6029 Evidence of sub-therapeutic vancomycin trough levels in children: results from a closed-loop audit in a Tertiary Centre
Bibliographic record
Abstract
Objectives Vancomycin is a commonly used glycopeptide antibiotic to treat gram-positive bacterial infections in paediatric patients.1 Currently, empiric dosing regimens of 40- 60mg/kg daily in divided doses (higher than the BNFc recommended doses2 3 are used in a tertiary centre, to target therapeutic trough levels of 10–20 µg/mL, or 15–20 µg/mL in severe infections.1 There is limited evidence to inform and guide paediatric vancomycin dosing guidelines and regimens.1 2 The key aim of this study was to evaluate whether current empiric dosing regimens achieved therapeutic vancomycin trough levels in children receiving intravenous vancomycin at a tertiary centre. Methods Retrospective, fully anonymised data collection was completed, as part of a closed loop two-cycle audit, on all paediatric inpatients (aged between >30 days and <17 years) who received intravenous vancomycin. The audit periods were between 1st January 2019 and 30th June 2019, and between 1st August 2021 and 31st January 2022. Exclusion criteria were patients under Paediatric Haematology or Oncology, patients who received surgical prophylaxis doses or intrathecal doses. Full descriptive analyses were performed, with categorical variables reported as percentages. Statistical analyses and graphical production were performed using Microsoft Excel and R Data Software. No ethical approval was required for this study. Results A total of 57 patients were included. The demographics of the cohort were 5.6 years mean age, 42% female, 25-day mean length of stay, 2.3 mean co-morbidities. 94% had normal renal function. Mean CRP was 70. Sepsis was the most common indication. 75% had a blood culture taken, of which 12 were positive (11 vancomycin sensitive, 1 vancomycin resistant). Compliance to local trust dosing regimen was 80%. 22.6% of patients had a first trough level within therapeutic range, and 53.6% had a second trough level within therapeutic range after dose/frequency adjustments. The mean number of dosing/frequency adjustments required to reach therapeutic range was 1.2 adjustments. Conclusion This study highlights poor rates of achieving therapeutic vancomycin trough levels in children with normal renal function. Despite good compliance with local trust dosing regimens, which are higher than BNFc national guidance, only 22.6% achieved therapeutic trough levels initially, and 53.6% after dosing/frequency adjustments. Sub-therapeutic antibiotic levels can potentiate further antibiotic resistance,4 5 and our findings warrant urgent re-evaluation of current practices for intravenous vancomycin usage and dosing in children. References J Hoang, et al. Canadian Journal of Hospital Pharmacy 2014. C Nash, et al. Reports to the Neonatal and Paediatric Pharmacist Group January 2016. BMJ Group Pharmaceutical Press, British National Formulary for Children 2023. LM Weiner, et al. Infection Control & Hospital Epidemiology 2016. V Bakke, et al. Acta Anaesthesiologica Scandinavica 2017.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.043 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".