Flannery AH, Bissell BD, Bastin MT, et al. Continuous Versus Intermittent Infusion of Vancomycin and the Risk of Acute Kidney Injury in Critically Ill Adults: A Systematic Review and Meta-Analysis. Crit Care Med. 2020 Jun;48(6):912-918. doi: 10.1097/CCM.0000000000004326.
Abstract

OBJECTIVES: Critically ill patients routinely receive vancomycin as empiric antibiotic therapy. A continuous infusion administration strategy may be superior to intermittent infusion by minimizing peak concentrations and variability thereby optimizing safety. We performed a systematic review and meta-analysis to investigate the impact of vancomycin infusion strategy on acute kidney injury in critically ill adults.

DATA SOURCES: A systematic search of MEDLINE, CINAHL, Web of Science, International Pharmaceutical Abstracts, and Google Scholar was undertaken.

STUDY SELECTION: We included randomized controlled trials and observational studies evaluating acute kidney injury in critically ill adults comparing vancomycin administered by intermittent and continuous infusion. Secondary outcomes included mortality and pharmacokinetic target attainment.

DATA EXTRACTION: Eleven studies were identified for analysis with baseline demographics, endpoints, protocol definitions, and outcomes extracted.

DATA SYNTHESIS: When compared with intermittent infusion, continuous infusion was associated with a reduction in acute kidney injury in critically ill adults (odds ratio, 0.47; 95% CI, 0.34-0.65) and a 2.6 greater odds of pharmacokinetic target attainment (odds ratio, 2.63; 95% CI, 1.52-4.57). No difference in mortality was observed (odds ratio, 1.04; 95% CI, 0.80-1.35).

CONCLUSIONS: When administered via a continuous infusion, vancomycin is associated with a 53% reduction in the odds of acute kidney injury and a 2.6-fold higher odds of pharmacokinetic target attainment when compared with intermittent infusion without influencing overall mortality.

Ratings by Clinicians (at least 3 per Specialty)
Specialty Score
Nephrology
Hospital Doctor/Hospitalists
Internal Medicine
Intensivist/Critical Care
Comments from MORE raters

Hospital Doctor/Hospitalists rater

Vancomycin is one of the commonly used antibiotics for hospitalized patients. This meta-analysis adds to the body of science regarding the infusion strategy - continuous vs intermittent - on acute kidney injury in critically ill adults. Continuous infusion was noted to be effective with therapeutic drug level as well as lower risk for acute kidney injury. Continuous vancomycin infusion would effect better outcomes in MRSA infections with lower chance for renal side effects.

Nephrology rater

This information is very useful for physicians who work in intensive care units and for nephrologists.

Nephrology rater

This will make a change in the method of administration of vancomycin.