Prospective Evaluation of a Vancomycin Nomogram With a Continuous Infusion of Vancomycin for Surgical ICU Patients

Vancomycin is an essential antimicrobial which is frequently used in the ICU for suspected
methicillin-resistant Staphylococcus aureus (MRSA) infection. Therefore, it is vital to
optimize the dosing of vancomycin for this critically ill population. The most efficacious
method of administering vancomycin is debated in the literature. Since vancomycin is
associated with slow bactericidal activity, it is important to closely monitor serum
concentrations so as to achieve early target serum concentration, particularly when treating
aggressive S. aureus infections. One study has shown that vancomycin infused continuously
may enable faster and more consistent achievement of a therapeutic serum concentration when
compared to intermittent infusion. A faster achievement in the goal serum vancomycin
concentration would be a protective factor for intensive care unit mortality in patients
with MRSA infection.

Currently in the surgical ICU (SICU) of our institute, vancomycin is administered based on a
vancomycin dosing nomogram. Less than fifty percent of the ICU patients following this
nomogram achieved target vancomycin concentration of 15 after 24 hours. To better achieve
target vancomycin concentration in 24 hours, we developed a new vancomycin dosing nomogram
with a continuous infusion. The aim is to determine which of the two dosing nomogram is more
efficient and safer for SICU patients.