Clearance of vancomycin during continuous infusion in Intensive Care Unit patients: correlation with measured and estimated creatinine clearance and serum cystatin C

Martin G. Kees (1) , Justus W. Hilpert (1) , Carsten Gnewuch (2) , Frieder Kees (3) , Stephan Voegeler (1)

1 Department of Anesthesiology and Intensive Care
2 Universitätsstr. 31
3 Department of Pharmacology

Vancomycin (VAN) dosing requires adjustment to renal function, which is often estimated using the Cockcroft-Gault formula; however, its precision is poor in Intensive Care Unit (ICU) patients. VAN clearance (CL) during continuous infusion was prospectively determined in 25 ICU patients [14 male, 11 female; age range 31-82 years; body mass index (BMI) 16.5-41.5kg/m; Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission 8-36; creatinine clearance 25-195mL/min) and its correlation with measured creatinine clearance (CL), estimated creatinine clearance using the Cockcroft-Gault formula (CL) and estimated glomerular filtration rate according to Hoek's formula based on serum cystatin C (GFR) was investigated. The correlation between CL and CL was very good (=0.88), but it was rather poor with CL (=0.37) and was acceptable with GFR (=0.70). For VAN dose adjustments in ICU patients, determination of cystatin C may be an interesting and practical alternative to measured CL, whereas the Cockcroft-Gault formula should be used with caution.

Mots clés: HPLC; Pharmacokinetics; ICU; Cystatin C; Creatinine clearance; Dosing

Martin G. Kees, Justus W. Hilpert, Carsten Gnewuch, Frieder Kees, Stephan Voegeler. Clearance of vancomycin during continuous infusion in Intensive Care Unit patients: correlation with measured and estimated creatinine clearance and serum cystatin C. International Journal of Antimicrobial Agents, 2010, 36 (6), pp.545. ⟨10.1016/j.ijantimicag.2010.07.015⟩. ⟨hal-00640450⟩