Vancomycin Associated Acute Kidney Injury: A Longitudinal Study in China

Abstract

Background: Vancomycin-associated acute kidney injury (VA-AKI) is a recognizable condition with known risk factors. However, the use of vancomycin in clinical practices in China is distinct from other countries. We conducted this longitudinal study to show the characteristics of VA-AKI and how to manage it in clinical practice.Patients and Methods: We included patients admitted to hospital, who received vancomycin therapy between January 1, 2016 and June 2019. VA-AKI was defined as a patient having developed AKI during vancomycin therapy or within 48 h following the withdrawal of vancomycin therapy.Results: A total of 3719 patients from 7058 possible participants were included in the study. 998 patients were excluded because of lacking of serum creatinine measurement. The incidence of VA-AKI was 14.3%. Only 32.3% (963/2990) of recommended patients performed therapeutic drug monitoring of vancomycin. Patients with VA-AKI were more likely to concomitant administration of cephalosporin (OR 1.55, 95% CI 1.08–2.21, p = 0.017), carbapenems (OR 1.46, 95% CI 1.11–1.91, p = 0.006) and piperacillin-tazobactam (OR 3.12, 95% CI 1.50–6.49, p = 0.002). Full renal recovery (OR 0.208, p = 0.005) was independent protective factors for mortality. Compared with acute kidney injury stage 1, AKI stage 2 (OR 2.174, p = 0.005) and AKI stage 3 (OR 2.210, p = 0.005) were independent risk factors for fail to full renal recovery.Conclusion: Lack of a serum creatinine measurement for the diagnosis of AKI and lack of standardization of vancomycin therapeutic drug monitoring should be improved. Patient concomitant with piperacillin-tazobactam are at higher risk. Full renal recovery was associated with a significantly reduced morality.

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

“…Among these, 261 studies were excluded for the following reasons: evaluating antibiotics other than vancomycin ( n = 104), evaluating outcomes other than AKI ( n = 45), not assessing risk factors ( n = 68), not original articles ( n = 4), involving paediatric patients ( n = 8), involving nonhuman subjects ( n = 12), overlapping study population ( n = 3), not a patient‐level analysis ( n = 1), involving patients who underwent renal replacement therapy ( n = 4), and data extraction not possible or feasible ( n = 12). Finally, 53 studies were included in the meta‐analysis 6–8,10–12,21–67 . A flow diagram summarizing the study selection process is shown in Figure 1.…”

Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application

“…The combination of vancomycin and piperacillin-tazobactam is among the most often prescribed antibiotic therapies in the hospital setting [47]. Previous clinical studies found that piperacillin-tazobactam carries a significantly higher risk of AKI than other comparator antibiotics when concurrently prescribed with vancomycin [16]. Although conflicting results exist [48,49], similar findings were reported in some review work, a meta-analysis [50], and a network meta-analysis [51].…”

“…The reported incidence of VA-AKI ranges from 5% to 43% according to various clinical settings and AKI definitions. More recently, many investigators recommend diagnosing VA-AKI using existing AKI criteria, such as RIFLE, AKIN, and KDIGO criteria [11,13,16]. Nevertheless, the coexistence of infections and other risk factors for AKI in most reported cases makes it hard to evaluate the true incidence rate of VA-AKI.…”

Impact of pharmacist intervention in reducing vancomycin‐associated acute kidney injury: A systematic review and meta‐analysis

“…Our previous cross‐sectional surveys of vancomycin‐associated AKI revealed that the main management barriers to reducing AKI were lack of standardization of vancomycin TDM and lack of SCr measurements for the diagnosis of AKI 45–47 . For patients who were recommended to monitor vancomycin trough concentration, the actual monitoring rate was only 26.3–32.5% 45–47 . Only 8.2–21.5% patients were monitored initially before the fourth or fifth vancomycin administration 46,47 .…”

“…53 However, the SCr of patients treated with vancomycin have not been adequately monitored. [45][46][47] Appropriate and timely monitoring of renal function contributes to the early and adequate diagnosis of AKI, the timely treatment of AKI, and ultimately improves the prognosis of patients. 50 In this meta-analysis, only 2 of the 34 studies reported the date of SCr monitoring, 11,18 which may imply that both pharmacists and physicians were not paying enough attention to the monitoring of renal function.…”