Augmented renal clearance in septic patients and implications for vancomycin optimisation

The aim of this study was to evaluate the effect of augmented renal clearance (ARC) on vancomycin serum concentrations in critically ill patients. This prospective, single-centre, observational, cohort study included 93 consecutive, critically ill septic patients who started treatment that included vancomycin by continuous infusion, admitted over a 2-year period (March 2006 to February 2008). ARC was defined as 24-h creatinine clearance (CLCr) > 130 mL/min/1.73 m2. Two groups were analysed: Group A, 56 patients with a CLCr ≤ 130 mL/min/1.73 m2; and Group B, 37 patients with a CLCr > 130 mL/min/1.73 m2. Vancomycin therapeutic levels were assessed on the first 3 days of treatment (D1, D2 and D3). Serum vancomycin levels on D1, D2 and D3, respectively, were 13.1, 16.6 and 18.6 μmol/L for Group A and 9.7, 11.7 and 13.8 μmol/L for Group B (P < 0.05 per day). The correlation between CLCr and serum vancomycin on D1 was −0.57 (P < 0.001). ARC was strongly associated with subtherapeutic vancomycin serum concentrations on the first 3 days of treatment.