P0512 / #1237: OPTIMAL SERUM VANCOMYCIN MONITORING IN CRITICALLY ILL CHILDREN WITH COMPLEX INFECTIONS: ARE WE REACHING RECOMMENDED THERAPEUTIC TARGETS?

Abstract

Aims & Objectives: To evaluate the current prescribing, dosing and monitoring of Vancomycin in critically ill children reviewing effectiveness of current guidelines in reaching therapeutic trough target levels in the initial 48 hours of treatment. Methods: A single center retrospective chart review of children aged 1 month to 16 years admitted to the Pediatric Intensive Care Unit (PICU) and prescribed vancomycin therapy for ≥ 24 hours over 2 years. Results: 76% (46/60) of the participants were aged <5 years. Pneumonia was the leading primary admission diagnosis with infections of respiratory origin comprising 73.33%(44/60) of all cases requiring Vancomycin. Laboratory confirmed Methicillin Resistant Staphylococcus Aureus (MRSA) cases was 28% (17/60) with 70.58% (12/17) of these being children of Aboriginal or Torres Strait Islander (ATSI) ethnicity. The median serum Vancomycin plasma concentration (SVPC) fell below the therapeutic trough target of 15-20mg/ml for all dosing regimens. 8.33% (5/60) did not have Vancomycin levels taken and 54.54% (30/55) never reached the therapeutic targets. 20% (11/55) reached therapeutic targets in <48 hours and 23.6% (13/55) reached therapeutic targets in >48 hours.Conclusions: Current dosing regimens demonstrate efficacy in reaching therapeutic levels in initial 48 hours of treatment in 20% of cases and over half of the children prescribed Vancomycin never achieve the current therapeutic trough ranges currently specified. Further prospective investigation is needed with a view to use of Area under curve (AUC) and minimum inhibitory concentration (MIC) as markers of efficacy in our local population to determine if customised pharmacokinetic (PK) dosing models offer a better alternative.