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Vancomycin AND Nephrotoxicity

Talal Alzahrani, Angelike P Liappis, Larry M Baddour, Pamela E Karasik
BACKGROUND: Cefazolin is used as standard preoperative prophylaxis for a variety of surgical procedures that involve the skin. In contrast, vancomycin is recommended for a minority of patients, specifically those with an IgE-mediated allergy to beta-lactams and considered in patients with known colonization with methicillin-resistant Staphylococcus aureus or at high risk for such. Vancomycin, however, has been overprescribed, has nephrotoxicity risk, and may be less effective due to its inferior coverage of methicillin-susceptible S...
September 17, 2018: Pacing and Clinical Electrophysiology: PACE
Atsushi Komoto, Takayoshi Maiguma, Daisuke Teshima, Tetsuhiro Sugiyama, Yuto Haruki
OBJECTIVE: We conducted a retrospective study based on composite endpoints for treatment failure to evaluate the effect of pharmacist-led VCM initial dose planning for Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia patients. METHODS: A retrospective cohort study was performed between pharmacist intervention and non-intervention groups. In this study, four types of failure were defined as the composite endpoint. When any one of the following failures occurred: 1) Death within 30 days from the start of VCM therapy, 2) Positive blood culture 7 days after the start of VCM therapy, 3) Change of VCM to another anti-MRSA agent, and 4) Development of nephrotoxicity, we considered that VCM treatment had failed...
2018: PloS One
Bryan T Mogle, Jeffrey M Steele, Robert W Seabury, Utkarsh J Dang, Wesley D Kufel
Limited evidence exists evaluating pharmacokinetic thresholds for vancomycin efficacy and nephrotoxicity using non-Bayesian methods. The objective of this study was to evaluate 24-hour steady-state vancomycin area under the concentration-time curve (AUC24 ) thresholds for efficacy and nephrotoxicity in patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia (MRSA-B) after implementing two-point pharmacokinetic therapeutic drug monitoring (TDM). A single-center, retrospective cohort study was performed that included adult patients admitted between June 1, 2016 - January 1, 2018 with MRSA-B treated with vancomycin for ≥72 hours...
August 31, 2018: International Journal of Antimicrobial Agents
Diana J Schreier, Kianoush B Kashani, Ankit Sakhuja, Kristin C Mara, Mohammad S Tootooni, Heather A Personett, Sarah Nelson, Andrew D Rule, James M Steckelberg, Aaron J Tande, Erin F Barreto
Background: Nephrotoxins contribute to 20-40% of acute kidney injury (AKI) cases in the intensive care unit (ICU). The combination of piperacillin/tazobactam and vancomycin (PTZ/VAN) has been identified as nephrotoxic, but existing studies focus on extended durations of therapy rather than the brief empiric courses often used in the ICU. Objective: Compare the risk of AKI with a short course of PTZ/VAN to other anti-pseudomonal beta-lactam/vancomycin combinations...
August 24, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Ling-Ling Zhu, Quan Zhou
Background: Sporadic studies in antimicrobial therapy have evaluated the effects of infusion rates on therapeutic and economic outcomes, and new findings may challenge the regular infusion regimen. Methods: Focusing on studies comparing the outcomes of different infusion regimens, the relevant literature was identified by searching PubMed, Web of Science, and Scopus from January 1, 2013 to March 1, 2018. Papers were finally chosen using a PRISMA flowchart. Results: Antimicrobials with the superiority of prolonged infusion to standard infusion in terms of efficacy and safety include meropenem, doripenem, imipenem, cefepime, ceftazidime, piperacillin/tazobactam, linezolid, and vancomycin...
2018: Infection and Drug Resistance
Min Huang, Hao Wu, Jing Zhou, Min Xu, Suming Zhou
BACKGROUND: Vancomycin is widely used for infections caused by gram-positive bacteria, but little attention has been paid to vancomycin in the treatment of critically ill patients aged ≥80 years. The aim of the current study was to investigate the efficacy of vancomycin and risk factors associated with nephrotoxicity of vancomycin in elderly critically ill patients. METHODS: A retrospective study was performed in a 14-bed medical-surgical geriatric ICU between January 2007 and June 2014...
August 1, 2018: Archives of Iranian Medicine
Jaime Barceló-Vidal, Eva Rodríguez-García, Santiago Grau
Vancomycin has usually been associated with nephrotoxicity. Generally, this toxicity is presented as proximal tubular cells injury with or without necrosis and as acute interstitial nephritis. However, development of both lesions is uncommonly described in literature. We present a case of vancomycin-induced nephrotoxicity resulting in both acute interstitial nephritis and tubular cells damage confirmed by renal biopsy. Peak and trough levels of 77.11 and 63.60 μg/mL, respectively, were obtained at the first plasma determination...
2018: Infection and Drug Resistance
Ketki Bhise, Samaresh Sau, Razieh Kebriaei, Seth A Rice, Kyle C Stamper, Hashem O Alsaab, Michael J Rybak, Arun K Iyer
Vancomycin is the treatment of choice for infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Clinically, combinations of vancomycin (VAN) and beta-lactams have been shown to improve patient outcomes compared to VAN alone for the treatment of MRSA bloodstream infections. However, VAN is known to cause nephrotoxicity, which could be ameliorated using biocompatible lipid drug delivery systems or liposomes. Previous attempts have been made for encapsulation of VAN in liposomes; however, drug loading has been poor, mainly because of the high aqueous solubility of VAN...
July 20, 2018: Materials
Fatih Mehmet Kandemir, Serkan Yildirim, Sefa Kucukler, Cuneyt Caglayan, Amdia Mahamadu, Muhammet Bahaeddin Dortbudak
Vancomycin (VCM) is a glycopeptidic broad-spectrum antibiotic against methicillin-resistant Staphylococcus aureus, though it has some adverse effects, including nephrotoxicity, that limit its usefulness. Zingerone (ZO), a component of dry ginger root, has several pharmacological activities due to its antioxidant, anti-inflammatory and antiapoptotic properties. The aim of this study was to determine the therapeutic efficacy of ZO against VCM-induced oxidative stress, inflammation, apoptosis and kidney aquaporin 1 (AQP1) levels in rats...
September 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Huifang Zhang, Ruilan Wang, Wen Shu, Rong Tang, Xiaoyu Liang, Jing Zhang, Jufang Wu
OBJECTIVE: To investigate the relationship between the serum level of vancomycin and its clinical efficacy as well as adverse reactions in adult patient so as to provide recommendations for clinical management. METHODS: An open observational research was performed from 1st July 2013 to 31st December 2017 in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, which recruited the adult patients who were infected with Gram positive (G+ ) bacteria and treated with vancomycin...
June 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
T Nakashima, K Koido, H Baba, R Otsuka, K Okinaka, T Sano, R Nishigaki, H Hashimoto, T Otsuka, M Esaki, H Terakado
BACKGROUND/AIM: Dose adjustment of vancomycin (VCM) is important in improving clinical outcomes and avoiding adverse effects such as nephrotoxicity. Although pharmacist-managed VCM therapy has been reported to optimize treatment, there are no studies focused on pharmacist expertise to date. In this study, we compared the contribution of pharmacists trained for infectious diseases and general pharmacists to dose adjustment of VCM. PATIENTS AND METHODS: We retrospectively investigated VCM trough concentration after dose adjustment by both trained (n = 67) and general (without special training for infectious diseases; n = 85) pharmacists...
July 1, 2018: Die Pharmazie
Amanda M Uber, Maria E Montez-Rath, David M Kwiatkowski, Catherine D Krawczeski, Scott M Sutherland
BACKGROUND: Though acute kidney injury (AKI) is often multifactorial, investigators are now emphasizing the specific contribution of nephrotoxins. This study examines the epidemiology of nephrotoxin exposure and nephrotoxin-associated AKI among children undergoing congenital heart surgery (CHS). METHODS: This is a retrospective cohort study of children admitted following CHS between June 1, 2014, and September 30, 2014. Nephrotoxins were defined according to the Nephrotoxic Injury Negated by Just-in-time-Action (NINJA) collaborative; high nephrotoxin exposure was defined as receipt of ≥ 3 nephrotoxins concurrently...
July 9, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Shijie Wen, Changyuan Wang, Xiaokui Huo, Qiang Meng, Zhihao Liu, Shilei Yang, Yanna Zhu, Huijun Sun, Xiaodong Ma, Kexin Liu
The present study aimed to investigate the regulation of JBP485 on the expressions of renal organic anion transporter (Oat) 1, Oat3, organic cation transporter 2 (Oct2), multidrug resistance-associated protein 2 (Mrp2) and P-glycoprotein (P-gp), which can accelerate the renal excretion of accumulated endogenous toxins to attenuate vancomycin-induced nephrotoxicity (VIN) in rats. Vancomycin suppressed the mRNA and protein expressions of Oat1, Oat3, Oct2, Mrp2 and P-gp to reduce the renal excretion of endogenous toxins (e...
October 1, 2018: Toxicology Letters
James Truong, Shawn R Smith, John J Veillette, Steven C Forland
Dosing vancomycin in critically ill patients often results in subtherapeutic and supratherapeutic trough concentrations. In this retrospective study, we compared the time to goal trough attainment and incidence of acute kidney injury in intensive care unit (ICU) patients whose vancomycin was dosed by a pharmacy pharmacokinetic (PK) dosing and monitoring service to the standard of care. Three-hundred fifty adult ICU patients at a Level 1 trauma, teaching hospital who received vancomycin for >24 hours from February 1, 2016, to November 30, 2016, were screened...
September 2018: Journal of Clinical Pharmacology
Jun Jie Benjamin Seng, Mei Hui Amanda Yong, Zi Xin Peh, Jie Lin Soong, Mooi Heong Tan
Background Vancomycin therapeutic drug monitoring (TDM) is commonly performed to ensure safe and effective use of the antibiotic. Aim of Study To evaluate appropriateness of vancomycin TDM and its outcomes in Singapore General Hospital. Method A retrospective, cross-sectional study was conducted between 1 January 2014 and 28 February 2014 involving patients who received ≥ 1 dose of intravenous vancomycin with TDM. Patient demographics and relevant vancomycin TDM data were collected from medical records...
June 12, 2018: International Journal of Clinical Pharmacy
Erin F Barreto, Andrew D Rule, Stacy A Voils, Sandra L Kane-Gill
Over the last decade, the discovery of novel renal biomarkers and research on their use to improve medication effectiveness and safety has expanded considerably. Pharmacists are uniquely positioned to leverage this new technology for renal assessment to improve medication dosing and monitoring. Serum cystatin C is a relatively new, inexpensive, functional renal biomarker that responds more quickly to changing renal function than creatinine and is not meaningfully affected by age, sex, skeletal muscle mass, dietary intake, or deconditioning...
August 2018: Pharmacotherapy
Hanna K Welch, John A Kellum, Sandra L Kane-Gill
STUDY OBJECTIVE: Acute kidney injury (AKI) is a common condition associated with both short-term and long-term consequences including dialysis, chronic kidney disease, and mortality. Although the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database is a powerful tool to examine drug-associated events, to our knowledge, no study has analyzed this database to identify the most common drugs reported with AKI. The objective of this study was to analyze AKI reports and associated medications in the FAERS database...
August 2018: Pharmacotherapy
Corinne Muirhead, Jeong Y Lim, Jodi Lapidus, Kelvin MacDonald
Background The risk for acute kidney injury (AKI) has been associated with both tobramycin and vancomycin. Objective To determine whether the rate of drug therapy-related nephrotoxicity is greater in Cystic Fibrosis (CF) patients receiving concomitant vancomycin and tobramycin than patients receiving either agent alone. Methods Adult CF patients admitted for acute pulmonary exacerbation (APE) over a seven-year period (2008-2014), who received at least 72 hours of intravenous vancomycin, tobramycin or a combination of the two agents were evaluated for AKI...
December 6, 2017: Curēus
Shirin Kalimuddin, Yvonne F Z Chan, Rachel Phillips, Siew Pei Ong, Sophia Archuleta, David Chien Lye, Thuan Tong Tan, Jenny G H Low
BACKGROUND: Studies have suggested the reduced effectiveness of vancomycin against methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections with high vancomycin minimum inhibitory concentrations. Alternative agents such as daptomycin may be considered. We conducted a randomized controlled study comparing daptomycin against vancomycin in the treatment of MRSA bloodstream infections with high vancomycin minimum inhibitory concentrations. METHODS: Patients were randomized to receive vancomycin or daptomycin for a minimum of 14 days...
June 1, 2018: Trials
Jacomien Aleman, Dirk Jan F Moojen, Marc L van Ogtrop, Rudolf W Poolman, Eric J F Franssen
Objectives : Antimicrobial therapy is one of the cornerstones of orthopaedic implant-related infections (OIRI) treatment. Infections with Gram-positive bacteria are often treated with vancomycin, penicillin or clindamycin. A recent IDSA guideline suggests increasing the dose of vancomycin to increase the trough vancomycin target serum concentrations. This is deemed necessary because of an observed decrease in vancomycin susceptibility among Gram-positive bacteria. However, elevated vancomycin concentrations are correlated with the risk of nephrotoxicity, especially with prolonged therapy...
2018: Journal of Bone and Joint Infection
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