MENU ▼
Read by QxMD icon Read
search
OPEN IN READ APP
JOURNAL ARTICLE

Nephrotoxicity in patients with vancomycin trough concentrations of 15-20 μg/ml in a pediatric intensive care unit

Jeffrey J Cies, Venkat Shankar
Pharmacotherapy 2013, 33 (4): 392-400
23471688

STUDY OBJECTIVES: To determine if a higher serum vancomycin (Vt) target trough concentration of 15-20 μg/ml or greater is associated with an increased rate of vancomycin-induced nephrotoxicity in children admitted to a pediatric intensive care unit (PICU), and to determine risk factors for developing vancomycin-induced nephrotoxicity.

DESIGN: Retrospective cohort study.

SETTING: A PICU within a freestanding tertiary care pediatric hospital.

PATIENTS: A total of 113 patients received vancomycin for at least 48 hours The high-trough cohort (H group [57 patients]) received vancomycin therapy between November 2008 and June 2009 for pneumonia, bacteremia, or meningitis that was managed by a clinical pharmacist who directed dosage adjustments driven by a novel algorithm to attain a target Vt concentration of 15-20 μg/ml or greater; the control group (C group [56 patients]) received vancomycin therapy during the preceding 10 months (between January and October 2008) for pneumonia or meningitis using standard dosing guidelines with lower target Vt concentrations of 5-15 μg/ml.

MEASUREMENTS AND MAIN RESULTS: The highest grade of renal dysfunction according to the Common Terminology Criteria for Adverse Events criteria, v.4.0, was recorded. The mean ± SD Vt was 17.8 ± 3.1 and 8.4 ± 3.1 in the H and C groups, respectively (p<0.001). The rate of grade 1 nephrotoxicity was not significantly different between groups (8.8% in the H group vs 5.4% in the C group; p=0.72). No patient in either group developed a higher grade of renal dysfunction. In the univariable analysis, duration of vancomycin therapy (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.01-1.02, p=0.003), use of extracorporeal membrane oxygenation (OR 1.32, 95% CI 1.13-1.75, p=0.003), and vasopressor use (OR 1.41, 95% CI 1.11-1.37, p<0.001) were associated with nephrotoxicity. In the multivariable analysis, vasopressor use (OR 11.1, 95% CI 1.4-85, p=0.021) and duration of therapy were associated with nephrotoxicity (OR 1.19, 95% CI 1.04-1.37, p=0.011).

CONCLUSION: Our observations suggest that maintaining Vt concentrations 15 µg/ml or greater is not associated with an increased rate of nephrotoxicity in a PICU population.

Comments

You need to log in or sign up for an account to be able to comment.

No comments yet, be the first to post one!

Related Papers

Available on the App Store

Available on the Play Store

Read Institutional Edition
Remove bar
Read by QxMD icon Read
23471688
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"