Published online Nov 26, 2018. doi: 10.4330/wjc.v10.i11.234
Peer-review started: July 10, 2018
First decision: August 2, 2018
Revised: September 2, 2018
Accepted: October 11, 2018
Article in press: October 11, 2018
Published online: November 26, 2018
Processing time: 140 Days and 3.6 Hours
Based on evidence suggesting that Staphylococcus aureus exposure to low vancomycin concentrations can produce vancomycin-resistant strains, it is recommended that trough therapeutic serum concentrations of vancomycin are maintained above 10 mg/L.
There are no recommendations in the literature indicating target vancomycin concentrations to maintain intraoperatively for effective antimicrobial prophylaxis.
The aim of this prospective study was to evaluate the incidence and risk factors for vancomycin concentrations under 10 mg/L in adult patients undergoing cardiac surgery.
In this study, the frequency of suboptimal vancomycin levels intraoperatively was investigated in samples collected from cardiac surgery patients receiving a single 1000 mg vancomycin dose.
We found an incidence of intraoperative potentially suboptimal concentrations of vancomycin in almost 50% of these patients. The multivariate analysis identified female gender, body mass index > 25, and creatinine clearance above 70 mL/min as risk factors for vancomycin levels less than 10 mg/L.
Although we arbitrarily considered vancomycin levels of 10 mg/L as a cut-off, the findings of our study are interesting because they suggest a high incidence of potentially suboptimal serum concentrations in the case of antimicrobial prophylaxis.
Further studies will be necessary to define the cut-off of intraoperative vancomycin levels representing the optimal concentration of vancomycin for appropriate antimicrobial prophylaxis in patients undergoing cardiac surgery.