885: EXTENDED-INFUSION CEFEPIME PHARMACOKINETICS/PHARMACODYNAMICS IN CONTINUOUS RENAL REPLACEMENT THERAPY

Abstract

Learning Objectives: There is a paucity of information regarding how to adequately dose vancomycin for a patient who is concomitantly receiving hemodialysis. Although the IDSA, ASHP, and SIDP guidelines do not propose recommendations for dosing vancomycin during hemodialysis, they do provide that adequate trough levels for vancomycin should be maintained within 15-20mg/L. Many institutions have protocols in place based on these guidelines to aid in the dosing of vancomycin due to its narrow therapeutic index; however, when a patient is on concomitant hemodialysis, additional protocols must be developed and followed. The study facility utilizes a strategy in which a weight-based loading dose is calculated with subsequent doses given during the last hour of hemodialysis. Methods: This is a single center retrospective chart review assessing the appropriateness of, and the compliance with, a vancomycin dosing protocol during hemodialysis in a large tertiary care community hospital. This study is considered a quality improvement project and was exempt from Institutional Review Board approval. Adult patients between July 1, 2016 and June 31, 2017 who were given vancomycin per hemodialysis protocol by a pharmacist while inpatient, were included in this study. Results: Of the 588 patients screened, 234 met inclusion criteria and underwent comprehensive retrospective chart review. All 234 patients were assessed for protocol compliance; however, only 154 of these patients had a first vancomycin level drawn and were included for assessment of protocol appropriateness. Of these 154 patients with a first vancomycin level, 52 (33.8%) achieved a goal vancomycin level. When compared, those with a goal level were given a significantly larger loading dose on average (1355.8, 1156.0, P=0.0031) as compared to those who did not achieve a goal vancomycin level. Of those who received a loading dose above protocol recommendations, 71% achieved a goal vancomycin level as compared to only 28.4% of those who received a protocol based loading dose (P<0.0001). Conclusions: Among patients receiving vancomycin and concomitant hemodialysis, the use of this institution’s current dosing protocol is not producing vancomycin levels that are consistently at goal.