Endothelial Cell Toxicity of Vancomycin Infusion Combined with Other Antibiotics

Drouet, Maryline; Chai, Feng; Barthélémy, Christine; Lebuffe, Gilles; Debaene, B.; Décaudin, Bertrand; Odou, Pascal

doi:10.1128/aac.00612-15

Cited by 15 publications

(9 citation statements)

References 24 publications

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“…The limitations of this study suggest that other experiments more suitable for simulating multi-infusion need to be performed to answer this scientific question. Nevertheless, endothelial cell toxicity induced by a mechanical trauma due to multi-drug infusion, simulated in our model by medium removal and the addition of vancomycin at a constant concentration, could increase the risk of phlebitis, thus confirming our previous study [ 7 ]. This mechanical cell stress could mimic the flush induced by infusion of drugs at a high flow rate on previously damaged endothelial cells surrounding the catheter outlet.…”

Section: Discussionsupporting

confidence: 90%

“…In previous studies, we analyzed factors influencing vancomycin (VAN)-associated phlebitis in peripheral intravenous (PIV) infusion. We showed that vancomycin endothelial toxicity depended on concentration and infusion duration [ 6 ] and that vancomycin in combination with other antibiotics increased endothelial toxicity, enabling us to recommend using a separate line to infuse vancomycin via a PIV access [ 7 ]. However, in surgical and intensive care units, multiple simultaneous infusion of several drugs with one catheter (multi-infusion) could lead to dosing errors and highs and lows in medication levels [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Disturbance of Vancomycin Infusion Flow during Multidrug Infusion: Influence on Endothelial Cell Toxicity

Drouet¹,

Cuvelier²,

Chai

et al. 2021

Antibiotics

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Background: Phlebitis is a common side effect of vancomycin peripheral intravenous (PIV) infusion. As only one PIV catheter is frequently used to deliver several drugs to hospitalized patients through the same Y-site, perturbation of the infusion flow by hydration or other IV medication may influence vancomycin exposure to endothelial cells and modulate toxicity. Methods: We assessed the toxicity of variations in vancomycin concentration induced by drug mass flow variations in human umbilical vein endothelial cells (HUVECs), simulating a 24 h multi-infusion therapy on the same line. Results were expressed as the percentage of viable cells compared with a 100% control, and the Kruskal–Wallis test was used to assess the toxicity of vancomycin. Results: Our results showed that variations in vancomycin concentration did not significantly influence local toxicity compared to a fixed concentration of vancomycin. Nevertheless, the loss of cell viability induced by mechanical trauma mimicking multidrug infusion could increase the risk of phlebitis. Conclusion: To ensure that vancomycin-induced phlebitis must have other causes than variation in drug mass flow, further in vitro experiments should be performed to limit mechanical stress to frequent culture medium change.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Disturbance of Vancomycin Infusion Flow during Multidrug Infusion: Influence on Endothelial Cell Toxicity

Drouet¹,

Cuvelier²,

Chai

et al. 2021

Antibiotics

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“…If this cotoxicity has not been studied yet, a recent article tested the toxicity on endothelial cells viability when vancomycin was combined with piperacillin-tazobactam, revealing no excess cell death compared with the cell death rate from vancomycin alone. [5] Finally, evidence suggests that presence of particles in infusion uid was a major cause of chemical phlebitis, [6] supporting that use of in-line intravenous lters could reduce infusion particles. [7] To prevent any damaging effect, the administration of vancomycin at a concentration lower than 2.5 mg/mL should be recommended when a central venous catheter is not available for the administration of injectable vancomycin.…”

Section: Discussionmentioning

confidence: 99%

Risk of Skin Necrosis Related to Injectable Vancomycin in Critically Ill Newborn Infants

Gilliot

Boukhris

Masse

et al. 2021

Preprint

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Skin necrosis caused by the administration of vancomycin via a peripheral venous catheter is rarely diagnosed. We report a case of a male infant born at 30 weeks’ gestational age who developed a skin necrosis, most probably related to vancomycin administration on a peripheral venous catheter. The frailty of this critically ill newborn probably increased its risk of exposition to adverse events. To prevent any damaging effect, the administration of vancomycin at a concentration lower than 2.5 mg/mL should be recommended when a central venous catheter is not available for the administration of injectable vancomycin in critically ill newborn.

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“…furosemide and caffeine in our case, may have enhanced the cumulative endothelial toxicity. A recent article tested the toxicity on endothelial cells viability when vancomycin was combined with piperacillin-tazobactam, revealing no excess cell death compared with the cell death rate from vancomycin alone [ 6 ]. However, there is no evidence that vancomycin was here the only irritant drug related to the skin lesion.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Case report: risk of skin necrosis related to injectable vancomycin in critically ill newborn infants

et al. 2021

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Background Vancomycin is commonly used as part of empiric antibiotic therapy in the preterm infants who develop signs and symptoms of infection. Although skin necrosis has been noted to occur following injection of vancomycin into a peripheral vein in an adult patient, this complication has not been previously described in a preterm infant. Case presentation We report the case of a very low birthweight male infant born at 30 weeks gestational age who developed skin necrosis, most likely as a complication of vancomycin administration via a peripheral venous catheter. The immature skin and endothelial cells of this preterm infant may have increased the risk of drugs related venous and skin toxicity. In this case, assumption of a cumulative toxicity with other drugs administered concomitantly via the same catheter can’t be excluded. Conclusions To prevent the risk of skin damage, we advocate that in newborn infants, the administration of vancomycin should be limited to a concentration of < 2.5 mg/mL via a peripheral intravenous catheter if a central venous catheter is not available.

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Endothelial Cell Toxicity of Vancomycin Infusion Combined with Other Antibiotics

Cited by 15 publications

References 24 publications

Disturbance of Vancomycin Infusion Flow during Multidrug Infusion: Influence on Endothelial Cell Toxicity

Disturbance of Vancomycin Infusion Flow during Multidrug Infusion: Influence on Endothelial Cell Toxicity

Risk of Skin Necrosis Related to Injectable Vancomycin in Critically Ill Newborn Infants

Case report: risk of skin necrosis related to injectable vancomycin in critically ill newborn infants

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