Factors associated with vancomycin nephrotoxicity in the critically ill

Hanrahan, T. P., Kotapati, C., Roberts, M. J., Rowland, J., Lipman, J., Roberts, J. A. and Udy, A. (2015) Factors associated with vancomycin nephrotoxicity in the critically ill. Anaesthesia and Intensive Care, 43 5: 594-599.

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Author Hanrahan, T. P.
Kotapati, C.
Roberts, M. J.
Rowland, J.
Lipman, J.
Roberts, J. A.
Udy, A.
Title Factors associated with vancomycin nephrotoxicity in the critically ill
Journal name Anaesthesia and Intensive Care   Check publisher's open access policy
ISSN 0310-057X
Publication date 2015-09
Year available 2015
Sub-type Article (original research)
Volume 43
Issue 5
Start page 594
End page 599
Total pages 6
Place of publication North Sydney, NSW Australia
Publisher Australian Society of Anaesthetists
Collection year 2016
Language eng
Formatted abstract
Vancomycin is a glycopeptide antibiotic commonly used in the management of methicillin-resistant Staphylococcus aureus infection. The recent increase in prevalence of methicillin-resistant Staphylococcus aureus with reduced susceptibility to vancomycin has prompted experts to advocate for higher target trough serum concentrations. This study aimed to evaluate the potential consequences of more aggressive vancomycin therapy, by examining the association between higher serum concentrations and acute kidney injury (AKI) in a population of critically ill patients. We collected data for all patients whoreceived vancomycin over a five-year period and evaluated the prevalence of new-onset AKI using the Risk, Injury, Failure, Loss and End-stage (RIFLE) kidney disease criteria. One-hundred and fifty-nine patients provided complete data, with 8.8% manifesting new onset AKI while receiving vancomycin. The median age was 57 (44 to 68) years, while the median trough serum concentration was 16 (10 to 19) mg/l. Multivariate logistic regression analysis identified mean trough concentration (OR=1.174, P=0.024), APACHE II score (OR=1.141, P=0.012) and simultaneous aminoglycoside prescription (OR=18.896, P=0.002) as significant predictors of AKI. These data suggest higher trough vancomycin serum concentrations are associated with greater odds of AKI in the critically ill.
Vancomycin is a glycopeptide antibiotic commonly used to treat methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci infections in the critically ill1,2. Recently, there has been an increase in the prevalence of methicillin-resistant Staphylococcus aureus with reduced susceptibility to vancomycin, with serum concentrations <10 mg/l associated with the emergence of vancomycin-resistant Staphylococcus aureus3. Subsequently, current consensus guidelines now recommend a target serum vancomycin trough concentration between 15 and 20 mg/l4. Given the historical target was 5 to 10 mg/l5, there is a relative paucity of data examining the effect of more aggressive drug exposures on the incidence of vancomycin-associated adverse effects, especially in the critically ill.
Vancomycin-associated nephrotoxicity has been reported in up to 40% of recipients, although the exact factors predictive of acute kidney injury (AKI) in this setting are still debated2. Current data suggests that higher daily doses, higher trough serum concentrations and increased duration of therapy are associated with nephrotoxicity6,7. Given the baseline risk of developing nephrotoxicity is between 36% and 67% in the critically ill (depending on the definition employed)8, there is an imperative to more specifically identify which factors are linked with vancomycin-associated AKI, in order to optimise clinical efficacy and safety when prescribing this agent.
As such, our aim was to examine the incidence of new-onset AKI in critically ill patients receiving vancomycin, admitted to a tertiary-referral hospital over a five-year period. Furthermore, we aimed to evaluate independent risk factors predictive of AKI in this cohort, with a view to informing future dosing practice.
Keyword Acute kidney injury
Intensive care unit
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
School of Pharmacy Publications
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Citation counts: TR Web of Science Citation Count  Cited 3 times in Thomson Reuters Web of Science Article | Citations
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