Assessment of vancomycin utilization in intensive care unit patients of a tertiary care hospital in the United Arab Emirates

Background: Adequate dosing and monitoring of vancomycin serum concentrations is necessary to maximize efficacy, minimize toxicity, and reduce the emergence of resistance. The aim of this study was to assess vancomycin dosing, administration and monitoring among adult and pediatric patients admitted to the intensive care unit. Methods: A retrospective, cohort study performed from October 2020- October 2022 in a tertiary care hospital in the UAE. All patients received an IV vancomycin for a systemic bacterial infection. Results: Only 18.1% of the patients received loading doses. In 75.5% of the study population, vancomycin was started empirically. 55.4% of the patients had their trough levels measured, 61% of them had only 1 trough level measured, and the rest had more than 1 trough measured. Trough level was outside the target range in 50.6% of the patients. Obtaining the trough level before the 4th dose occurred in the majority (68.8%) of the patients. Nephrotoxicity occurred for 5.8% of the patients while receiving vancomycin. 61.2% of the patients did not have adequate renal function monitoring for patients who are on vancomycin. Total vancomycin appropriateness was achieved in only 16.7% of the patients which was mainly due to total trough inappropriateness. Conclusion: This study demonstrates a disparity in the proper utilization of vancomycin according to international guidelines within the included tertiary care hospital. It underscores the necessity for the development of dosing and monitoring protocols tailored to the utilization of vancomycin in these healthcare facilities.