Continuous infusion of vancomycin in septic patients receiving continuous renal replacement therapy.

Vancomycin is frequently administered as a continuous infusion to treat severe infections caused by Gram-positive bacteria. Previous studies have suggested a loading dose of 15 mg/kg followed by continuous infusion of 30 mg/kg in patients with normal renal function; however, there are no dosing recommendations in patients with renal failure undergoing continuous renal replacement therapy (CRRT). Data from all adult septic patients admitted to a Department of Intensive Care over a 3-year period in whom vancomycin was given as a continuous infusion were reviewed.

Determinants of early inadequate vancomycin concentrations during continuous infusion in septic patients.

Vancomycin is frequently administered to critically ill patients by continuous infusion in order to optimise drug efficacy; however, there are few data available on the efficacy of this strategy in septic patients. In this retrospective analysis, 261 patients treated with continuous infusion of vancomycin in the Department of Intensive Care at Hôpital Erasme (Brussels, Belgium) were evaluated. Creatinine clearance (CL(Cr)) was calculated from 24-h urine collection and normalised to body surface area.

Evolving concepts in sepsis definitions.

Developing effective therapies for any disease process relies on the ability to clearly define the population of patients who will benefit from that intervention. Advances in our understanding of sepsis pathogenesis have made it clear that the global definition or concept of sepsis as a single, homogeneous disease process is inadequate. The idea that all patients who have severe sepsis will respond positively to any single therapeutic intervention is probably too simple, although some interventions may target more general pathways and be globally beneficial.

Evolving concepts in sepsis definitions.

Standardization of definitions has been considered important in sepsis to facilitate accurate diagnosis and treatment, to clarify patient inclusion criteria for clinical trials, and to enable comparison of results from different studies. However, despite development and publication of consensus conference definitions, diagnosis of sepsis remains difficult in clinical practice and many patients do not receive the early specific therapy that could benefit them. Concepts of sepsis need to evolve such that good global definitions are accompanied by better strategies for individual diagnosis and disease characterization; patients can then be treated rapidly and appropriately to maximize their chances of survival.