Assessment of Initial Serum Vancomycin Trough Concentrations and Their Association with Initial Empirical Weight-Based Vancomycin Dosing and Development of Nephrotoxicity in Children: A Multicenter Retrospective Study

Abstract

No significant associations were found between initial empirical weight-based vancomycin dosing or elevated serum trough concentrations and development of nephrotoxicity in children; rather, nephrotoxicity was associated with combination therapy with vancomycin and other potentially nephrotoxic agents.

Retrospective analysis of vancomycin treatment outcomes in Chinese paediatric patients with suspected Gram-positive infection

“…Consistent with their finding, 71·4% (130/182) of our paediatric patients experienced treatment success with vancomycin. In our study, the incidence of nephrotoxicity was 2·4% (4/165) in children receiving at least 72 h of vancomycin therapy, which is lower than previously reported . Using a similar definition for nephrotoxicity, McKamy et al .…”

Review of vancomycin-induced renal toxicity: an update

“…In a retrospective study, there was 14% greater risk of VIN for those with higher APACHE II score while the concurrent use of aminoglycoside accounted for an 18-fold greater probability [Hanrahan et al 2015]. Despite correction of confounding variables in regression analysis, coadministration of other agents that worsen renal perfusion including loop diuretics, vasopressors, angiotensin-converting enzyme inhibitors, and nonsteroidal anti-inflammatory drugs also increased the odds of developing AKI by 43-, 18-, 5-and 19-fold respectively [Matson et al 2015].…”

“…In a retrospective study of 530 patients stratified by body mass index (>30 kg/m 2 ), APACHE II score greater than 21 was the only variable associated with nephrotoxicity in a regression analysis [Davies et al 2015]. There was no significant relationship between obesity and a higher risk of nephrotoxicity [Davies et al 2015;Matson et al 2015]. However, a different outcome was obtained in another study: there was fivefold greater likelihood of attaining a serum vancomycin greater than 20 mg/l in patients with exogenous obesity [Richardson et al 2015].…”

“…In addition, the increase in blood volume and cardiac output results in augmented renal delivery. Studies have examined the impact of greater drug exposure imposed by the use of unadjusted body weight to calculate the dose of vancomycin in patients with obesity [Davies et al 2015;Matson et al 2015]. Apparently influenced by the retrospective design, the results of such studies are inconsistent.…”

The Overestimation of Vancomycin-Associated Nephrotoxicity: The Effect of Rhabdomyolysis and Nephrotoxicants at a Referral Poison Center, Tehran, Iran

“…Although the rate of vancomycin-induced nephrotoxicity was extremely variable, the relationship between vancomycin trough and nephrotoxicity was largely uniform across studies (5,23). The results of this study showed that patients, who developed nephrotoxicity were significantly more likely to have greater median vancomycin serum trough concentrations than patients, who did not develop nephrotoxicity (P = 0.007).…”