Background and importance Vancomycin, a glycopeptide antibiotic, is used for the treatment of serious infections by gram positive microorganisms, especially methicillin resistant Staphylococcus aureus (MRSA). However, the attributable mortality of paediatric patients treated with vancomycin in paediatric intensive care units (PICU) has been limited.
Aim and objectives Our study aimed to determine the factors influencing mortality of paediatric patients treated with vancomycin in the PICU.
Material and methods A retrospective study was conducted in paediatric patients admitted to the PICU who received vancomycin from April 2018 to April 2019. We investigated variables such as age, sex, underlying disease, diagnosis, length of stay in the PICU, paediatric index of mortality 2 score, mechanical ventilator use, renal replacement therapy, laboratory data, dose, level of vancomycin and mortality rate.
Results A total of 160 paediatrics patients were enrolled (median age 12 months (range 2–180), 69.4% male). The percentage of patients reaching therapeutics trough levels of vancomycin (10–20 mg/L) was 32.5% (n=52). Septic shock was the most common diagnosis (49.3%) and mortality rate was 39.4%. Our study found that children who had vancomycin levels outside the therapeutic range, and used mechanical ventilation and renal replacement therapy were associated with a higher mortality rate (OR 3.14, 95% CI 1.34–7.35, p=0.008; OR 6.1, 95% CI 1.6–22.7, p=0.007; and OR 10.4, 95% CI 2.6–41.4, p=0.001, respectively).
Conclusion and relevance Improper therapeutic vancomycin levels, mechanical ventilator use and renal replacement therapy are factors associated with mortality in the PICU.
References and/or acknowledgements 1. Miloslavsky M, Galler MF, Moawad I, et al. The impact of pediatric-specific vancomycin dosing guidelines: a quality improvement initiative. Pediatrics 2017;139(6).
2. Glover ML, Cole E, Wolfsdorf J. Vancomycin dosage requirements among pediatric intensive care unit patients with normal renal function. J Crit Care 2000;15:1–4.
3. Maloni TM, Belucci TR, Malagutti SR, Furtado GHC. Describing vancomycin serum levels in pediatric intensive care unit (ICU) patients: are expected goals being met. BMC Pediatr 2019;19:240.
4. Arias Lopez MP, Fernandez AL, et al. Pediatric index of mortality 2 as a predictor of death risk in children admitted to pediatric intensive care units in Latin America: A prospective, multicenter study. J Crit Care 2015;30:1324–1330.
No conflict of interest.
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