Vancomycin Loading Doses in Septic Patients

Abstract

Objectives: To (1) characterize loading doses of vancomycin administered to patients with sepsis and (2) evaluate the relative impact of loading dose on clinical outcomes between patients who received a 1 gram loading dose or any other amount. Methods: Retrospective, observational chart review of adult patients who received vancomycin for treatment of sepsis through emergency department triage. Data from November 2013 through March 2014 were obtained for timing and administration of vancomycin as well as clinical outcomes: survival; length of hospitalization and intensive care unit (ICU) stay; need for mechanical ventilation. Results: Sepsis-related hospital encounters were identified for 123 patients, of which 114 charts were fully able to be evaluated. The majority of patients (84.21%) received a 1 gram loading dose as opposed to any other amount (p=0.001); few patients (1.75%) received a dose within 25-30 mg/kg. No significant differences in trends for timing of administration, inpatient survival, duration of hospital stay, or need for mechanical ventilation were identified between patients who received 1 gram doses or any other amount. Greater effective vancomycin loading doses were associated, albeit not significantly, with shorter durations of hospitalization, ICU admissions, and mechanical ventilation. Conclusions: Despite weight-based loading dose recommendations, vancomycin was frequently administered as a fixed 1 gram loading dose to patients with sepsis. However, there was little distinguishable impact on clinical outcomes in this preliminary study.