Name: Evaluation of Guideline-Recommended Weight-Based Initial Vancomycin Dosing in Septic Patients and the Effects on Therapeutic Level Achievement and Clinical Outcomes
Start: 2026-05-19T10:30:00-0400
End: 2026-05-19T10:50:00-0400

Evaluation of Guideline-Recommended Weight-Based Initial Vancomycin Dosing in Septic Patients and the Effects on Therapeutic Level Achievement and Clinical Outcomes

Tuesday May 19, 2026 10:30am - 10:50am EDT

a.Pavilion Hub WEST

Abstract Title: Evaluation of Guideline-Recommended Weight-Based Initial Vancomycin Dosing in Septic Patients and the Effects on Therapeutic Level Achievement and Clinical Outcomes
Purpose: This study was designed to evaluate guideline-recommended weight-based initial vancomycin dosing of 25 mg/kg in septic patients and the effects on therapeutic level achievement and clinical outcomes.
Methods: Institutional Review Board approval was obtained for this retrospective observational chart review. Patients were identified based on the order set utilized by providers for vancomycin loading dose. The order set used prior to September 2023 allowed providers to order a maximum loading dose of 1,500 mg, while the new sepsis order set guides providers to order 25 mg/kg loading doses with a maximum dose of 3,000 mg. Data was collected from March 1^st 2023, through March 31^st, 2025. The primary outcome is to determine if sufficient loading doses of vancomycin in septic patients result in faster achievement of therapeutic levels. Secondary outcomes include the rate of patients who experienced nephrotoxicity, time to administration of loading doses, length of stay, 30-day mortality, critical care admission, and the rate of MRSA bacteremia. Data analysis was completed with descriptive statistics, Wilcoxon Sum Rank test and Chi-squared test.
Results: Initial vancomycin doses of 25 mg/kg, based on total body weight, in septic patients results in faster therapeutic achievement (p-value 0.000004) and lower rates of acute kidney injuries (p-value 0.005). The time from order to administration of initial vancomycin doses in the post-implementation group was about 25 minutes faster than the pre-implementation group and was almost one day shorter for the average length of stay compared to the pre-implementation group. In the pre-implementation group, the average loading dose was 15.5 (SD of 3.1) and the average AUC was 365.3 mg/h/L (SD of 122.6). In the post-implementation group, the average loading dose was 20.1 (SD of 4.4) and the average AUC was 419.9 (SD of 95.2).
Conclusion: Increased initial vancomycin doses resulted in faster therapeutic achievement and lower rates of acute kidney injury. There were no statistically significant differences between 30-day mortality, admission to critical care unit, MRSA bacteremia, time from order to administration and length of stay. Results support updating non-sepsis vancomycin order sets to increase the initial dose, as well as promoting batching larger vancomycin doses.
Authorship: Paige de Fremery, PharmD; Miranda Cason, PharmD, BCPS; Troy Albrecht, PharmD, BCPS, BCIDP

Moderators

Tuesday May 19, 2026 10:30am - 10:50am EDT
a.Pavilion Hub WEST

Critical Care

PSHP 2026 Residency Conference

Meghin Haines

Samantha Macko, PharmD

Alyssa Polotti, PharmD, BCCCP

Paige de Fremery

Attendees (12)

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