681: EVALUATION OF A VANCOMYCIN NOMOGRAM WITH A CONTINUOUS INFUSION OF VANCOMYCIN FOR ICU PATIENTS

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: To determine whether continuous or intermittent vancomycin infusion dosing reached a therapeutic 24 hour serum concentration in critically ill patients with preserved renal function. Methods: Single center, prospective, unblinded, parallel-arm, randomized controlled trial in two surgical ICUs in a tertiary academic medical center. Critically ill adults requiring vancomycin therapy were randomized to receive one of two methods of vancomycin infusion: continuous infusion or intermittent infusion. The study was registered with ClinicalTrials.gov (NCT01786161). Results: The primary outcome was achievement of a therapeutic 24-hour serum concentration. The study was terminated after an unplanned interim analysis of 44 patients (22 continuous infusions (CIV) and 22 intermittent infusions (IIV)) that documented significant differences. The groups were well matched for baseline characteristics. Patients randomized to the continuous infusion group [CIV] achieved a therapeutic 24-hour serum concentration more frequently than the patients in the intermittent infusion group [IIV]; 20/22 (90.9%) versus 5/22 (22.7%), respectively; OR: 34.0 (95%CI: 6.97 -267.4, p < 0.001). Time to achieve the therapeutic levels was 54.1 ± 25.8 hours and 26.1 ± 7 hours in the IIV and CIV groups, respectively (p < 0.001). The incidence of nephrotoxicity was similar between the two groups. In the subgroup of 22 patients who demonstrated augmented renal clearance, therapeutic 24 hour levels were achieved in none versus 10/10 in IIV and CIV, respectively (p < 0.001) Conclusions: Continuous infusion of vancomycin reached target levels of vancomycin more frequently compared to patients who received intermittent dosing. This was despite higher total daily doses administered to patients who received intermittent doses of vancomycin.