Intravenous Vancomycin Associated With the Development of Nephrotoxicity in Patients With Class III Obesity

Choi, Yoon Hee; Saw, Stephen; Soliman, Daniel; Bingham, Angela L.; Pontiggia, Laura; Hunter, Krystal; Chuang, Linda C.; Siemianowski, Laura A.; Ereshefsky, Benjamin; Hollands, James M.

doi:10.1177/1060028017720946

Cited by 34 publications

(30 citation statements)

References 16 publications

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“…There have been studies on the risk factors for VA-AKI in the past [22][23][24]. Like previous studies, a positive correlation between VA-AKI and increasing vancomycin trough concentrations and baseline serum creatinine was found in this study.…”

Section: Discussionsupporting

confidence: 85%

“…In this study, we found age was correlated with VA-AKI, yet compared with new-borns and infants age group, older age group had less OR for development of VA-AKI. Concomitant administration of diuretics, PTZ and meropenem could increase the incidence of nephrotoxicity [22,26,27], except concomitant NSAIDs seems to have a protective role for VA-AKI. In each age group, VA-AKI incidence was lower in patients with concomitant NSAIDs.…”

Section: Discussionmentioning

confidence: 99%

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Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

et al. 2020

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Background:To study the incidence of vancomycin-associated acute kidney injury (VA-AKI) in Hong Kong and identify risk factors for VA-AKI. Method: Patients with vancomycin prescription and blood level measurement in 2012-2016 were identified using the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System. Acute kidney injury was defined using KDIGO criteria. Patients without creatinine measurements, steady-state trough vancomycin level or who had vancomycin treatment < 3 days were excluded. Results were analyzed using SPSS version 22.0. Logistic regression was used to identify the predictors for VA-AKI. Odds ratio and 95% confidence interval were estimated. Results: One thousand four hundred fifty patients were identified as VA-AKI from 12,758 records in Hong Kong in 2012-2016. The incidence was respectively 10.6, 10.9, 11.3, 12.2, 11.2% from 2012 to 2016. The incidence of VA-AKI was 16.3, 12.2, 11.3 and 6.2% in patients aged 1-12, 12-60, elderly aged > 60 and newborn and infants, respectively. Baseline creatinine, serum trough vancomycin level, systematic disease history including respiratory failure, hypertension, congestive heart failure, chronic renal failure, anemia and type II diabetes, and concomitant diuretics, piperacillin-tazobactam (PTZ) and meropenem prescription were significantly higher in VA-AKI patients older than 12 years. Logistic regression showed that older age group, higher baseline creatinine, serum trough vancomycin level, respiratory failure, chronic renal failure and congestive heart failure, concomitant diuretics, PTZ and meropenem prescription, and longer hospital stay were all associated with increased risk of VA-AKI. Conclusion: The incidence of VA-AKI in Hong Kong is low but shows no decline. Patients with higher baseline creatinine, multi-organ diseases and multiple drugs administration should have their vancomycin level monitored to decrease the risk of VA-AKI.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

et al. 2020

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“…Data suggesting a causal relationship between doses and therapeutic targets of vancomycin and nephrotoxicity are conflicting and marked by confounding factors . Although there is minimal evidence supporting efficacy in maintaining therapeutic levels between 15 and 20 mg/L, several studies have evaluated the safety of this recommendation, comparing nephrotoxicity rates above and below 15 mg/L levels . A systematic review and a meta‐analysis conducted by van Hal et al included 15 studies in which trough serum levels of vancomycin ≥15 mg/L were associated with a higher risk of nephrotoxicity when compared to levels <15 mg/L (OR 2.67, P < 0.01).…”

Section: Vancomycinmentioning

confidence: 93%

“…The incidence of nephrotoxicity caused by vancomycin varies greatly among various studies, with rates as low as zero in the absence of other concomitant nephrotoxins, up to 40% in combination with other potentially nephrotoxic drugs, with a higher prevalence frequently described from 5% to 7%, involving different factors that may speed up or enhance the occurrence of nephrotoxicity, which may be related to the patient and/or the drug . Among the patient‐related factors, the most important are advanced age, reduced kidney function, dehydration, reduced renal mass, sex (women have lower muscle mass and body water quantity), obesity, hypoalbuminemia, and sepsis, while drug‐related risk factors include administration concomitant with other nephrotoxic drugs such as aminoglycosides, loop diuretics, amphotericin B, piperacillin‐tazobactam, acyclovir, vasopressors and intravenous contrast media; as well as long treatment duration and high serum dosage of this antimicrobial …”

Section: Vancomycinmentioning

confidence: 99%

“…A retrospective study conducted by Choi et al identified in 62 cases of nephrotoxicity that 8.7% of them occurred in non‐obese individuals, 14.3% in patients with obesity class I and II, and 26.3% in patients with obesity class III ( P = 0.002). Patients with obesity class III presented three times more nephrotoxicity when compared to non‐obese patients (OR 2.99, CI 1.12‐7.94), and patients with obesity class I and II (OR 3.14, CI 1.27‐7.75).…”

Section: Vancomycinmentioning

confidence: 99%

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Vancomycin dosing, monitoring and toxicity: Critical review of the clinical practice

Zamoner

Prado

Balbi

et al. 2019

Clin Exp Pharma Physio

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Summary Vancomycin is an antibiotic used in the treatment of infections caused by multidrug‐resistant Gram‐positive bacteria, especially methicillin‐resistant Staphylococcus aureus. In the last decades, vancomycin has been widely used in hospital environments due to the increasing incidence of sepsis and septic shock. Sepsis may lead to multiple organ failure; it is considered a risk factor for the development of acute kidney injury (AKI), with an overall mortality rate of around 45%, which can reach the surprising rate of 70% with the combination of AKI and sepsis. Considering the high mortality rate of sepsis and its related costs of hospitalization and treatment, specific measures should be adopted, such as early‐goal treatment protocols: proper and early administration of antimicrobials, fluids, vasoactive drugs and transfusion support. Besides the careful selection of the antimicrobial, another concern related to critically ill patients is the proper dose of the antimicrobial, since pharmacokinetic changes are observed due to drug absorption, distribution, metabolism and elimination. Gram‐positive pathogens are very common in hospitalized patients with septic shock, so vancomycin has been the antimicrobial of choice for more than 60 years. However, discussions about its dosage, administration and monitoring are extremely important, considering the risk of nephrotoxicity and the emergence of resistant S. aureus. This narrative review aims to discuss controversial aspects related to the efficacy and safety of vancomycin, correlating them with data available in the literature and identifying knowledge gaps in guide future lines of research.

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The Influence of a Therapeutic Drug Monitoring Service on Vancomycin‐Associated Nephrotoxicity

Yang,

Brett,

Sordo

et al. 2023

The Journal of Clinical Pharma

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Vancomycin's widespread use as the mainstay antibiotic against methicillin‐resistant Staphylococcus aureus infections is complicated by its narrow therapeutic index. Therapeutic drug monitoring (TDM) using area‐under the concentration curve (AUC)‐guided dosing is recommended to optimise therapy and prevent vancomycin‐associated nephrotoxicity (VAN). In 2018, a consultative TDM Advisory Service (the Service) was piloted at an Australian hospital to enable AUC‐guided vancomycin dosing. This study sought to compare the incidence of VAN pre‐ and post‐Service implementation. A 4‐year retrospective observational study of intravenous vancomycin therapy (>48 hours) in adults (≥18 years), spanning 3‐years pre‐ and 1‐year post‐implementation of the Service was undertaken. Nephrotoxicity was defined as an increase in serum creatinine concentrations of ≥26.5 μmol/L or ≥50% from baseline, on ≥2 consecutive days. Univariate analysis was performed to compare patients pre‐ and post‐implementation, and with and without VAN. Independent factors associated with VAN were identified using a multivariate model. In total, 971 courses of vancomycin therapy, administered to 781 patients, were included; 764 courses (603 patients) pre‐implementation and 207 courses (163 patients) post‐implementation. The incidence of VAN decreased by 5% post‐Service implementation [15% pre‐implementation vs 10% post‐implementation; p = 0.075). Independent factors associated with VAN were sepsis, heart failure, solid organ transplant, concomitant piperacillin‐tazobactam, and average vancomycin AUC during therapy. In conclusion, there was a non‐significant trend towards a reduced incidence of VAN after the Service. Larger, prospective studies are needed to confirm the efficacy of the Service.This article is protected by copyright. All rights reserved

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Intravenous Vancomycin Associated With the Development of Nephrotoxicity in Patients With Class III Obesity

Abstract: Obesity and other factors are associated with a higher risk of vancomycin-associated nephrotoxicity.

Cited by 34 publications

References 16 publications

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

Vancomycin dosing, monitoring and toxicity: Critical review of the clinical practice

The Influence of a Therapeutic Drug Monitoring Service on Vancomycin‐Associated Nephrotoxicity

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