Analyzing the pharmacokinetic difference of vancomycin 24hour infusion versus conventional infusion in hospitalized patients a pilot study| International Journal of Innovative Science and Research Technology

Analyzing the Pharmacokinetic Difference of Vancomycin 24-Hour Infusion Versus Conventional Infusion in Hospitalized Patients: A Pilot Study

Authors : Sheikh Muhammad Saad; Muhammad Hamid Hanif; Arif Ali Arain; Aslam Shah; Abdul Manan; Samreen Sarfaraz

Volume/Issue : Volume 10 - 2025, Issue 9 - September

Google Scholar : https://tinyurl.com/bdcv6v89

Scribd : https://tinyurl.com/5dwacnzf

DOI : https://doi.org/10.38124/ijisrt/25sep333

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Abstract : Background: Methicillin-Resistant Staphylococcus aureus (MRSA) causes severe infections with high morbidity. Vancomycin remains the recommended therapy, but conventional intermittent infusion (II) requires delayed monitoring and is associated with nephrotoxicity. Continuous infusion (CI) may achieve therapeutic exposure earlier with improved renal safety.  Aim: To compare the efficacy, nephrotoxicity, and cost-effectiveness of continuous versus intermittent infusion of vancomycin in patients with MRSA infections.  Methods: A retrospective observational study was conducted at Indus Hospital, Karachi, over six months. Patients >14 years with MRSA infection receiving ≥72 hours of vancomycin were included. Participants were randomly allocated to CI (n=22) or II (n=22). Data from hospital records included demographics, dosing, serum creatinine, vancomycin levels, and costs. Outcomes were time to achieve target AUC, change in creatinine, and therapy-related costs.  Results: Baseline demographics and creatinine were comparable. CI patients had significantly smaller increases in serum creatinine (0.05 ± 0.20 vs 0.41 ± 0.76 mg/dL; p<0.05) and achieved target AUC faster (1.6 ± 1.3 vs 3.3 ± 1.5 days; p<0.05). At 48 hours, 81.8% of CI versus 50% of II patients reached target AUC (p=0.03). Treatment duration and costs were slightly lower in the CI group, though not statistically significant.  Conclusion: Continuous infusion of vancomycin achieved therapeutic exposure earlier with reduced nephrotoxicity and potential cost benefits compared to intermittent infusion. CI may be a safer and more efficient option, particularly in resource-limited settings, though larger prospective studies are required for validation.

Keywords : Vancomycin, Continuous Infusion, Pharmacokinetics, MRSA, Nephrotoxicity, Cost-Effectiveness.

References :

Siddiqui AH, Koirala J. Methicillin-Resistant Staphylococcus aureus. [Updated 2023 Apr 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482221/
Hassoun A, Linden PK, Friedman B. Incidence, prevalence, and management of MRSA bacteremia across patient populations—a review of recent developments in MRSA management and treatment. Crit Care. 2017;21(1):211. doi:10.1186/s13054-017-1801-3
Zhou S, Hu X, Wang Y, Fei W, Sheng Y, Que H. The global prevalence of methicillin-resistant Staphylococcus aureus in patients with diabetic foot ulcers: a systematic review and meta-analysis. Diabetes Metab Syndr Obes. 2024;17:563–74. doi:10.2147/DMSO.S446911
World Health Organization. Proportion of bloodstream infection due to methicillin-resistant Staphylococcus aureus (MRSA) (%) [Internet]. 2024 [cited 2024 Apr 14]. Available from: https://data.who.int/indicators/i/5DD9606
Ullah A, Qasim M, Rahman H, Khan J, Haroon M, Muhammad N, et al. High frequency of methicillin-resistant Staphylococcus aureus in Peshawar Region of Pakistan. Springerplus. 2016;5:600. doi:10.1186/s40064-016-2277-3
Wang G, Hindler JF, Ward KW, Bruckner DA. Increased vancomycin MICs for Staphylococcus aureus clinical isolates from a university hospital during a 5-year period. J Clin Microbiol. 2006;44(10):3883–6. doi:10.1128/JCM.01388-06
Kumar VA, Steffy K, Chatterjee M, Sugumar M, Dinesh KR, Manoharan A, et al. Detection of oxacillin-susceptible mecA-positive Staphylococcus aureus isolates by use of chromogenic medium MRSA ID. J Clin Microbiol. 2013;51(1):318–9. doi:10.1128/JCM.01040-12
Mahjabeen F, Saha U, Mostafa MN, Siddique F, Ahsan E, Fathma S, et al. An update on treatment options for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia: a systematic review. Cureus. 2022;14(11):e31486. doi:10.7759/cureus.31486
Choo EJ, Chambers HF. Treatment of methicillin-resistant Staphylococcus aureus bacteremia. Infect Chemother. 2016;48(4):267–73. doi:10.3947/ic.2016.48.4.267
Rose W, Volk C, Dilworth TP, Sakoulas G. Approaching 65 years: is it time to consider retirement of vancomycin for treating methicillin-resistant Staphylococcus aureus endovascular infections? Open Forum Infect Dis. 2022;9(5):ofac137. doi:10.1093/ofid/ofac137
Kim B, Hwang S, Heo E, Kim HS, Jung J, Kim ES, et al. Evaluation of vancomycin TDM strategies: prediction and prevention of kidney injuries based on vancomycin TDM results. J Korean Med Sci. 2023;38(14):e101. doi:10.3346/jkms.2023.38.e101
Al-Maqbali JS, Shukri ZA, Sabahi NA, Al-Riyami I, Al Alawi AM. Vancomycin therapeutic drug monitoring (TDM) and its association with clinical outcomes: a retrospective cohort. J Infect Public Health. 2022;15(5):589–93. doi:10.1016/j.jiph.2022.04.007
Rybak MJ, Le J, Lodise TP, Levine DP, Bradley JS, Liu C, et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline and review. Am J Health Syst Pharm. 2020;77(11):835–64. doi:10.1093/ajhp/zxaa036
Maluangnon C, Tongyoo S, Permpikul C. Continuous vancomycin infusion versus intermittent infusion in critically ill patients. Infect Drug Resist. 2022;15:7751–60. doi:10.2147/IDR.S395385
Flannery AH, Bissell BD, Bastin MT, Morris PE, Neyra JA. 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;48(6):912–8. doi:10.1097/CCM.0000000000004326
van Maarseveen EM, Gipmans S, Vasbinder E, Petjak M, van Zanten AR. Switching from intermittent to continuous infusion of vancomycin in critically ill patients: toward a more robust exposure. Ther Drug Monit. 2016;38(3):398–401. doi:10.1097/FTD.0000000000000295
Stanford Health Care. Vancomycin dosing guide [Internet]. Stanford: Stanford Medicine; c2024 [cited 2024 Apr 14]. Available from: https://med.stanford.edu/content/dam/sm/bugsanddrugs/documents/antimicrobial-dosing-protocols/SHC%20Vancomycin%20Dosing%20Guide.pdf
Hutschala D, Kinstner C, Skhirdladze K, Thalhammer F, Müller M, Tschernko E. Influence of vancomycin on renal function in critically ill patients after cardiac surgery: continuous versus intermittent infusion. Anesthesiology. 2009;111(2):356–65. doi:10.1097/ALN.0b013e3181ae6151
Barbour A, Schmidt S, Rout WR, Ben-David D, Burkhardt O, Derendorf H. Soft tissue penetration of vancomycin in diabetic patients with bacterial foot infections. Int J Antimicrob Agents. 2009;34(5):480–5. doi:10.1016/j.ijantimicag.2009.06.019
Wysocki M, Delatour F, Faurisson F, Rauss A, Pean Y, Misset B, et al. Continuous infusion of vancomycin in severe staphylococcal infections: a pilot study. Antimicrob Agents Chemother. 2001;45(9):2465–7. doi:10.1128/AAC.45.9.2465-2467.2001
Adane ED, Herald M, Pfaller MA, Diekema DJ, Doern GV, Karre T, et al. Pharmacodynamic targets and continuous infusion of vancomycin in critically ill patients: a retrospective study. Ther Drug Monit. 2015;37(5):607–13. doi:10.1097/FTD.0000000000000187
Elyasi S, Khalili H, Dashti-Khavidaki S, Mohammadpour A. Vancomycin-induced nephrotoxicity: mechanism, incidence, risk factors and special populations. Eur J Clin Pharmacol. 2012;68(9):1243–55. doi:10.1007/s00228-012-1259-9
Lodise TP, Patel N, Lomaestro B, Rodvold KA, Drusano GL. Relationship between initial vancomycin concentration-time profile and nephrotoxicity among hospitalized patients. Clin Infect Dis. 2009;49(4):507–14. doi:10.1086/600884
Wallace KL, Neyra JA, Kanji Z, Bissell BD, Flannery AH. Cost-effectiveness of continuous infusion versus intermittent infusion of vancomycin in critically ill patients. Crit Care Med. 2019;47(5):e405–11. doi:10.1097/CCM.0000000000003712
Gill J, Ko J, Schilling AL. Economic evaluation of continuous infusion vancomycin for serious infections. Am J Health Syst Pharm. 2016;73(2):e25–31. doi:10.2146/ajhp140798

Background: Methicillin-Resistant Staphylococcus aureus (MRSA) causes severe infections with high morbidity. Vancomycin remains the recommended therapy, but conventional intermittent infusion (II) requires delayed monitoring and is associated with nephrotoxicity. Continuous infusion (CI) may achieve therapeutic exposure earlier with improved renal safety.  Aim: To compare the efficacy, nephrotoxicity, and cost-effectiveness of continuous versus intermittent infusion of vancomycin in patients with MRSA infections.  Methods: A retrospective observational study was conducted at Indus Hospital, Karachi, over six months. Patients >14 years with MRSA infection receiving ≥72 hours of vancomycin were included. Participants were randomly allocated to CI (n=22) or II (n=22). Data from hospital records included demographics, dosing, serum creatinine, vancomycin levels, and costs. Outcomes were time to achieve target AUC, change in creatinine, and therapy-related costs.  Results: Baseline demographics and creatinine were comparable. CI patients had significantly smaller increases in serum creatinine (0.05 ± 0.20 vs 0.41 ± 0.76 mg/dL; p<0.05) and achieved target AUC faster (1.6 ± 1.3 vs 3.3 ± 1.5 days; p<0.05). At 48 hours, 81.8% of CI versus 50% of II patients reached target AUC (p=0.03). Treatment duration and costs were slightly lower in the CI group, though not statistically significant.  Conclusion: Continuous infusion of vancomycin achieved therapeutic exposure earlier with reduced nephrotoxicity and potential cost benefits compared to intermittent infusion. CI may be a safer and more efficient option, particularly in resource-limited settings, though larger prospective studies are required for validation.

Keywords : Vancomycin, Continuous Infusion, Pharmacokinetics, MRSA, Nephrotoxicity, Cost-Effectiveness.