scholarly journals A High Serum Vancomycin Level Is Associated with Lower Relapse Rates in Coagulase-Negative Staphylococcal Peritonitis

2014 ◽  
Vol 34 (2) ◽  
pp. 232-235 ◽  
Author(s):  
R. Dahlan ◽  
S. Lavoie ◽  
M. Biyani ◽  
D. Zimmerman ◽  
B. B. McCormick
Keyword(s):  
High Serum ◽  
Serum Vancomycin ◽  
Relapse Rates ◽  
Vancomycin Level

Vancomycin Penetration of a Brain Abscess: Case Report and Review of the Literature

Neurosurgery ◽  
1986 ◽  
Vol 18 (5) ◽  
pp. 632-636 ◽  
Author(s):  
Robert M. Levy ◽  
Philip H. Gutin ◽  
David S. Baskin ◽  
Vincent G. Pons
Keyword(s):  
Radiation Therapy ◽  
Brain Abscess ◽  
Review Of The Literature ◽  
Operative Removal ◽  
Iodine 125 ◽  
Serum Vancomycin ◽  
The Brain ◽  
Interstitial Radiation Therapy ◽  
Vancomycin Level ◽  
Interstitial Radiation

Abstract A 56-year-old man developed an abscess within a right parietal cystic anaplastic astrocytoma 3 days after removal of iodine-125 sources placed 9 days earlier for interstitial radiation therapy. After treatment with cephalosporin antibioties proved unsuccessful, the patient was treated with intravenous vancomycin and intermittent percutaneous drainage of the abscess. Vancomycin levels obtained from the brain abscess fluid, both before and during later operative removal of the abscess, were 15 and 18 μg/ml, respectively; the serum vancomycin level was 21 μg/ml. This is the first report of the excellent penetration of vancomycin into brain abscess fluid.

scholarly journals Incidence and risk factors of vancomycin-associated acute kidney injury in a single center: Retrospective study

2021 ◽  
Vol 5 (1) ◽  
pp. 010-016
Author(s):  
Yalamarti Tanuja ◽  
Zonoozi Shahrzad ◽  
Adu Ntoso Kwabena ◽  
Alborzi Pooneh
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
High Serum ◽  
Hospitalized Patients ◽  
Close Monitoring ◽  
Iodinated Contrast ◽  
Vancomycin Trough ◽  
Serum Vancomycin ◽  
Trough Levels

Background: There is enough evidence to suggest that vancomycin increases the risk of acute kidney injury (AKI) but the exact mechanism is not well understood. This study aims to understand the incidence of vancomycin-associated acute kidney injury (VA-AKI) among hospitalized patients and to identify the risk factors for VA-AKI. Methods: Patients aged 18 and above who received a minimum of 24 hours of intravenous vancomycin and who had serial creatinine measurements over a 13-month period were identified through electronic records. Patients with pre-existing AKI, or eGFR of less than 30ml/min, and patients with end stage kidney disease were excluded. Results were analyzed using t-test and Fisher’s test. A logistic regression model was used to identify the predictors for VA-AKI. Results: From the 598 patients who met the inclusion criteria, 70 developed AKI. Compared to those without AKI, patients with VA-AKI had higher mean serum vancomycin trough levels (22.6 mg/L vs. 14.6 mg/L), and a statistically significant longer duration of vancomycin use (6.7 vs. 5.2 days). Multivariate analysis revealed that serum vancomycin level of > 20 mg/L was associated with a six-fold increase in odds of VA-AKI when compared to those with vancomycin levels < 15 mg/L. The presence of hypotension, iodinated contrast use, and concomitant use of piperacillin-tazobactam were all associated with increased odds of VA-AKI. Conclusion: The incidence of VA-AKI in hospitalized patients with eGFR > 30 ml/min was 11.7%. Serum vancomycin levels of > 20 mg/L, hypotension and administration of iodinated contrast significantly increased the risk of VA-AKI. Piperacillin-tazobactam, when used with vancomycin, was noted to be an independent predictor of AKI, regardless of serum vancomycin trough levels, prompting a reevaluation of the safety of this widespread practice as empiric therapy. Close monitoring of kidney function, avoiding high serum vancomycin levels, maintaining hemodynamic stability, and avoiding unnecessary use of iodinated contrast seem to be essential for the prevention of VA-AKI.

Vancomycin Intermittent Dosing versus Continuous Infusion for Treatment of Ventilator-associated Pneumonia in Trauma Patients

2013 ◽  
Vol 79 (11) ◽  
pp. 1185-1190 ◽  
Author(s):  
Thomas M. Schmelzer ◽  
A. Britton Christmas ◽  
H. James Norton ◽  
B. Todd Heniford ◽  
Ronald F. Sing
Keyword(s):  
Injury Severity ◽  
Randomized Study ◽  
Total Body Weight ◽  
Primary Outcome Measure ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Treatment Groups ◽  
Trauma Society ◽  
Serum Vancomycin ◽  
Vancomycin Level

Current guidelines for the empiric treatment of ventilator-associated pneumonia (VAP) recommend that vancomycin is dosed 15 mg/kg and administered twice daily for a target trough level of 15 to 20 mg/mL. This study compared conventional intermittent vancomycin infusion (IVI) with continuous vancomycin infusion (CVI). Our prospective, randomized study compared CVI with IVI in trauma patients with suspected VAP. The primary outcome measure was a serum vancomycin level within the target level 48 hours after initiation of therapy. Treatment groups were compared using standard statistical methods. The study included 73 patients, 36 IVI and 37 CVI. Eighteen patients were withdrawn from the study as a result of discontinuation of the drug before 48 hours or failure to draw levels at the appropriate time, resulting in 27 IVI and 28 CVI study patients. There were no differences between treatment groups in gender ( P = 0.97), Injury Severity Score ( P = 0.70), total body weight ( P = 0.36), or age ( P = 0.81). The mean serum vancomycin level for the IVI group was 8.9 ± 3.9 mg/mL, and the CVI level was 19.8 ± 6.13 mg/mL ( P < 0.0001). Two patients in the IVI group (7.4%) were in the therapeutic range compared with 16 (57.1%) in the CVI group ( P < 0.0001). Six patients in the CVI group (21.4%) and none of the IVI patients had supratherapeutic levels. Four patients developed renal insufficiency, three IVI (11.1%) and one CVI (3.6%) ( P = 0.36). The current American Trauma Society dosing recommendations for vancomycin for presumptive VAP treatment are inadequate. Continuous vancomycin infusion should be adopted as the standard dosing strategy.

scholarly journals An Unusual Case of Ototoxicity with Use of Oral Vancomycin

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Umut Gomceli ◽  
Srija Vangala ◽  
Cosmina Zeana ◽  
Paul J. Kelly ◽  
Manisha Singh
Keyword(s):  
Renal Function ◽  
Clostridium Difficile ◽  
Normal Renal Function ◽  
Systemic Absorption ◽  
Temporal Association ◽  
Oral Vancomycin ◽  
Patient Reported ◽  
Serum Vancomycin ◽  
Detectable Serum ◽  
Vancomycin Level

Introduction. Systemic absorption of oral vancomycin is poor due to the size of the molecule and its pharmacokinetics. It has an elimination half life of 5–11 hours in patients with normal renal function. We present a rare case of ototoxicity after oral vancomycin administration and detectable serum vancomycin levels 24 hours after cessation of vancomycin. Case Presentation. A 42-year-old woman with a history of hypertension, diabetes mellitus, and previously treated Clostridium difficile colitis presented with abdominal pain and diarrhea for two weeks. Clostridium difficile infection was confirmed by PCR, and at the time of diagnosis and initiation of therapy, the patient had normal renal function. Vancomycin was initiated at a dose of 125 mg po q6h. After the third dose of oral vancomycin, the patient reported new symptoms of lightheadedness, sensations of “buzzing” and whistling of bilateral ears, and decreased perception of hearing described as “clogged ears.” The patient reported to the emergency department the next day due to worsening of these symptoms, and vancomycin dosing was reduced to every 8 hours; however, the patient reported the auditory symptoms persisted. On day three, vancomycin was discontinued with gradual resolution of symptoms over the next 12 hours. On day four, a serum random vancomycin level obtained 24 hours after the last dose was detectable at 2 mcg/dl. Temporal association of the patient’s symptoms and improvement with cessation of therapy along with a detectable vancomycin level indicates systemic absorption of oral vancomycin with subsequent ototoxicity. Discussion. The potential for absorption of oral vancomycin is not well described and is attributed to compromised intestinal epithelium allowing for increased drug absorption. Few studies suggested that oral vancomycin may result in therapeutic or even potentially toxic levels of serum vancomycin in patients with impaired renal function. Ototoxicity may be a transient or permanent side effect of vancomycin therapy and is related to high serum levels. Symptoms usually resolve after decreasing the dose or cessation of vancomycin. No detectable serum vancomycin levels were found in 98% of the patients treated with oral vancomycin in a prospective study. The described case is unusual because despite normal renal function, the patient still developed ototoxicity, and systemic absorption of the drug was confirmed with a measurable vancomycin level approximately 24 hours after the drug was stopped. Additionally, the only other medication prescribed to the patient at the time of vancomycin administration was metformin at a dose of 500 mg po bid which has no known idiosyncratic interactions potentiating adverse side effects to vancomycin. This case reflects that some patients may be more susceptible to increased systemic absorption via the oral route, and the possibility for ototoxicity should be considered and discussed with patients while prescribing oral vancomycin.

scholarly journals Intraperitoneal Vancomycin Concentrations during Peritoneal Dialysis–Associated Peritonitis: Correlation with Serum Levels

2012 ◽  
Vol 32 (3) ◽  
pp. 332-338 ◽  
Author(s):  
Richard Fish ◽  
Robert Nipah ◽  
Chris Jones ◽  
Hazel Finney ◽  
Stanley L.S. Fan
Keyword(s):  
Single Dose ◽  
Peritoneal Dialysis ◽  
Inhibitory Concentration ◽  
Serum Levels ◽  
Serum Concentrations ◽  
Active Infection ◽  
Peritoneal Dialysate ◽  
Serum Vancomycin ◽  
Continuous Dosing ◽  
Vancomycin Level

BackgroundFor the treatment of peritoneal dialysis–associated peritonitis (PDP), it has been suggested that serum concentrations of vancomycin be kept above 12 mg/L – 15 mg/L. However, studies correlating vancomycin concentrations in serum and peritoneal dialysate effluent (PDE) during active infection are sparse. We undertook the present study to investigate this issue and to determine whether achieving the recommended serum level of vancomycin results in therapeutic levels intraperitoneally.MethodsWe studied patients treated with intraperitoneal (IP) vancomycin for non-gram-negative PDP. We gave a single dose (approximately 30 mg/kg) at presentation, and we subsequently measured vancomycin levels in PDE on day 5; we wanted to determine if efflux of vancomycin from serum to PDE during a 4-hour dwell was consistent and resulted in therapeutic levels.ResultsOf the 48 episodes of PDP studied, serum vancomycin concentrations exceeding 12 mg/L were achieved in 98% of patients, but in 11 patients (23%), a PDE vancomycin level below 4 mg/L—the minimal inhibitory concentration (MIC) of many gram-positive organisms—was observed at the end of a 4-hour dwell on day 5. The correlation between the concentrations of vancomycin in serum and PDE (from efflux of antibiotic over 4 hours) was statistically significant, but poor ( R2= 0.18).ConclusionsOur data support the International Society for Peritoneal Dialysis statement that adequate serum vancomycin concentrations can be achieved with intermittent dosing (single dose every 5 days), but cannot guarantee therapeutic PDE levels in the treatment of PDP. Intermittent dosing of vancomycin may not consistently result in PDE concentrations markedly greater than MIC of many important pathogens. Although the clinical significance of this finding remains to be determined, it may be preferable to give smaller but more frequent doses of PDE vancomycin (continuous dosing) for adults with PDP (as is currently recommended for children).

scholarly journals The Role of Monitoring Vancomycin Levels in Patients with Peritoneal Dialysis-Associated Peritonitis

2015 ◽  
Vol 35 (2) ◽  
pp. 222-228 ◽  
Author(s):  
Sarah Stevenson ◽  
Wen Tang ◽  
Yeoungjee Cho ◽  
David W. Mudge ◽  
Carmel M. Hawley ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Median Number ◽  
Gram Positive ◽  
Empiric Antibiotic ◽  
Serum Vancomycin ◽  
Cure Rates ◽  
Culture Negative ◽  
Vancomycin Level

BackgroundThere is limited available evidence regarding the role of monitoring serum vancomycin concentrations during treatment of peritoneal dialysis (PD)-associated peritonitis.MethodsA total of 150 PD patients experiencing 256 episodes of either gram-positive or culture-negative peritonitis were included to investigate the relationship between measured serum vancomycin within the first week and clinical outcomes of cure, relapse, repeat or recurrence of peritonitis, catheter removal, temporary or permanent transfer to hemodialysis, hospitalization and death.ResultsVancomycin was used as an initial empiric antibiotic in 54 gram-positive or culture-negative peritonitis episodes among 34 patients. The median number of serum vancomycin level measurements in the first week was 3 (interquartile range; IQR 1 - 4). The mean day-2 vancomycin level, measured in 34 (63%) episodes, was 17.5 ± 5.2 mg/L. Hospitalized patients were more likely to have serum vancomycin levels measured on day 2 and ≥ 3 measurements in the first week. The peritonitis cure rates were similar between patients with < 3 and ≥ 3 measurements in the first week (77% vs 57%, p = 0.12) and if day-2 vancomycin levels were measured or not (68% vs 65%, p = 0.84). The average day-2 (18.0 ± 5.9 vs 16.6 ± 3.2, p = 0.5), first-week average (18.6 ± 5.1 vs 18.6 ± 4.3, p = 0.9) and nadir (14.5 ± 4.1 vs 13.6 ± 4.2, p = 0.5) vancomycin levels were comparable in patients who did or did not achieve peritonitis cure. Similar results were observed for all other clinical outcomes.ConclusionThe clinical outcomes of gram-positive and culture-negative peritonitis episodes are not associated with either the frequency or levels of serum vancomycin measurements in the first week of treatment when vancomycin is dosed according to International Society for Peritoneal Dialysis (ISPD) Guidelines.

Fibronexus-Like Adhesion Sites are Present at the Invasive Zones of Human Epidermoid Carcinomas

1982 ◽  
Vol 40 ◽  
pp. 106-109
Author(s):  
Irwin I. Singer
Keyword(s):  
Cell Cycle ◽  
Serum Concentration ◽  
Substrate Binding ◽  
High Serum ◽  
Adhesion Sites ◽  
Substrate Adhesion ◽  
Focal Contacts ◽  
Adhesion Complex ◽  
Low Serum

Our previous results indicate that two types of fibronectin-cytoskeletal associations may be formed at the fibroblast surface: dorsal matrixbinding fibronexuses generated in high serum (5% FBS) cultures, and ventral substrate-adhering units formed in low serum (0.3% FBS) cultures. The substrate-adhering fibronexus consists of at least vinculin (VN) and actin in its cytoplasmic leg, and fibronectin (FN) as one of its major extracellular components. This substrate-adhesion complex is localized in focal contacts, the sites of closest substratum approach visualized with interference reflection microscopy, which appear to be the major points of cell-tosubstrate adhesion. In fibroblasts, the latter substrate-binding complex is characteristic of cultures that are arrested at the G1 phase of the cell cycle due to the low serum concentration in their medium. These arrested fibroblasts are very well spread, flattened, and immobile.

Surgery, Radio- and Chemo- therapy for Multimodal Treatment of Rectal Cancer

Swiss Surgery ◽  
2001 ◽  
Vol 7 (6) ◽  
pp. 256-274 ◽  
Author(s):  
Link ◽  
Staib ◽  
Kornmann ◽  
Formentini ◽  
Schatz ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Multimodal Treatment ◽  
Local Relapse ◽  
Phase Iii ◽  
Neoadjuvant Radiotherapy ◽  
Term Survival ◽  
Primary Tumors ◽  
Impact On Survival ◽  
Relapse Rates

The possibilities and results of multimodal treatment in rectal cancer were reviewed with respect to the results of surgical treatment only. Based on the results of 4 studies, reducing local relapse rates and increasing long term survival rates significantly, postoperative radiochemotherapy (RCT) + chemotherapy (CT) should remain the recommended standard for R0 resected UICC II and III rectal cancers. The addition of RT to adjuvant CT reduces local relapses without significant impact on survival (NSABP R-02). Vice versa, the addition of CT to RT or an improved CT in the RCT-concept prolongs survival. Preoperative neoadjuvant radiotherapy (RT) reduced local relapse rates in 9 studies, and extended survival in one study that evaluated all eligible patients. Preoperative RT reduced local relapse rates in addition to total mesorectal excision (TME) but did not extend survival. The preoperative RCT + CT downstages resectable and nonresectable tumors and induces a higher sphincter preservation rate. Phase III data justifying its routine use in all UICC II + III stages are not yet available. This treatment may be routinely applied in nonresectable primary tumors or local relapses. Preoperative RCT (or RT) may evolve as standard, if the patient selection is improved and postoperative morbidity and long term toxicity reduced. Intraoperative RT could be added to this concept or be used together with preoperative/postoperative RT at the same indications. Postoperative adjuvant RT reduced local relapses significantly in a single trial, and no impact on survival time is reported. Since postoperative RT is inferior to preoperative RT, this treatment cannot be recommended, if RT is chosen as a single treatment modality in adjunction to surgery. The results of local tumor excisions may be improved with pre- or postoperative RCT + CT. In the future, multimodal treatment of rectal cancer might be more effective, if individualized according to prognostic factors.

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