Vancomycin-Related Problems In Hemodialysis

Introduction: Vancomycin is a glycopeptide antimicrobial and is regarded as the drug of first choice for the treatment of Methicillin-ResistantSstaphylococcus aureus (MRSA) infections. This antimicrobial is commonly prescribed for infection treatment in dialysis centres. Objective: The aim of this study is to identify vancomycin related problems, including inappropriate doses and mismonitoring, as well as to establish the associations between vancomycin related problems and hemodialysis patient outcomes (recovery or death), in a University Hospital. Methods: A retrospective cross sectional study was carried out with 15 stage 5 Chronic Kidney Disease patients on low-flux hemodialysis and on vancomycin treatment (1 gram per dose). Vancomycin doses were evaluated according to the literature recommendations. Vancomycin troughs were evaluated in order to verify whether vancomycin level was within the therapeutic range. Patients were classified into two groups according to the outcome (recovery or death). Statistical analyses were performed in order to identify whether misdosing and mismonitoring were associated to patient outcome. Results: All patients underwent vancomycin inadequate dose in, at least, one moment during the hospital stay. Troughs were out of renge in 68.8% of blood samples (p = 0.0004). Multi-resistant microorganisms were identified in six patients who died (p= 0.0002). Conclusions: It isimperative to prescribe vancomycin correctly, based upon the patient actual body weight. In addition, it is also important to monitor this antimicrobial adequately. Gram-negative double coverage is also strongly recommended in settings in which MDR microorganisms are identified.