Acute Kidney Injury Risk in Patients Treated with Vancomycin Combined with Meropenem or Cefepime

Sussman, Matthew S.; Mulder, Michelle B.; Ryon, Emily L.; Urréchaga, Eva M.; Lama, Gabriel; Bahga, Amritpal; Eidelson, Sarah A.; Lieberman, Howard; Schulman, Carl I.; Namias, Nicholas; Proctor, Kenneth G.

doi:10.1089/sur.2020.105

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…Among the 57 included studies (Table 2), 4 made direct comparisons between AUC-guided and trough-guided cohorts 9,18–20 ; 10 reported both AUC-guided and trough-guided monitoring 21–28,64,65 ; 2 reported only AUC-guided monitoring 29,30 ; and 41 reported only trough-guided monitoring. 31–63,66–73 Four studies had vancomycin doses adjusted based on both AUC-guided and trough-guided monitoring; 48 had vancomycin doses adjusted based solely on trough-guided monitoring; and 5 had vancomycin doses titrated based solely on AUC-guided monitoring. Most studies were from the United States (n = 34) and Asia-Pacific region (n = 18).…”

Section: Resultsmentioning

confidence: 99%

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Area-Under-Curve–Guided Versus Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-Analysis

Lim

Foo

Seng

et al. 2023

Therapeutic Drug Monitoring

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Background: Conventionally, vancomycin trough levels have been used for therapeutic drug monitoring (TDM). Owing to the increasing evidence of trough levels being poor surrogates of area under the curve (AUC) and the advent of advanced pharmacokinetics software, a paradigm shift has been made toward AUC-guided dosing. This study aims to evaluate the impact of AUC-guided versus trough-guided TDM on vancomycin-associated nephrotoxicity.Methods: A systematic review was conducted using PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Google scholar, and Cochrane library databases; articles published from January 01, 2009, to January 01, 2021, were retrieved and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies that evaluated trough-guided or AUC-guided vancomycin TDM and vancomycin-associated nephrotoxicity were included. Randomeffects models were used to compare the differences in nephrotoxicity.Results: Of the 1191 retrieved studies, 57 were included. Most studies included adults and older adults (n = 47, 82.45%). The pooled prevalence of nephrotoxicity was lower in AUC-guided TDM [6.2%; 95% confidence interval (CI): 2.9%-9.5%] than in trough-guided TDM (17.0%; 95% CI: 14.7%-19.2%). Compared with the trough-guided approach, the AUC-guided approach had a lower risk of nephrotoxicity (odds ratio: 0.53; 95% CI: 0.32-0.89). The risk of nephrotoxicity was unaffected by the AUC derivation method. AUC thresholds correlated with nephrotoxicity only within the first 96 hours of therapy. Conclusions:The AUC-guided approach had a lower risk of nephrotoxicity, supporting the updated American Society of Health-System Pharmacists guidelines. Further studies are needed to evaluate the optimal AUC-derivation methods and clinical utility of repeated measurements of the AUC and trough levels of vancomycin.

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Section: Resultsmentioning

confidence: 99%

“…Forty-eight studies 9,18–22,25,26,31–34 with 36–61 scores 63–67 of 69–73 ≥7 on the Newcastle–Ottawa scale were considered for the meta-analysis. Of these, 10 included patients aged <18 years (neonates–adolescents).…”

Section: Resultsmentioning

confidence: 99%

Area-Under-Curve–Guided Versus Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-Analysis

Lim

Foo

Seng

et al. 2023

Therapeutic Drug Monitoring

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“…Similar results were demonstrated in another study (retrospective cohort study, period 20134—2019 years), where AKI incidence was reported to be 33.3% in patients receiving vancomycin with piperacillin tazobactam compared with 9.1% for those who received vancomycin with meropenem or doripenem [ 238 ]. Estimating AKI risks for meropenem, it is worth noting that the comparison of vancomycin plus meropenem versus vancomycin plus cefepime revealed a nearly 2-fold increase in AKI incidence for the first combination (38% versus 19.1%; p = 0.049) [ 239 ].…”

Section: General Considerations On Ab Pharmacokinetics In the Elderlymentioning

confidence: 99%

Pharmacokinetics of Antibacterial Agents in the Elderly: The Body of Evidence

et al. 2023

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Infections are important factors contributing to the morbidity and mortality among elderly patients. High rates of consumption of antimicrobial agents by the elderly may result in increased risk of toxic reactions, deteriorating functions of various organs and systems and leading to the prolongation of hospital stay, admission to the intensive care unit, disability, and lethal outcome. Both safety and efficacy of antibiotics are determined by the values of their plasma concentrations, widely affected by physiologic and pathologic age-related changes specific for the elderly population. Drug absorption, distribution, metabolism, and excretion are altered in different extents depending on functional and morphological changes in the cardiovascular system, gastrointestinal tract, liver, and kidneys. Water and fat content, skeletal muscle mass, nutritional status, use of concomitant drugs are other determinants of pharmacokinetics changes observed in the elderly. The choice of a proper dosing regimen is essential to provide effective and safe antibiotic therapy in terms of attainment of certain pharmacodynamic targets. The objective of this review is to perform a structure of evidence on the age-related changes contributing to the alteration of pharmacokinetic parameters in the elderly.

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Comparative Prevalence of Acute Kidney Injury in Chinese Patients Receiving Vancomycin with Concurrent β-Lactam Antibiotics: A Retrospective Cohort Study

Liu

Zhang

et al. 2021

Clinical Therapeutics

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Acute Kidney Injury Risk in Patients Treated with Vancomycin Combined with Meropenem or Cefepime

Cited by 4 publications

References 27 publications

Area-Under-Curve–Guided Versus Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-Analysis

Area-Under-Curve–Guided Versus Trough-Guided Monitoring of Vancomycin and Its Impact on Nephrotoxicity: A Systematic Review and Meta-Analysis

Pharmacokinetics of Antibacterial Agents in the Elderly: The Body of Evidence

Comparative Prevalence of Acute Kidney Injury in Chinese Patients Receiving Vancomycin with Concurrent β-Lactam Antibiotics: A Retrospective Cohort Study

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