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Vancomycin AND Nephrotoxicity

J Barberan, J Mensa, A Artero, F Epelde, J C Rodriguez, J Ruiz-Morales, J L Calleja, J M Guerra, I Martínez-Gil, M J Giménez, J J Granizo, L Aguilar
OBJECTIVE: To evaluate nephrotoxicity development in patients treated with vancomycin (VAN) and daptomycin (DAP) for proven severe Gram-positive infections in daily practice. METHODS: A practice-based, observational, retrospective study (eight Spanish hospitals) was performed including patients ≥18 years with a baseline glomerular filtration rate (GFR)>30 mL/min and/or serum creatinine level<2 mg/dL treated with DAP or VAN for >48h. Nephrotoxicity was considered as a decrease in baseline GRF to <50 mL/min or decrease of >10 mL/min from a baseline GRF<50 mL/min...
January 8, 2019: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
Welder Zamoner, Iara Ranona Sousa Prado, André Luis Balbi, Daniela Ponce
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...
January 9, 2019: Clinical and Experimental Pharmacology & Physiology
Corey Cavanaugh, Gilbert W Moeckel, Mark A Perazella
Telavancin is a lipoglycopeptide semi-synthetic derivative of vancomycin used for select infections caused by Gram-positive bacteria including Staphylococcus aureus . Human clinical trials suggest that telavancin is potentially nephrotoxic, however there is no histopathologic description of acute kidney injury (AKI) in humans. An animal model has recently characterized the histologic changes associated with telavancin-induced AKI as proximal tubular injury with numerous phagolysosomes. We present a case of a 47-year-old man with methicillin-resistant Staphylococcus aureus bacteremia treated with telavancin, who developed AKI after 5 weeks of intravenous therapy...
January 7, 2019: Clinical Nephrology
Erin F Barreto, Jason N Barreto, Andrew D Rule
No abstract text is available yet for this article.
January 2019: Mayo Clinic Proceedings
Philip G Drennan, Evan J Begg, Sharon J Gardiner, Carl M J Kirkpatrick, Steve T Chambers
We have evaluated the literature to review optimal dosing and monitoring of intravenous vancomycin in adults, in response to evolving understanding of targets associated with efficacy and toxicity. The area under the total concentration-time curve (0 - 24 h) divided by the MIC (AUC24 /MIC) is the most commonly accepted index to guide vancomycin dosing for the treatment of Staphylococcus aureus infections, with a value of 400 h a widely recommended target for efficacy. Upper limits of AUC24 exposure of around 700 (mg/L)...
December 29, 2018: International Journal of Antimicrobial Agents
Xuan Xu, Jian Pan, Huiling Li, Xiaozhou Li, Fang Fang, Dengke Wu, Yu Zhou, Peiling Zheng, Li Xiong, Dongshan Zhang
Recent studies have shown that autophagy exhibits a renoprotective role in various models of acute kidney injury (AKI). However, its role in vancomycin (Van)-induced AKI remains largely unclarified. This study was the first to indicate that autophagy was rapidly activated in both human kidney-2 cells and renal tissues, and mammalian target of rapamycin (mTOR) was inactivated via the suppression of ERK1/2 and mTOR during Van treatment. Interestingly, for both in vitro and in vivo experiments, the suppression of autophagy via chloroquine and PT-Atg7-KO significantly ameliorated Van-induced kidney injury and renal tubular cell apoptosis...
December 27, 2018: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
Ian M DeStefano, Annie S Wayne, Elizabeth A Rozanski, Jonathan M Babyak
BACKGROUND: Vancomycin is commonly used to treat resistant bacterial infections in people. Reported adverse effects of vancomycin in people include acute kidney injury (AKI), neutropenia, and systemic allergic reaction. Given the increased incidence of vancomycin-resistant bacterial infections in people, support is growing for restriction of vancomycin. OBJECTIVES: To evaluate the use of intravenous (IV) vancomycin in a university teaching hospital and to describe potential adverse effects...
November 30, 2018: Journal of Veterinary Internal Medicine
Cameron J Phillips, Alice J Wisdom, Ross A McKinnon, Richard J Woodman, David L Gordon
Purpose: Vancomycin prescribing requires individualized dosing and monitoring to ensure efficacy, limit toxicity, and minimize resistance. Although there are nationally endorsed guidelines from several countries addressing the complexities of vancomycin dosing and monitoring, there is limited consideration of how to implement these recommendations effectively. Methods: We conducted a systematic search of multiple databases to identify relevant comparative studies describing the impact of interventions of educational meetings, implementation of guidelines, and dissemination of educational material on vancomycin dosing, monitoring, and nephrotoxicity...
2018: Infection and Drug Resistance
Kristýna Zahálková, Aleš Chrdle, Olga Dvořáčková, Marie Kašparová, Magdalena Horníková, Václav Chmelík
OBJECTIVE: Vancomycin therapeutic drug monitoring (TDM) is recommended for better treatment efficacy and safety. The Scottish Antimicrobial Prescribing Group model recommends weight-based loading dose, next 3-4 doses based on creatinine clearance and maintenance doses according to trough concentrations. METHODS: Retrospective cohort study of all adult patients treated with vancomycin before and after introducing the guideline in a large Czech hospital in 2015 compares the success rate in achieving recommended trough concentrations (10-20 mg/l) during first measurement and efficiency of maintaining these concentrations subsequently...
2018: Vnitr̆ní Lékar̆ství
Xiaoyu Liang, Yaxing Fan, Minjie Yang, Jing Zhang, Jufang Wu, Jicheng Yu, Jinhao Tao, Guoping Lu, Huifang Zhang, Ruilan Wang, Xiaoxing Wen, Huayin Li, Fengying Zhang, Jingqin Hang, Lihua Shen, Zhongwei Zhang, Qionghua Lin, Fengming Fu, Shengbin Wu, Bo Shen, Weifeng Huang, Chunkang Chang, Hong Zhang, Qiwei Huang, Yifan Shi, Hong Ren, Qing Yuan, Xiaolian Song, Xuming Luo, Hong Zhang
Background: Vancomycin is a first-line antibiotic used for the treatment of severe gram-positive bacterial infections. Clinical guidelines recommend that the vancomycin trough concentration be 10-15 mg/L for regular infections and 15-20 mg/L for severe infections. We investigated whether increasing the vancomycin concentration would result in better clinical outcomes with sustainable adverse effects (AEs) in the Chinese population. Methods: A prospective, open, multicenter clinical observational study was performed in patients with gram-positive bacterial infections from 13 teaching hospitals...
November 13, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Shaoqi Qu, Cunchun Dai, Fengting Lang, Longfei Hu, Qihe Tang, Haixia Wang, Yanping Zhang, Zhihui Hao
Nephrotoxicity is the major limiting factor for the clinical use of vancomycin (VCM) for treatment of serious infections caused by multi-resistant Gram-positive bacteria. This study investigated the renal protective activity of rutin in a rat model of VCM-induced kidney injury in male Wistar rats. VCM intraperitoneally at 200 mg/kg twice daily for 7 successive days resulted in significant elevation of blood urea nitrogen and creatinine as well as urinary N-acetyl-β-D-glucosaminidase. Co-administration of VCM with oral rutin at 150 mg/kg significantly reduced these markers of kidney damage...
November 5, 2018: Antimicrobial Agents and Chemotherapy
N He, Y Y Yan, Y Q Ying, M Yi, G Q Yao, Q G Ge, S D Zhai
Pharmacokinetic parameters can be significantly altered for acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO) and continuous veno-venous hemofiltration therapy (CVVH). Here we reported a case of individualized vancomycin dosing for a patient diagnosed as severe acute pancreatitis treated with concurrent ECMO and CVVH. A 65 kg 32-year-old woman was admitted to hospital presented with severe acute pancreatitis (SAP), respiratory failure, metabotropic acidosis and hyperkalemia. She was admitted to intensive care unit (ICU) on hospital day 1 and was initiated on CVVH...
October 18, 2018: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Shungo Imai, Takehiro Yamada, Kumiko Kasashi, Yusuke Niinuma, Masaki Kobayashi, Ken Iseki
OBJECTIVES: In our previous study, we built a risk prediction model of vancomycin (VCM)-associated nephrotoxicity using decision tree (DT) analysis. However, this has several limitations in clinical applications. Our objective here was to construct a clinically applicable risk prediction model to be used at the time of initial therapeutic drug monitoring (TDM), in patients with uncomplicated infections. METHOD: A retrospective study was conducted at Hokkaido University Hospital...
October 2, 2018: Journal of Evaluation in Clinical Practice
Zuhal Uckun, Sevda Guzel, Necmiye Canacankatan, Cem Yalaza, Deniz Kibar, Banu Coskun Yilmaz
Vancomycin (VCM), a glycopeptide antibiotic, is a drug widely used in severe infections. However, VCM induce notable nephrotoxic side effects. Naringenin (NAR) is a natural of flavonoid and are known as strongly antioxidant, nefroprotective, antiapoptotic, and anti-inflammatory. The purpose of this study was to determine the potential protective effects of NAR against VCM-induced nephrotoxicity by measuring apoptotic and oxidative stress markers and evaluating histopathological alterations in rats. For this purpose, we used male Wistar albino rats that divided into seven groups: (i) Control [saline, intraperitoneally (i...
September 27, 2018: Drug and Chemical Toxicology
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...
November 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 the 24-h steady-state vancomycin area under the concentration-time curve (AUC24 ) thresholds for efficacy and nephrotoxicity in patients with methicillin-resistant Staphylococcus aureus bacteraemia (MRSA-B) after implementing two-point pharmacokinetic therapeutic drug monitoring. A single-centre, retrospective cohort study was performed including adult patients admitted between 1 June 2016 and 1 January 2018 with MRSA-B treated with vancomycin for ≥72 h...
December 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
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