Risk factors for vancomycin‐associated acute kidney injury: A systematic review and meta‐analysis

Abstract

and obesity (OR 1.46, 95% CI: 1.12-1.90) were associated with an increase in vancomycin-associated AKIs. In terms of vancomycin-related factors, longer treatment duration (>14 d; OR 1.73, 95% CI: 1.06-2.83), serum vancomycin trough level >15 μg/mL (OR 2.10, 95% CI: 1.43-3.07) and vancomycin trough level >20 μg/mL (OR 2.84, 95% CI: 1.48-5.44) increased the risks of vancomycin-associated AKI. For comorbidities and clinical factors, renal disease (OR 2.19, 95% CI: 1.51-3.17) showed the highest odds of vancomycin-associated AKI, followed by hepatic disease, intensive care unit admission, heart failure, sepsis, coronary heart disease and diabetes mellitus. For concomitant nephrotoxic drugs, amphotericin B (OR 5.21, 95% CI: 3.44-7.87) showed the highest odds of vancomycin-associated AKI, followed by acyclovir (OR 3.22, 95% CI: 1.39-7.46), vasopressors, loop diuretics, piperacillintazobactam and aminoglycoside. The use of any concomitant nephrotoxic agent (OR 1.74, 95% CI: 1.17-2.58) increased the odds of vancomycin-associated AKI. Conclusion:Our results may help predict the risk of vancomycin-associated AKI in the clinical setting. K E Y W O R D S acute kidney injury, meta-analysis, risk factors, systematic review, vancomycin 1 | INTRODUCTION Vancomycin is a glycopeptide antibiotic agent used to treat severe infections, such as sepsis, osteomyelitis or pneumonia caused by methicillin-resistant Staphylococcus aureus. 1 Acute kidney injury (AKI) is a well-known adverse drug reaction of vancomycin. Estimates of the incidence of vancomycin-associated AKI vary from 5 to 43%. 2Since AKI has a significant impact on clinical outcomes, such as length of hospital stay or overall mortality, it is crucial to decrease the AKI incidence in hospitals. [3][4][5] Several studies have reported risk factors for vancomycinassociated AKI. [6][7][8][9][10][11][12] The reported risk factors are diverse, including patient factors (e.g., sex, body weight and race), drug-related factors (e.g., dose and duration of vancomycin) and concomitant drug factors

Risk factors for acute kidney injury associated with intravenous vancomycin in neurosurgical inpatients: a retrospective study

“…The use of loop diuretics also significantly increases the risk of VA-AKI, consistent with previous findings [ 7 ]. Prerenal factors lead to inadequate renal perfusion by decreasing the body's effective circulating blood volume, consequently resulting in AKI [ 16 – 18 ].…”

“…Previous reports have shown that the incidence of VAN-associated AKI (VA-AKI) varies widely among different patient groups, ranging from 5 to 43% [ 6 ]. A meta-study discovered that independent risk factors for VAN-related nephrotoxicity included VAN serum trough concentrations, treatment duration and intensive care unit (ICU) stay, and concomitant use of nephrotoxic medications (acyclovir, aminoglycosides, amphotericin B, loop diuretics, piperacillin-tazobactam and vasopressor medications) [ 7 ]. Diabetes mellitus, heart disease, liver disease, kidney disease and sepsis can also contribute to kidney damage [ 8 ].…”

Vancomycin AUC-Based Dosing Practices in a Non-Teaching Community Hospital and Associated Outcomes: A One-Year Survey of Uniform Targets for Infections with or without MRSA

“…The rates of AKI in our patients with MRSA (3.6%) were higher than the reported rates of AKI in 1 to 1.4% of patients in another study when vancomycin AUC was limited to less than 600 [ 19 ]. A higher rate of poly-microbial infections in the MRSA group, which resulted in concomitant piperacillin–tazobactam use, may have contributed to inflating the rate of AKI in our study [ 26 , 27 , 28 , 29 , 30 ]. Interestingly, regarding acute kidney injury rates, in studies involving non-MRSA or non-serious MRSA, significantly higher rates have been reported for patients with non-MRSA compared to patients with MRSA.…”

Mismatch rate of empirical antimicrobial treatment in fracture-related infections

“…One advantage of vancomycin is its effectiveness against methicillin-resistant staphylococci, and for that reason, Triffault-Fillit et al 23 recommended vancomycin as empirical therapy to cover methicillin-resistant coagulasenegative staphylococci in PJI patients. On the other hand, disadvantages of vancomycin are the high risk of complications, such as acute kidney injury 27 and its potentially inferior effectiveness against methicillin-sensitive S. aureus. 28,29 Vancomycin treatment also needs therapeutic drug monitoring.…”