The Association Between Serum Vancomycin Level and Clinical Outcome in Patients With Peritoneal Dialysis-Associated Peritonitis

2) We welcome first-time @ckd_ce author Jade Teakell PhD MD @jmteakell, #Nephrologist, Fellowship APD @UTKidney. This is another #tweetorial with 🆓 CE/#CME brought to you by the collaboration of @ckd_ce & @KIReports. No industry funding was provided for this program. pic.twitter.com/3aTaLp09c9

— @CKD_ce (@ckd_ce) February 14, 2024

4) #Peritonitis is a very serious complication of #PeritonealDialysis. Prompt identification & treatment are key. #Intraperitoneal (IP) #vancomycin is a 1st-line antimicrobial agent recommended by @ISPD1 to be given at the 1st suspicion of peritonitis.
🔓 https://t.co/6SIUEX8rD9 pic.twitter.com/Y1F3BXxvLc

— @CKD_ce (@ckd_ce) February 14, 2024

6a) Knowledge check: After a 4-6 hour dwell, how much Intraperitoneal (IP) #Vancomycin, is absorbed into systemic circulation?

— @CKD_ce (@ckd_ce) February 14, 2024

7a) But wait—there’s more!! What’s the target serum #vancomycin trough level for treatment of PD-associated #peritonitis?

— @CKD_ce (@ckd_ce) February 14, 2024

8) Here’s a table summary of prior studies comparing #Vancomycin level and peritonitis outcomes in #PeritonealDialysis (all retrospective): pic.twitter.com/dt6G5dDKZa

— @CKD_ce (@ckd_ce) February 14, 2024

9b) . . . and that higher peritoneal solute transport status was associated with suboptimal trough serum levels on day 5.https://t.co/uw2OY7ybNJ pic.twitter.com/qE1mjhtgFx

— @CKD_ce (@ckd_ce) February 14, 2024

11) Secondary objective:
Investigate confounders (e.g. #eGFR, body weight) that might affect the association between nadir trough level and likelihood of cure.

— @CKD_ce (@ckd_ce) February 14, 2024

13) Variables:
Exposure = nadir serum vanc level (lowest recorded during treatment episode)
Outcome = composite relapse/recurrent #peritonitis, catheter removal, transfer to #HD, or death
Covariates = index demographics, clinical data (wgt, eGFR, time on PD, infectious organism)

— @CKD_ce (@ckd_ce) February 14, 2024

15) The mean nadir vanc level =16.4 (4.8) mg/l.
The average # of vanc levels measured = 2.3
(similar between those who experienced cure and those who did not, 2.18 vs 2.68). pic.twitter.com/0xMAUNvuJk

— @CKD_ce (@ckd_ce) February 14, 2024

17) After adjustment for age, sex, wgt, eGFR, days on #PD (covariates not independently associated with outcome) …
Nadir vanc level ≥15 mg/L → 7.5 times more likely to experience cure compared to those w/ nadir level <15 mg/l
OR 7.58, 95%CI 1.71–33.57
P = 0.008 pic.twitter.com/h08EJslMF8

— @CKD_ce (@ckd_ce) February 14, 2024

19) Study limitations:
🤔 Single center
🤔 Small sample size
🤔 No comorbidity information
🤔 No cases with #MRSA
🤔 Frequency/timing of vanc levels not standardized

— @CKD_ce (@ckd_ce) February 14, 2024

21) ✅ In agreement with prior @ISPD1 peritonitis guidelines, target for serum vancomycin level
Check out this awesome #VisualAbstract by @ckd_ce faculty @brian_rifkin 👇 pic.twitter.com/bOoQwFvwNt

— @CKD_ce (@ckd_ce) February 14, 2024

23) Thank you! This #KIReports #Tweetorial brought to you by @jmteakell for the @KIReports Social Media Team, have a great day!https://t.co/G1m5iYuTVMhttps://t.co/Zap2Al75YOhttps://t.co/eXdinpTAQ2@ghobby @Sophia_Kidney #NephTwitter #MedTwitter

— @CKD_ce (@ckd_ce) February 14, 2024