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Antimicrobial Agents and Chemotherapy, September 2001, p. 2460-2467, Vol. 45, No. 9
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.9.2460-2467.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Continuous versus Intermittent Infusion of Vancomycin in Severe Staphylococcal Infections: Prospective Multicenter Randomized Study

Marc Wysocki,1,* Frederique Delatour,2 François Faurisson,2 Alain Rauss, Yves Pean,4 Benoit Misset,5 Frank Thomas,6 Jean-François Timsit,7 Thomas Similowski,8 Herve Mentec,9 Laurence Mier,10 Didier Dreyfuss,10 and The Study Groupdagger

Medico-Surgical Intensive Care Unit1 and Microbiology,4 Institut Mutualiste Montsouris, Medico-Surgical Intensive Care Unit, Hôpital Saint-Joseph,5 Medico-Surgical Intensive Care Unit, Hôpital de Diaconesses,6 INSERM U132 and Infectious Diseases Critical Care Unit,7 Hôpital Bichat-Claude Bernard, and Respiratory Intensive Care Unit, Hôpital de la Pitié-Salpêtrière,8 Paris, Medico-Surgical Intensive Care Unit, Hôpital V. Dupouy, Argenteuil,9 and Medical Intensive Care Unit, Hôpital Louis Mourier, Colombes,10 France

Received 28 June 2000/Returned for modification 2 January 2001/Accepted 5 June 2001

A continuous infusion of vancomycin (CIV) may provide an alternative mode of infusion in severe hospital-acquired methicillin-resistant staphylococcal (MRS) infections. A multicenter, prospective, randomized study was designed to compare CIV (targeted plateau drug serum concentrations of 20 to 25 mg/liter) and intermittent infusions of vancomycin (IIV; targeted trough drug serum concentrations of 10 to 15 mg/liter) in 119 critically ill patients with MRS infections (bacteremic infections, 35%; pneumonia, 45%). Microbiological and clinical outcomes, safety, pharmacokinetics, ease of treatment adjustment, and cost were compared. Microbiological and clinical outcomes and safety were similar. CIV patients reached the targeted concentrations faster (36 ± 31 versus 51 ± 39 h, P = 0.029) and fewer samples were required for treatment monitoring than with IIV patients (7.7 ± 2.2 versus 11.8 ± 3.9 per treatment, P < 0.0001). The variability between patients in both the area under the serum concentration-time curve (AUC24h) and the daily dose given over 10 days of treatment was lower with CIV than with IIV (variances, 14,621 versus 53,975 mg2/liter2/h2 [P = 0.026] and 414 versus 818 g2 [P = 0.057], respectively). The 10-day treatment cost per patient was $454 ± 137 in the IIV group and was 23% lower in the CIV group ($321 ± 81: P < 0.0001). In summary, for comparable efficacy and tolerance, CIV may be a cost-effective alternative to IIV.

* Corresponding author. Mailing address: Réanimation Polyvalente, Institut Mutualiste Montsouris, 42 Bd. Jourdan, 75674 Paris Cedex, France. Phone: 331.56.61.61.79. Fax: 331.56.61.61.99. E-mail: marc.wysocki{at}imm.fr.

dagger The members of the study group are listed in an appendix at the end of the text.

Antimicrobial Agents and Chemotherapy, September 2001, p. 2460-2467, Vol. 45, No. 9
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.9.2460-2467.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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