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Vancomycin nephrotoxicity

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https://www.readbyqxmd.com/read/29203493/a-prospective-trial-on-the-use-of-trough-concentration-versus-area-under-the-curve-auc-to-determine-therapeutic-vancomycin-dosing
#1
Michael N Neely, Lauren Kato, Gilmer Youn, Lironn Kraler, David Bayard, Michael van Guilder, Alan Schumitzky, Walter Yamada, Brenda Jones, Emi Minejima
We hypothesized that dosing vancomycin to achieve trough concentrations >15 mg/L overdoses many adults compared to AUC-guided dosing. We conducted a 3-year, prospective study of vancomycin dosing, plasma concentrations, and outcomes. In year 1, non-study clinicians targeted trough concentrations of 10-20 mg/L (infection dependent) and controlled dosing. In years 2 and 3, the study team controlled vancomycin dosing with the BestDose Bayesian software to achieve a daily, steady-state AUC:MIC≥400, with maximum AUC 800 mg*h/L, regardless of trough concentration...
December 4, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29193836/continuous-vancomycin-in-a-pediatric-cystic-fibrosis-patient
#2
Cameron J McKinzie, Charles R Esther, Timothy J Vece
Continuous vancomycin has been previously reported to maximize antimicrobial activity while avoiding toxicities associated with dose escalation, but the efficacy of this dosing strategy has not been reported. This case report describes the successful use of continuous vancomycin, including improvement in lung function and avoidance of nephrotoxicity, demonstrated in a pediatric cystic fibrosis (CF) patient with MRSA.
November 29, 2017: Pediatric Pulmonology
https://www.readbyqxmd.com/read/29181890/acute-kidney-injury-induced-by-concomitant-use-of-vancomycin-and-piperacillin-tazobactam-in-pediatrics
#3
Manal Abouelkheir, Sarah Alsubaie
BACKGROUND: Vancomycin is very commonly used in combination with piperacillin-tazobactam (PTZ) as an initial empiric therapy for moderate to severe infections, whenever coverage for both methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa is required. The combination of vancomycin and PTZ in adults has recently been reported to significantly increase the risk of developing acute kidney injury (AKI) relative to vancomycin monotherapy; such reports in pediatrics are sparse...
November 27, 2017: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/29109576/baseline-competency-assessment-of-pharmacists-prescribing-and-managing-vancomycin-therapy-in-the-regina-qu-appelle-health-region
#4
Kirsten Tangedal, Jennifer Bolt, Suzanne Len, Ali Bell
Background: Pharmacists in the Regina Qu'Appelle Health Region (RQHR), Saskatchewan, independently dose, monitor, and adjust vancomycin therapy. No framework exists for ongoing competency assessment of pharmacists. Objectives: The primary objective was to determine pharmacists' overall level of competency for all components of the vancomycin prescribing procedure. The secondary objectives were to determine competency for individual prescribing phases, to stratify overall competency in relation to pharmacist and patient factors, and to identify the 3 most frequent errors...
September 2017: Canadian Journal of Hospital Pharmacy
https://www.readbyqxmd.com/read/29103776/systemic-absorption-of-antibiotics-from-antibiotic-loaded-cement-spacers-for-the-treatment-of-periprosthetic-joint-infection
#5
Adam I Edelstein, Kamil T Okroj, Thea Rogers, Craig J Della Valle, Scott M Sporer
BACKGROUND: Two-stage treatment of periprosthetic joint infections involves placement of high-dose antibiotic-loaded cement spacers (ACSs). Reports of ACS-induced nephrotoxicity have raised concern regarding systemic absorption of antibiotics after ACS placement. We sought to characterize the serum concentrations of antibiotics that occur after ACS placement. METHODS: We performed a prospective study of patients with an infected primary total hip (THA) or knee arthroplasty (TKA) treated with standardized ACSs with vancomycin, gentamicin, and tobramycin...
October 5, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29095798/relationship-between-initial-vancomycin-trough-levels-and-early-onset-vancomycin-associated-nephrotoxicity-in-critically-ill-patients
#6
Masayuki Chuma, Makoto Makishima, Toru Imai, Naohiro Tochikura, Shinichiro Suzuki, Tsukasa Kuwana, Nami Sawada, Tomohide Komatsu, Takako Sakaue, Norikazu Kikuchi, Yoshikazu Yoshida, Kosaku Kinoshita
BACKGROUND: Appropriate initial dosing of vancomycin (VCM) is important in improving survival and in preventing nephrotoxicity in critically ill patients, but the potential relationship between initial VCM trough levels and early-onset nephrotoxicity remains unclear. We examined the relationship between initial VCM trough levels and early-onset VCM-associated nephrotoxicity. METHODS: We performed a retrospective study of patients who had therapeutic drug monitoring of VCM with initial trough levels within 4 days after the beginning of VCM administration...
October 31, 2017: Therapeutic Drug Monitoring
https://www.readbyqxmd.com/read/29080067/interventions-targeting-the-prescribing-and-monitoring-of-vancomycin-for-hospitalized-patients-a-systematic-review-protocol
#7
REVIEW
Cameron J Phillips, Alice J Wisdom, Ross A McKinnon, Richard J Woodman, David L Gordon
INTRODUCTION: Vancomycin remains one of our essential antibiotics after fifty years of treating serious infections such as methicillin-resistant Staphylococcus aureus. Vancomycin, unlike many other antibiotic agents, requires individualized dosing and monitoring of serum drug levels to ensure it is efficacious, to minimize toxicity, and to limit the development of antibiotic resistance. These issues have led to numerous vancomycin clinical practice guidelines being published in recent years including several key national guidelines...
October 27, 2017: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/29063519/clinical-pharmacokinetics-and-pharmacodynamics-of-oxazolidinones
#8
REVIEW
Claire Roger, Jason A Roberts, Laurent Muller
Oxazolidinones are a class of synthetic antimicrobial agents with potent activity against a wide range of multidrug-resistant Gram-positive pathogens including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. Oxazolidinones exhibit their antibacterial effects by inhibiting protein synthesis acting on the ribosomal 50S subunit of the bacteria and thus preventing formation of a functional 70S initiation complex. Currently, two oxazolidinones have been approved by the US Food and Drug Administration: linezolid and more recently tedizolid...
October 23, 2017: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/29037461/sustained-improvement-in-vancomycin-dosing-and-monitoring-post-implementation-of-guidelines-results-of-a-three-year-follow-up-after-a-multifaceted-intervention-in-an-australian-teaching-hospital
#9
Cameron J Phillips, Ross A McKinnon, Richard J Woodman, David L Gordon
INTRODUCTION: Despite vancomycin being in use for over half-a-century, it is still not dosed or monitored appropriately in many centers around the world. The objective of this study was to determine the effectiveness of a multifaceted intervention to implement a vancomycin dosing and monitoring guideline across multiple medical and surgical units over time. METHODS: This was an observational before-and-after interventional cohort study. The pre-intervention period was August to December 2010-2011 and the post-intervention period was September to November 2012-2014...
October 13, 2017: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
https://www.readbyqxmd.com/read/29035197/drug-induced-kidney-injury-a-large-case-series-from-the-berlin-case-control-surveillance-study%C3%A2
#10
Antonios Douros, Elisabeth Bronder, Andreas Klimpel, Christiane Erley, Edeltraut Garbe, Reinhold Kreutz
OBJECTIVES: Drug-induced kidney injury (DIKI) may affect patients regardless of their baseline kidney function. Therefore, this study evaluated DIKI in patients with or without previous chronic kidney disease (CKD). MATERIALS AND METHODS: Potential DIKI cases were ascertained using the network of the Berlin Case-Control Surveillance Study in all 51 Berlin hospitals from April 2010 until December 2011. Via face-to-face interviews and medical chart reviews, information on all previous drug intake, comorbidities, and demographics was gathered...
October 16, 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/29020249/increasing-evidence-of-the-nephrotoxicity-of-piperacillin-tazobactam-and-vancomycin-combination-therapy-what-is-the-clinician-to-do
#11
Richard R Watkins, Stan Deresinski
Early and appropriate empiric antibiotics are essential for achieving the best possible outcomes in sepsis. Yet, the choice of antibiotic therapy has become more challenging due to recent reports of nephrotoxicity with the combination of vancomycin and piperacillin/tazobactam, the "workhorse" regimen at many institutions. In this article we assess the evidence for nephrotoxicity and its possible mechanisms, provide recommendations for risk mitigation, address the advantages and disadvantages of alternative antibiotic choices, and suggest areas for future research...
July 29, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28943633/vancomycin-induced-leukocytoclastic-vasculitis-and-acute-renal-failure-due-to-tubulointerstitial-nephritis
#12
Chandra Shekar Pingili, Emmanuel E Okon
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and sepsis are commonly treated with intravenous vancomycin. However, vancomycin treatment is associated adverse reactions, including skin rashes and nephrotoxicity. We present a case of acute renal failure due to acute tubulointerstitial nephritis associated with a diffuse leukocytoclastic vasculitic skin eruption following intravenous vancomycin treatment. CASE REPORT A 79-year-old Caucasian male patient was treated with intravenous vancomycin for MRSA bacteremia...
September 25, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28923869/a-quasi-experiment-to-study-the-impact-of-vancomycin-area-under-the-concentration-time-curve-guided-dosing-on-vancomycin-associated-nephrotoxicity
#13
Natalie A Finch, Evan J Zasowski, Kyle P Murray, Ryan P Mynatt, Jing J Zhao, Raymond Yost, Jason M Pogue, Michael J Rybak
Evidence suggests that maintenance of vancomycin trough concentrations at between 15 and 20 mg/liter, as currently recommended, is frequently unnecessary to achieve the daily area under the concentration-time curve (AUC24) target of ≥400 mg · h/liter. Many patients with trough concentrations in this range have AUC24 values in excess of the therapeutic threshold and within the exposure range associated with nephrotoxicity. On the basis of this, the Detroit Medical Center switched from trough concentration-guided dosing to AUC-guided dosing to minimize potentially unnecessary vancomycin exposure...
December 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28885936/vancomycin-vs-vancomycin-piperacillin-tazobactam-associated-acute-kidney-injury-in-noncritically-ill-patients-at-a-tertiary-care-military-treatment-facility
#14
Caleb W Anderson, Kathy S Cazares, Michael B Lustik, Shivam M Patel, Troy M Denunzio
BACKGROUND: Broad-spectrum antibiotics are often used as initial empiric therapy in patients at risk for infections by multidrug-resistant organisms. Emerging literature and anecdotal reports within Tripler Army Medical Center indicate an increased incidence of vancomycin-associated acute kidney injury when used in combination with piperacillin-tazobactam. This is a retrospective, single-center study comparing the incidence of acute kidney injury in noncritically ill patients receiving either vancomycin or vancomycin in combination with piperacillin-tazobactam in a 206-bed tertiary care military training facility...
September 2017: Military Medicine
https://www.readbyqxmd.com/read/28846665/assessment-of-initial-vancomycin-dosing-in-pediatric-oncology-patients
#15
Hillary Orr, Deni Trone, Joshua Elder, Ashok Raj
This was a retrospective audit assessing vancomycin dosing of 60 mg/kg/day in the attainment of therapeutic concentrations between 10-20 mcg/mL among 56 pediatric oncology patients. Twelve patients (21%) achieved therapeutic concentrations of 10-20 mcg/mL, while 44 patients (79%) obtained trough levels below 10 mcg/mL despite the addition of nephrotoxic agents.
August 28, 2017: Children
https://www.readbyqxmd.com/read/28816069/risk-of-nephrotoxicity-among-patients-who-received-vancomycin
#16
Yi-Chia Su, Pei-Chin Lin, Chih-Chien Wu
No abstract text is available yet for this article.
August 17, 2017: Infectious Diseases
https://www.readbyqxmd.com/read/28793957/a-comparison-of-telavancin-and-vancomycin-for-treatment-of-methicillin-resistant-staphylococcus-aureus-infections-a-meta-analysis
#17
Yu Liu, Juan Wang
OBJECTIVE: The objective of this study was to systematically review and evaluate the efficacy and safety of telavancin and vancomycin in the treatment of infections due to methicillin-resistant Staphylococcus aureus (MRSA). MATERIALS AND METHODS: We performed a systematic literature search using Pubmed, Embase, VIP Chinese Science and Technique Journals Database, and Wanfang Database resulting in the inclusion of seven publications in this study. Outcomes were calculated using pooled relative risk (RR) and 95% confidence interval (CI)...
August 10, 2017: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28760891/influence-of-%C3%AE-lactam-infusion-strategy-on-acute-kidney-injury
#18
Sarah E Cotner, W Cliff Rutter, Donna R Burgess, Katie L Wallace, Craig A Martin, David S Burgess
Limited literature is available assessing nephrotoxicity with prolonged β-lactam infusions. This study compared the incidence of acute kidney injury (AKI) associated with a prolonged β-lactam infusion or an intermittent infusion. This was a retrospective, matched-cohort study at an academic medical center from July 2006 to September 2015. Adult patients who received piperacillin-tazobactam (TZP), cefepime (FEP), or meropenem (MEM) for at least 48 h were evaluated. Patients were excluded for preexisting renal dysfunction or pregnancy...
October 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28739223/decreased-mortality-in-patients-prescribed-vancomycin-after-implementation-of-antimicrobial-stewardship-program
#19
Erin L Conway, John A Sellick, Amy Horey, Kristen Fodero, Michael C Ott, Michael P Krajewski, Kari A Mergenhagen
BACKGROUND: The impact of an antimicrobial stewardship program (ASP) on 30-day mortality rates was evaluated in patients prescribed vancomycin in a Veterans Affairs hospital. METHODS: A retrospective chart review of patients receiving a minimum of 48 hours of vancomycin during October 2006-July 2014. A multivariate logistic regression analysis was used to determine predictors of mortality. Interventions of the ASP consist of appropriate antibiotic selection, dosing, microbiology, and treatment duration...
July 21, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28709394/intravenous-vancomycin-associated-with-the-development-of-nephrotoxicity-in-patients-with-class-iii-obesity
#20
Yookyung Christy Choi, Stephen Saw, Daniel Soliman, Angela L Bingham, Laura Pontiggia, Krystal Hunter, Linda Chuang, Laura A Siemianowski, Benjamin Ereshefsky, James M Hollands
BACKGROUND: A consensus statement recommends initial intravenous (IV) vancomycin dosing of 15-20 mg/kg every 8- 24 hours, with an optional 25- to 30-mg/kg loading dose. Although some studies have shown an association between weight and the development of vancomycin-associated nephrotoxicity, results have been inconsistent. OBJECTIVE: To evaluate the correlation between incidence of nephrotoxicity associated with weight-based IV vancomycin dosing strategies in nonobese and obese patients...
November 2017: Annals of Pharmacotherapy
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