scholarly journals Evaluation of Vancomycin Dosing in Pediatric Cystic Fibrosis Patients

2016 ◽  
Vol 21 (2) ◽  
pp. 155-161 ◽  
Author(s):  
Erin J. McDade ◽  
Jennifer L. Hewlett ◽  
Siby P. Moonnumakal ◽  
Carol J. Baker
Keyword(s):  
Cystic Fibrosis ◽  
Pulmonary Function ◽  
Pediatric Patients ◽  
Primary Objective ◽  
Vancomycin Trough ◽  
Vancomycin Dosage ◽  
Trough Concentrations ◽  
The Mean ◽  
The Impact ◽  
Vancomycin Treatment

OBJECTIVES: The presence of methicillin-resistant Staphylococcus aureus (MRSA) in cystic fibrosis (CF) patients' sputa is associated with a decline in pulmonary function and increased mortality. Vancomycin is the preferred treatment for MRSA pneumonia in children. No published studies have evaluated the vancomycin dose needed to achieve goal vancomycin trough concentrations (VTCs; 15–20 mg/L) in pediatric patients with CF. The primary objective is to determine whether a vancomycin dosage of 60 mg/kg/day achieves a goal VTC in pediatric CF patients. Secondary objectives include determining the average dosage required to reach a goal VTC and the impact of achieving a goal VTC on estimated glomerular filtration rate (eGFR) and pulmonary function. METHODS: A retrospective review of pediatric patients with CF who received vancomycin was conducted. RESULTS: A total of 90 vancomycin treatment courses were analyzed. Standard vancomycin dosing (60 mg/kg/day) achieved goal VTC in 11 courses (12.2%). The mean dosage required to achieve a goal VTC for all courses was 70.6 ± 16.7 mg/kg/day. Patients who achieved goal VTCs were more often older, weighed more, and had higher serum creatinine concentrations at therapy initiation. On average, a dosage of 70.6 mg/kg/day was required to achieve a goal VTC. Despite dosages up to 120 mg/kg/day, no significant changes in renal function occurred. Achieving a goal VTC had no significant impact on eGFR or pulmonary function during therapy. CONCLUSIONS: Vancomycin dosing of 60 mg/kg/day does not reliably achieve a VTC of 15 to 20 mg/L in pediatric CF patients. Younger CF patients may require higher vancomycin doses.

scholarly journals Different Vancomycin Immunoassays Contribute to the Variability in Vancomycin Trough Measurements in Neonates

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Janko Samardzic ◽  
Anne Smits ◽  
Isabel Spriet ◽  
Ivan Soldatovic ◽  
Andrew Atkinson ◽  
...  
Keyword(s):  
Blood Volume ◽  
Clinical Characteristics ◽  
Mean Difference ◽  
Circumstantial Evidence ◽  
Similar Extent ◽  
Dosing Regimens ◽  
Vancomycin Trough ◽  
Trough Concentrations ◽  
The Mean ◽  
The Impact

Substantial interassay variability (up to 20%) has been described for vancomycin immunoassays in adults, but the impact of neonatal matrix is difficult to quantify because of blood volume constraints in neonates. However, we provide circumstantial evidence for a similar extent of variability. Using the same vancomycin dosing regimens and confirming similarity in clinical characteristics, vancomycin trough concentrations measured by PETINIA (2011-2012,n=400) were 20% lower and the mean difference was 1.93 mg/L compared to COBAS (2012–2014,n=352) measurements. The impact of vancomycin immunoassays in neonatal matrix was hereby suggested, supporting a switch to more advanced techniques (LC-MS/MS).

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.

scholarly journals Comparação entre a evolução de pré-escolares com fibrose cística identificados por triagem neonatal ou por sintomatologia clínica

2018 ◽  
Vol 28 (2) ◽  
pp. 29566
Author(s):  
Magali Santos Lumertz ◽  
Ângela De Moura ◽  
Leonardo Araújo Pinto ◽  
Paulo Augusto Moreira Camargos ◽  
Paulo José Cauduro Marostica
Keyword(s):  
Body Mass Index ◽  
Cystic Fibrosis ◽  
Pulmonary Function ◽  
Body Mass ◽  
Screening Test ◽  
Preschool Age ◽  
Index Number ◽  
Significant Difference ◽  
The Mean

AIMS: To compare clinical, laboratory and spirometric parameters of preschoolers (ages from three to six years old) with cystic fibrosis identified by abnormal newborn screening test (NS group), with data of patients whose diagnostic suspicion arose from characteristic clinical signs and symptoms (CS group).METHODS:  Retrospective cohort study, with a sample obtained from the medical charts of patients who received specialized and multidisciplinary outpatient follow-up. All the included children had a confirmed diagnosis of cystic fibrosis by sweat electrolyte testing and/or genetic sequencing. Variables included sex, weight, height, body mass index, number of hospitalizations per year, Pseudomonas aeruginosa colonization, presence of pancreatic insufficiency and Shwachman score, which covers four domains: general activity, nutrition, radiological examination and physical evaluation, each one scored between 5 and 25 points. A total score ≤40 points indicates severe state, and ≥86 points indicates excellent state. For comparison of pulmonary function, data from the last spirometry performed before the age of six years were used. Outcomes were compared by chi-square or Student's t test, with a significance limit of 0.05.RESULTS: Twenty-four patients were included in the study, seven children in the NS group and 17 children in the CS group. The children of the NS group started follow-up with a mean age of 1.51±2.04 months, and those of the CS group started with 3.77±1.80 months (p=0.014). The mean Shwachman score was 94.40±2.19 in the NS vs. 87.67±8.00 in the CS group (p=0.018). The mean Z score for body mass index was 0.95±1.02 in the NS group vs. 0.51±1.05 in the CS group (p=0.051). Spirometric variables had slightly higher values in the NS group, with no statistically significant difference between groups.CONCLUSIONS: The results suggest that those patients diagnosed with cystic fibrosis from the neonatal screening test suspicion benefited from an early intervention, being able to initiate pulmonary function tests and receive treatment and counseling earlier. Evaluation of clinical parameters with the Shwachman score showed that benefits could be already observed at the preschool age.

scholarly journals The Impact of Cystic Fibrosis on the Immunologic Profile of Pediatric Patients

2013 ◽  
Vol 89 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Daniela M. Bernardi ◽  
Antonio F. Ribeiro ◽  
Tais N. Mazzola ◽  
Maria M.S. Vilela ◽  
Valdemiro C. Sgarbieri
Keyword(s):  
Cystic Fibrosis ◽  
Pediatric Patients ◽  
The Impact ◽  
Immunologic Profile

scholarly journals Incidence and Risk Factors for Vancomycin Nephrotoxicity in Acutely Ill Pediatric Patients

2017 ◽  
Vol 34 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Henock Woldu ◽  
B. Joseph Guglielmo
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Serum Creatinine ◽  
Odds Ratio ◽  
Kidney Injury ◽  
Severe Toxicity ◽  
Vancomycin Trough ◽  
Trough Concentrations ◽  
The Mean ◽  
Mean Time

Background: Particularly with the current increased vancomycin dosing trends, the true risk of the agent’s nephrotoxicity is not well characterized and remains of concern. Objective: To determine the incidence of vancomycin nephrotoxicity in acutely ill hospitalized children and to secondarily characterize the risk factors for this complication. Methods: A single-center retrospective cohort study conducted at UCSF Benioff Children’s Hospital from June 2012 to June 2015. Inpatients 3 months to <19 years who received intravenous vancomycin for ≥48 hours were included. The primary outcome was incidence of nephrotoxicity, defined as an increase in serum creatinine by ≥50% from baseline. Univariate and multivariate analyses were conducted to identify risk factors for vancomycin nephrotoxicity. Results: A total of 291 patients (272 nonnephrotoxic and 19 nephrotoxic) were included in the analysis. Of the 19 patients, 12 (4.1%) were found to have moderate to severe toxicity. The median duration of therapy was 3 (3-5) and 4 (3-6) days for the group with “no nephrotoxicity” and “nephrotoxicity,” respectively. The mean time for the serum creatinine to return to normal in patients with nephrotoxicity was 5.1 days. In the multivariate analysis, only final trough concentration ≥15mg/dL (odds ratio = 3.49, 95% confidence interval = 1.2-10.1; P = .021) and receipt of piperacillin/tazobactam (odds ratio = 3.14, 95% confidence interval = 1.02-9.6; P = .046) were significantly associated with nephrotoxicity. Conclusion: The rate of moderate to severe vancomycin-associated nephrotoxicity in acutely ill children is relatively uncommon and reversible. Kidney injury is associated with increased vancomycin trough concentrations and concomitant receipt of nephrotoxins, particularly piperacillin/tazobactam.

scholarly journals Is FEV1 associated with quality of life in children with cystic fibrosis? An original article

2019 ◽  
Vol 6 (1) ◽  
pp. e06-e06
Author(s):  
Rohola Shirzadi ◽  
Safoura Navaei ◽  
Mohammadreza Modaresi ◽  
Farzad Masiha
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Pulmonary Function ◽  
Medical Center ◽  
Cross Sectional Study ◽  
Forced Expiratory Volume ◽  
Psychological Status ◽  
Cross Sectional ◽  
The Mean

Introduction: Cystic fibrosis (CF) is a serious genetic life-shortening disease. Quality of life (QoL) measurement related to CF children is a relatively new field of research, which includes the patient’s perspective in research and clinical practice. Objectives: This study aimed to evaluate the QoL in children with CF and its association with FEV1 (forced expiratory volume in 1 second). Patients and Methods: This cross-sectional study was carried out on 7-14 years old children with CF attending children’s medical center from March 2017 to March 2018. Throat swab cultures and spirometry evaluation was performed for all patients. FEV1 was determined and the 6-min walk test (6MWT) was conducted. The patient’s psychological status was assessed using the Persian version of pediatric QoL inventory. ANOVA, t test, and chisquare tests were used for data analysis. Results: Seventy-six subjects with the mean age of 10.49±3.18 years were studied since 59% of them (n=44) were boys. The mean total QoL was 65.34±17.73. Patients with lower pulmonary function had a lower QoL. There was a significant association between FEV1 and school and emotional functioning (P=0.005 and P=0.002, respectively). A significant association was found between SPO2 (peripheral capillary oxygen saturation) reduction after 6MWT and FEV1 decline (P=0.001). Additionally, a significant association was detected between FEV1 and the distance walked during 6MWT (P=0.030). Conclusion: Regarding the association between pulmonary function and QoL in CF patients and lower QoL score in our study, the importance of assessing pulmonary function in these patients should not be neglected.

scholarly journals Challenges of Vancomycin Dosing and Therapeutic Monitoring in Neonates

2020 ◽  
Vol 25 (6) ◽  
pp. 476-484
Author(s):  
Jennifer T. Pham
Keyword(s):  
Pediatric Patients ◽  
Late Onset ◽  
Therapeutic Monitoring ◽  
Pharmacokinetic Parameters ◽  
Coagulase Negative Staphylococci ◽  
Optimal Dosing ◽  
Increased Risk ◽  
Dosing Regimens ◽  
Vancomycin Trough ◽  
Trough Concentrations

Late-onset sepsis in neonates can lead to significant morbidity and mortality, especially in preterm infants. Vancomycin is commonly prescribed for the treatment of Gram-positive organisms, particularly methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococci, and ampicillin-resistant Enterococcus species in adult and pediatric patients. Currently, there is no consensus on optimal dosing and monitoring of vancomycin in neonates. Different vancomycin dosing regimens exist for neonates, but with many of these regimens, obtaining therapeutic trough concentrations can be difficult. In 2011, the Infectious Diseases Society of America recommended vancomycin trough concentrations of 15 to 20 mg/L or an AUC/MIC ratio of ≥400 for severe invasive diseases (e.g., MRSA) in adult and pediatric patients. Owing to recent reports of increased risk of nephrotoxicity associated with vancomycin trough concentrations of 15 to 20 mg/L and AUC/MIC of ≥400, a revised consensus guideline, recently published in 2020, no longer recommends monitoring vancomycin trough concentrations in adult patients. The guideline recommends an AUC/MIC of 400 to 600, which has been found to achieve clinical efficacy while reducing nephrotoxicity. However, these recommendations were derived solely from adult literature, as there are limited clinical outcomes data in pediatric and neonatal patients. Furthermore, owing to the variation of vancomycin pharmacokinetic parameters among the neonatal population, these recommendations for achieving vancomycin AUC/MIC of 400 to 600 in neonates require further investigation. This review will discuss the challenges of achieving optimal vancomycin dosing and monitoring in neonatal patients.

scholarly journals Evaluation of traditional initial vancomycin dosing versus utilizing an electronic AUC/MIC dosing program

2020 ◽  
Vol 18 (3) ◽  
pp. 2024
Author(s):  
Kerri A. McGrady ◽  
Makenzie Benton ◽  
Serina Tart ◽  
Riley Bowers
Keyword(s):  
Acute Kidney Injury ◽  
Adverse Events ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Vancomycin Dose ◽  
Trough Concentrations ◽  
The Mean ◽  
Trough Levels ◽  
Vancomycin Treatment ◽  
Background Area

Background: Area under the curve to minimum inhibitory concentration (AUC/MIC) has been recommended by the 2020 updated vancomycin guidelines for dosing vancomycin for both efficacy and safety. Previously, AUC/MIC has been cumbersome to calculate so surrogate trough concentrations of 15-20 mg/dL were utilized. However, trough-based dosing is not a sufficient surrogate as AUC/MIC targets of 400-600 can usually be reached without achieving troughs of 15-20 mg/dL. Targeting higher trough levels may also lead to adverse events including acute kidney injury (AKI) and nephrotoxicity. Objective: To compare the mean total first day vancomycin dose in traditional trough-based dosing versus dosing recommended by an AUC/MIC dosing program. Methods: Adult inpatients who received at least 24 hours of IV vancomycin treatment were included in this single-center, retrospective cohort study. The primary endpoint was difference in mean total first day vancomycin dose in milligrams (mg) received between patients’ traditional trough-based dosing and recommended dose via AUC/MIC electronic dosing calculator. Patients served as their own control by analyzing both actual dose received and dose recommended by the electronic AUC/MIC program. Rates of vancomycin induced adverse events, including acute kidney injury, elevated steady-state trough concentrations, and Red Man’s syndrome were also compared between patients who received doses consistent with the AUC/MIC dosing recommendation versus those who did not. Results: 264 patients were included in this study. Initial 24-hour vancomycin exposure was significantly lower with the recommended AUC/MIC dose versus the dose received (2380.7; SD 966.6 mg vs 2649.6; SD 831.8 mg, [95% CI 114.7:423.1] p=0.0007). Conclusions: Utilizing an electronic AUC/MIC vancomycin dosing calculator would result in lower total first day vancomycin doses.

scholarly journals The Impact of a Nanocellulose-Based Wound Dressing in the Management of Thermal Injuries in Children: Results of a Retrospective Evaluation

Life ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 212
Author(s):  
Julia Cattelaens ◽  
Laura Turco ◽  
Luc M. Berclaz ◽  
Birgit Huelsse ◽  
Wolfgang Hitzl ◽  
...  
Keyword(s):  
Wound Dressing ◽  
Pediatric Patients ◽  
Wound Dressings ◽  
Retrospective Evaluation ◽  
Thermal Injuries ◽  
Hospital Stays ◽  
The Mean ◽  
The Impact ◽  
First Time

The aim of this retrospective study is to evaluate for the first time the impact of a nanocellulose-based wound dressing in the treatment of pediatric patients with both partial- and deep-thickness burns. Usability and effectiveness were defined based on parameters such as frequency of dressing changes under narcosis, duration of hospital stay, onset of complications, need for additional treatments, and follow up scar formation assessment. Fifty-six children who sustained burns in the year 2018 and were treated with a nanocellulose-based wound dressing were included in the trial. The mean stay in hospital was 6.7 days. Patients underwent dressing changes under narcosis 2.4 times on average, and none had wound-associated infection. In all, 82% of the patients were treated only with nanocellulose-based wound dressings, and reepithelialization occurred after ten days. The majority of patients had scars with normal pigmentation (98%), vascularization (91%), height (92%), and pliability (92%). In conclusion, using a nanocellulose-based wound dressing for the treatment of both superficial, partial-thickness and deep, full-thickness burns has several advantages. Compared with the results published in literature on other wound dressings, it requires a moderate number of dressing changes under narcosis and results in short hospital stays. Additionally, it has a low associated infection rate and promotes wound healing.

Antithymocyte Globuline Given as Part of the Conditioning Regimen Has No Impact On Lung Function at 1 Year After Transplantation.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3306-3306
Author(s):  
Filippo Milano ◽  
Margaret A. Au ◽  
H. J. Deeg ◽  
Jason Chien
Keyword(s):  
Stem Cell ◽  
Lung Function ◽  
Pulmonary Function ◽  
Retrospective Analysis ◽  
Conditioning Regimen ◽  
Hematopoietic Stem ◽  
Lung Dysfunction ◽  
Significant Difference ◽  
The Mean ◽  
The Impact

Abstract Abstract 3306 Poster Board III-194 Background Pulmonary dysfunction is common following allogeneic hematopoietic stem cell transplantation (HSCT) and is associated with significant morbidity and mortality. The use of Antithymocyte globuline (ATG) has reduced the incidence of graft versus host disease (GVHD), particularly in its chronic form, but the impact of this approach on the prevention of lung dysfunction is not well characterized. Methods We performed a retrospective analysis of pulmonary function in all patients transplanted from January 2001 through December 2005 following conditioning with oral busulfan (BU) followed by either cyclophosphamide (CY) or fludarabine (FLU) with or without the addition of ATG. Pulmonary function tests (PFTs) were performed per transplant protocol before and around day 80 and 1 year after transplantation. Results Of 406 patients, 13 (3%) were excluded due to lack of pre-transplant PFTs. Seventy five patients received ATG (thymoglobulin, given on days -3 to -1 for total doses of 4.5 – 6 mg/kg), and 318 did not. The median patient age was 49 years for both the ATG (range 9-65) and non-ATG (range 7-66) groups; the median follow-up was 956 (range 19-2071) days and 903 (range 8-2697) days, respectively. The ATG group had proportionally more patients with high risk diseases (62.7% vs 45.7%, p= .03), whereas the use of bone marrow as stem cell source was higher in the non-ATG group (14.6% vs 5.3%, p=.03). The proportion of patients with PFTs at 1 year was similar for both groups (49.3% vs 54.6%, p=.55). No significant statistical differences between the 2 groups were seen in the mean percentage of the predicted values for FEV1, FVC, TLC and DLco at 80 days or 1 year after transplantation. The mean value of FEV1/FVC ratio at 1 year was higher for ATG patients (0.81±0.05 vs 0.77±0.09, p=.003). The mean change in PFT parameters from baseline to 1 year after HSCT also did not show a statistically significant difference between the 2 groups for any PFT parameters except for the FEV1/FVC ratio, which decline was lower in the ATG group (0.4±3.9 vs -2.8±7.3 p=.0002). This difference remained significant in multivariate analysis. The lung function score at 1 year after transplantation was similar in the 2 groups; they also had similar rates of lung function decline (expressed as the annualized rate of FEV1 decline) from baseline to 1 year after HSCT. The risk of developing severe airflow obstruction (AFO) or a restrictive pattern (RP), as well as the cumulative incidence of AFO and RP were not statistically significantly different between the 2 treatment groups at 1 year after HSCT. Conclusions In this retrospective analysis, incorporation of ATG into the HSCT conditioning regimen did not appear to be associated with superior outcome in terms of post transplant pulmonary function. However, further evaluations are needed to better clarify the role that ATG might have in the development of late-term pulmonary complications. Disclosures No relevant conflicts of interest to declare.

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