Flannery Alexander H, Hammond Drayton A, Oyler Douglas R, Li Chenghui, Wong Adrian, Smith Andrew P, Yeo Qiu Min, Chaney Whitney, Pfaff Caitlin E, Plewa-Rusiecki Angela M, Juang Paul
University of Kentucky College of Pharmacy, Lexington, KY, USA.
Rush University Medical Center, Chicago, IL, USA.
Infect Dis (Auckl). 2020 Sep 25;13:1178633720952078. doi: 10.1177/1178633720952078. eCollection 2020.
Critically ill patients and their pharmacokinetics present complexities often not considered by consensus guidelines from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Prior surveys have suggested discordance between certain guideline recommendations and reported infectious disease pharmacist practice. Vancomycin dosing practices, including institutional considerations, have not previously been well described in the critically ill patient population.
To evaluate critical care pharmacists' self-reported vancomycin practices in comparison to the 2009 guideline recommendations and other best practices identified by the study investigators.
An online survey developed by the Research and Scholarship Committee of the Clinical Pharmacy and Pharmacology (CPP) Section of the Society of Critical Care Medicine (SCCM) was sent to pharmacist members of the SCCM CPP Section practicing in adult intensive care units in the spring of 2017. This survey queried pharmacists' self-reported practices regarding vancomycin dosing and monitoring in critically ill adults.
Three-hundred and sixty-four responses were received for an estimated response rate of 26%. Critical care pharmacists self-reported largely following the 2009 vancomycin dosing and monitoring guidelines. The largest deviations in guideline recommendation compliance involve consistent use of a loading dose, dosing weight in obese patients, and quality improvement efforts related to systematically monitoring vancomycin-associated nephrotoxicity. Variation exists regarding pharmacist protocols and other practices of vancomycin use in critically ill patients.
Among critical care pharmacists, reported vancomycin practices are largely consistent with the 2009 guideline recommendations. Variations in vancomycin dosing and monitoring protocols are identified, and rationale for guideline non-adherence with loading doses elucidated.
重症患者及其药代动力学存在诸多复杂性，而美国卫生系统药师协会、美国传染病学会和传染病药师协会的共识指南往往未予以考虑。先前的调查表明，某些指南建议与报告的传染病药师实践之间存在不一致。万古霉素给药实践，包括机构方面的考虑因素，此前在重症患者群体中尚未得到充分描述。
与2009年指南建议及研究调查人员确定的其他最佳实践相比，评估重症监护药师自我报告的万古霉素使用情况。
2017年春季，危重症医学会（SCCM）临床药学与药理学（CPP）分会研究与学术委员会开发的一项在线调查被发送给在成人重症监护病房工作的SCCM CPP分会药师成员。该调查询问了药师关于重症成年患者万古霉素给药和监测的自我报告实践。
共收到364份回复，估计回复率为26%。重症监护药师自我报告在很大程度上遵循2009年万古霉素给药和监测指南。在指南建议依从性方面最大的偏差涉及负荷剂量的持续使用、肥胖患者的给药体重以及与系统性监测万古霉素相关肾毒性相关的质量改进措施。在重症患者中，药师方案和万古霉素使用的其他实践存在差异。
在重症监护药师中，报告的万古霉素使用情况在很大程度上与2009年指南建议一致。确定了万古霉素给药和监测方案的差异，并阐明了不依从负荷剂量指南的理由。
