 14% (7 to 19%;P< 0.0001), respectively. In contrast, using the full model as a Bayesian prior with trough-only data allowed 97% (93 to 102%;P= 0.23) accurate AUC estimation. On the basis of 5,000 profiles simulated from the full model, among adults with normal renal function and a therapeutic AUC of ≥400 mg · h/liter for an organism for which the vancomycin MIC is 1 mg/liter, approximately 60% are expected to have a trough concentration below the suggested minimum target of 15 mg/liter for serious infections, which could result in needlessly increased doses and a risk of toxicity. Our data indicate that adjustment of vancomycin doses on the basis of trough concentrations without a Bayesian tool results in poor achievement of maximally safe and effective drug exposures in plasma and that many adults can have an adequate vancomycin AUC with a trough concentration of <15 mg/liter.

Impact of Nursing Education on the Proportion of Appropriately Drawn Vancomycin Trough Concentrations

2016 ◽  
Vol 29 (5) ◽  
pp. 472-474 ◽  
Author(s):  
Lindsay K. Coleman ◽  
Ashley S. Wilson
Keyword(s):  
Nursing Education ◽  
Nursing Staff ◽  
Trough Concentration ◽  
Posttest Score ◽  
Further Education ◽  
Inpatient Setting ◽  
Vancomycin Trough ◽  
Trough Concentrations ◽  
The Mean ◽  
The Impact

Background: Few studies have investigated the timing of vancomycin trough concentration collection in the inpatient setting. To date, there are no published studies on the impact of targeted nursing staff education on the appropriate timing of vancomycin trough concentration collection. Objective: To evaluate the impact of educational sessions on nursing staff knowledge regarding vancomycin and proper collection of troughs. Methods: The nursing staffs of 5 hospital units with a high volume of vancomycin usage were targeted for voluntary vancomycin educational sessions. Comprehension of the educational content was measured by a 5-question pre-/posteducation quiz. Vancomycin trough concentrations were evaluated during a 2-month period pre-/posteducation for appropriate timing of sample draw, defined as ≤45 minutes prior to the next scheduled vancomycin dose. Results: A total of 114 nurses participated in the education sessions. The mean pretest score was 3.91 and the mean posttest score was 4.89 ( P < .001). Preeducation, 69% of trough concentrations were collected appropriately. Posteducation, 74% of samples were collected within the 45-minute time frame ( P = .20). Conclusions: A significant increase in short-term comprehension regarding vancomycin was seen posteducation. There was a nonsignificant increase in appropriately timed trough concentration collection posteducation. Further education of nursing staffs may be necessary to lessen timing errors.

The Relationship of Nephrotoxicity to Vancomycin Trough Serum Concentrations in a Veteran's Population: A Retrospective Analysis

2012 ◽  
Vol 46 (11) ◽  
pp. 1477-1483 ◽  
Author(s):  
Amy Horey ◽  
Kari A Mergenhagen ◽  
Arun Mattappallil
Keyword(s):  
Trough Concentration ◽  
Multiple Logistic Regression Analysis ◽  
Therapeutic Monitoring ◽  
Vancomycin Therapy ◽  
Baseline Serum ◽  
Trough Serum ◽  
Vancomycin Trough ◽  
Trough Concentrations ◽  
Stage Renal Disease ◽  
End Stage

BACKGROUND: The risk of vancomycin-associated nephrotoxicity varies greatly depending on the trough concentration. Recent guidelines suggest target vancomycin trough concentrations of 15–20 mg/L as a predictor of efficacy in the treatment of severe gram-positive infections. Limited data exist quantifying the risk for nephrotoxicity with various ranges of vancomycin troughs. OBJECTIVE: To determine the occurrence of nephrotoxicity during vancomycin therapy and up to 72 hours after its completion, in relation to the maximum trough concentration value, and identify risk factors that impact nephrotoxicity associated with vancomycin use. METHODS: We reviewed the medical records of veterans with a baseline serum creatinine less than 2 mg/dL who received 48 or more hours of vancomycin therapy and had 1 or more vancomycin trough samples obtained within 96 hours of therapy initiation from January 1, 2006, to November 1, 2008, to determine the occurrence of nephrotoxicity (as defined by RIFLE [Risk, Injury, Failure, Loss, and End-stage renal disease] criteria). RESULTS: Thirty-four (12.6%) patients developed nephrotoxicity. In multiple logistic regression analysis, maximum trough concentrations (OR 1.14; 95% CI 1.09 to 1.20), documented hypotension (OR 4.7; 95% CI 1.3 to 16.4), and weight (OR 1.02; 95% CI 1.0 to 1.03) were found to be significantly associated with the occurrence of nephrotoxicity. Once stratified into ranges of 5–10 mg/L (4.9%), 10.1–15 mg/L (3.1%), 15.1–20 mg/L (10.6%), 20.1–35 mg/L (23.6%), and greater than 35 mg/L (81.8%), increasing trough ranges were associated with a subsequently higher risk of nephrotoxicity. CONCLUSIONS: In the population evaluated, hypotension and trough concentrations were predictors of nephrotoxicity; elevated vancomycin trough concentration had the highest odds of association. These data reinforce the close therapeutic monitoring guidelines for vancomycin trough concentrations, especially when targeting troughs of 15–20 mg/L.

scholarly journals Relationship between Vancomycin Trough Concentrations and Nephrotoxicity: a Prospective Multicenter Trial

2011 ◽  
Vol 55 (12) ◽  
pp. 5475-5479 ◽  
Author(s):  
John A. Bosso ◽  
Jean Nappi ◽  
Celeste Rudisill ◽  
Marlea Wellein ◽  
P. Brandon Bookstaver ◽  
...  
Keyword(s):  
South Carolina ◽  
Trough Concentration ◽  
Multicenter Trial ◽  
Content Type ◽  
Increased Risk ◽  
Vancomycin Trough ◽  
Trough Concentrations ◽  
Length Of Therapy ◽  
The Relationship ◽  
Higher Doses

ABSTRACTSeveral single-center studies have suggested that higher doses of vancomycin, aimed at producing trough concentrations of >15 mg/liter, are associated with increased risk of nephrotoxicity. We prospectively assessed the relative incidence of nephrotoxicity in relation to trough concentration in patients with documented methicillin-resistantStaphylococcus aureus(MRSA) infections at seven hospitals throughout South Carolina. Adult patients receiving vancomycin for at least 72 h with at least one vancomycin trough concentration determined under steady-state conditions were prospectively studied. The relationship between vancomycin trough concentrations of >15 mg/ml and the occurrence of nephrotoxicity was assessed using univariate and multivariate analyses, controlling for age, gender, race, dose, length of therapy, use of other nephrotoxins (including contrast media), intensive care unit (ICU) residence, episodes of hypotension, and comorbidities. Nephrotoxicity was defined as an increase in serum creatinine of 0.5 mg/dl or a ≥50% increase from the baseline for two consecutive measurements. MICs of vancomycin for the MRSA isolates were also determined. A total of 288 patients were studied between February 2008 and June 2010, with approximately one-half having initial trough concentrations of ≥15 mg/ml. Nephrotoxicity was observed for 42 patients (29.6%) with trough concentrations >15 mg/ml and for 13 (8.9%) with trough concentrations of ≤15 mg/ml. Multivariate analysis revealed vancomycin trough concentrations of >15 mg/ml and race (black) as risk factors for nephrotoxicity in this population. Vancomycin trough concentrations of >15 mg/ml appear to be associated with a 3-fold increased risk of nephrotoxicity.

scholarly journals Incidence of Delirium in Critically Ill Cancer Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Luis A. Sánchez-Hurtado ◽  
Nancy Hernández-Sánchez ◽  
Mario Del Moral-Armengol ◽  
Humberto Guevara-García ◽  
Francisco J. García-Guillén ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cancer Patients ◽  
Critically Ill ◽  
Potential Risk ◽  
Assessment Method ◽  
Icu Stay ◽  
Potential Risk Factors

Objective. The aim of this study was to estimate the incidence of delirium and its risk factors among critically ill cancer patients in an intensive care unit (ICU). Materials and Methods. This is a prospective cohort study. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was measured daily at morning to diagnose delirium by a physician. Delirium was diagnosed when the daily was positive during a patient’s ICU stay. All patients were followed until they were discharged from the ICU. Using logistic regression, we estimated potential risk factors for developing delirium. The primary outcome was the development of ICU delirium. Results. There were 109 patients included in the study. Patients had a mean age of 48.6 ± 18.07 years, and the main reason for admission to the ICU was septic shock (40.4%). The incidence of delirium was 22.9%. The mortality among all subjects was 15.6%; the mortality rate in patients who developed delirium was 12%. The only variable that had an association with the development of delirium in the ICU was the days of use of mechanical ventilation (OR: 1.06; CI 95%: 0.99–1.13;p=0.07). Conclusion. Delirium is a frequent condition in critically ill cancer patients admitted to the ICU. The duration in days of mechanical ventilation is potential risk factors for developing delirium during an ICU stay. Delirium was not associated with a higher rate of mortality in this group of patients.

Initial report on hospitalized cancer patients with COVID-19 from the National Cancer Institute (NCI) COVID-19 in Cancer Patients Study (NCCAPS).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6566-6566
Author(s):  
Nicholas M. Mark ◽  
Ana F. Best ◽  
Alok A. Khorana ◽  
Steven Pergam ◽  
Grace E. Mishkin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Mechanical Ventilation ◽  
Cancer Patients ◽  
Clinical Data ◽  
Invasive Mechanical Ventilation ◽  
Hematologic Malignancies ◽  
Initial Report ◽  
Discharge Data ◽  
Presenting Symptoms ◽  
High Dependency

6566 Background: Hospitalized cancer patients (pts) with COVID-19 have a severe disease course and high mortality. Pts with lung cancer, hematologic malignancies and metastatic disease may be at higher risk. Detailed prospective inpatient data may help to identify those at greatest risk for poor outcomes. Methods: NCCAPS is a longitudinal study aiming to accrue 2,000 cancer pts undergoing treatment for hematologic malignancy or solid tumor with COVID-19. For pts’ first COVID-19 hospitalization, clinical data, research blood specimens and imaging are collected, and additional clinical data are collected during subsequent hospitalizations. Results: As of Jan. 22, 2021, among 757 enrolled adult patients from 204 sites, 124 (16.3%) reported at least one hospitalization for COVID-19, and discharge data was available for 98 hospitalizations in 88 patients. The median age was 67 (range 21-93, 1Q:56, 3Q:72), 35/88 (40%) were female. The most common malignancies in hospitalized adult pts were lymphoma (18.2%), lung cancer (15.9%) and multiple myeloma (10.2%). The most common presenting symptoms were shortness of breath (65%), fatigue/malaise (64%), and fever (49%). 8/88 (9%) pts were neutropenic (ANC < 1000) at presentation; 17/88 (19%) were thrombocytopenic. Median length of stay was 6.5 days (range 1-41, 1Q:4, 3Q:12). Among those hospitalized, 20/88 (22.7%) received care in the ICU or high dependency unit, with a median ICU stay of 7 days (range 1-22, 1Q:2.5, 3Q:9.5); of those admitted to the ICU, 25% (5/20) received invasive mechanical ventilation. Of those in whom inpatient medications were recorded (n = 63), 63% received corticosteroids, 46% received remdesivir, and 14% received convalescent plasma. One pt received bamlanivimab and 2 patients received tocilizumab. Most (46/63; 73%) received anticoagulation, primarily prophylactic low molecular weight heparin; 11/63 (17%) received therapeutic dose anticoagulation. Inpatient D-dimer values were recorded in 43 inpatients, 26 of whom had multiple measurements. 16/98 hospitalizations ended with death (16%). Conclusions: Preliminary analysis of NCCAPS data reveals that inpatient hospital admission is common among oncology patients with COVID-19 and mortality rates appear high within this cohort. Hematologic malignancies and lung cancer are the most common underlying diagnoses in patients requiring hospitalization. Corticosteroids and anti-coagulation were the most commonly used therapies. Despite high rates of ICU admission, invasive mechanical ventilation may be instituted less often in an oncology cohort. These observations may inform decisions about vaccine policy and decisions to limit life sustaining treatment. Clinical trial information: NCT04387656.

Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18816-e18816
Author(s):  
Cesar Simbaqueba ◽  
Omar Mamlouk ◽  
Kodwo Dickson ◽  
Josiah Halm ◽  
Sreedhar Mandayam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Hazard Model ◽  
Cancer Center ◽  
Icu Admission ◽  
Significant Difference ◽  
History Of

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

Sign in / Sign up

Export Citation Format

Share Document