Vancomycin associated acute kidney injury in pediatric patients

Moffett, Brady S.; Morris, Jennifer; Kam, Charissa; Galati, Marianne; Dutta, Ankhi; Akcan-Arikan, Ayse

doi:10.1371/journal.pone.0202439

Cited by 23 publications

(21 citation statements)

References 45 publications

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“…The systematic review demonstrated that the median incidence of v-AKI was 11.8%16–40 (range 1.6–27.2) 22 34. Six specific risk factors were reported by two or more papers to be statistically significantly associated with v-AKI and are described as follows.…”

Section: Resultsmentioning

confidence: 99%

Vancomycin-associated acute kidney injury epidemiology in children: a systematic review

et al. 2022

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IntroductionVancomycin is a recognised cause of drug-induced acute kidney injury (AKI).ObjectiveThe aim of this systematic review was to summarise the incidence of, and the risk factors for, vancomycin-associated AKI (v-AKI) in children.DesignA systematic search was performed in November 2020 on the search engines PubMed, Web of Science and Medline, using predefined search terms. The inclusion criteria were primary paediatric studies, intervention with vancomycin and studies that included AKI as an outcome. Study quality was assessed using the relevant Critical Appraisal Skills Programme checklist. The data are reported using descriptive statistics.Results890 studies were identified and screened with 25 studies suitable for inclusion. A cohort of 12 730 patients with v-AKI were included and the incidence of v-AKI in children was found to be 11.8% (1.6%–27.2%). The median age of the cohort was 2.5 years (range 0–23) and 57% were male patients. Risk factors that increased the likelihood of v-AKI were concomitant use of nephrotoxic medications, increased trough concentrations and, to a lesser extent, increased dose, longer duration of treatment, impaired renal function and if the patient required paediatric intensive care.ConclusionsThe incidence of v-AKI in children is significant and methods to reduce this risk should be considered. Further prospective interventional studies to understand the mechanisms of nephrotoxicity from vancomycin are needed and targeting risk factors may make vancomycin administration safer.

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Section: Resultsmentioning

confidence: 99%

Vancomycin-associated acute kidney injury epidemiology in children: a systematic review

et al. 2022

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“…1). Of note, 4 pediatric studies were excluded because comparator groups were not well defined and/or the duration of exposure to concomitant vancomycin and TZP was not reported (12,(25)(26)(27).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of the Association of Acute Kidney Injury with the Concomitant Use of Vancomycin and Piperacillin-Tazobactam in Children

Kalligeros

Karageorgos

Shehadeh

et al. 2019

Antimicrob Agents Chemother

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Concomitant use of vancomycin plus piperacillin-tazobactam (TZP) has been associated with increased risk of acute kidney injury (AKI) in hospitalized adults. In this systematic review and meta-analysis, we searched PubMed and EMBASE for pediatric studies examining this hypothesis, with reference to vancomycin monotherapy or in combination with another beta-lactam antibiotic. Of 1,381 nonduplicate studies, 10 met our inclusion criteria. We performed a random-effects meta-analysis, based on crude odds ratios (ORs), and we accounted for both quality of included studies and publication bias. In primary analysis, concomitant vancomycin and TZP use yielded a statistically significant association with the development of AKI. More specifically, children with AKI had higher odds of having been exposed to vancomycin plus TZP than to vancomycin monotherapy (OR, 8.15; 95% confidence interval [CI], 3.49 to 18.99) or to vancomycin plus any other beta-lactam antibiotic (OR, 3.48; 95% CI, 2.71 to 4.46). On the basis of the results of the Newcastle-Ottawa scale quality assessment, a secondary analysis that included only higher-quality studies (6 of 10 studies) again yielded higher odds of exposure to vancomycin plus TZP than to vancomycin plus another beta-lactam antibiotic (OR, 3.76; 95% CI, 2.56 to 5.51). Notably, even after controlling for possible publication bias, our results remained statistically significant (OR, 3.09; 95% CI, 2.30 to 4.14). In conclusion, the concomitant use of vancomycin and TZP could be associated with AKI development and the clinical significance of this potential association needs to be studied further in the pediatric population.

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“…A previous study with pediatric patients reported acute kidney injury related to vancomycin use in 12.2% of the patients, a higher figure than that found in our study; however, this difference can be related to the difference in the number of patients studied and to differences in the age group. 25 The low death rate of the sample showed high effectiveness in treating neonates with sepsis. Of the cases that progressed to death, 2 patients presented positive blood cultures for S. epidermidis, 1 for CNS, and there was 1 case with negative blood culture.…”

Section: Rbfhssmentioning

confidence: 90%

Resistance to antimicrobials and vancomycin treatment in neonatal sepsis in a hospital in Brazil

Silveira¹,

Lima²,

Santos-Borowicz³

et al. 2020

Rev Bras Farm Hosp Serv Saude

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Objective: To describe the antimicrobial resistance profile of strains isolated from neonates with septicemia undergoing vancomycin treatment, to determine the agreement of treatment with guideline and blood cultures, to assess the presence of acute kidney injury (AKI) and the clinical outcome in a hospital in Brazil. Methods: A total of 51 newborns treated with vancomycin were studied in the period from January to December 2017. Treatment assessment was verified by the compliance with the Rational Use and Insurance Policy of Antibiotics in Neonatology and blood culture. The presence of AKI was based on the results of serum creatinine. The data were monitored by the computerized system of the laboratory. Results: The main isolated strain was Staphylococcus (coagulase negative) (82.9%), 93.5% with resistance to oxacillin for early infections and 100% for late infections. The same strain showed 54.8% resistance to gentamicin for cases of early sepsis and 66.6% for late sepsis. There were no cases of resistance to vancomycin. The treatments agreed with the reference protocol in 46.3% and with the results of blood cultures in 56%. Only two cases of AKI are observed. Conclusions: The oxacillin-resistant coagulase-negative staphylococcus strains were the main causes of neonatal sepsis. The use of gentamicin for sensitive strains may reduce the use of vancomycin. The results suggest the need for better standardization of the treatment to reduce the risk of toxicity and rational use of therapeutic resources.

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Vancomycin associated acute kidney injury in pediatric patients

Cited by 23 publications

References 45 publications

Vancomycin-associated acute kidney injury epidemiology in children: a systematic review

Vancomycin-associated acute kidney injury epidemiology in children: a systematic review

Systematic Review and Meta-analysis of the Association of Acute Kidney Injury with the Concomitant Use of Vancomycin and Piperacillin-Tazobactam in Children

Resistance to antimicrobials and vancomycin treatment in neonatal sepsis in a hospital in Brazil

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