Incidence and Risk Factors Influencing the Development of Vancomycin Nephrotoxicity in Children

McKamy, Susan; Hernandez, Elvin A.; Jahng, Maximillian; Moriwaki, Tiffany; Deveikis, Audra; Lê, Jennifer

doi:10.1016/j.jpeds.2010.08.019

Cited by 169 publications

(232 citation statements)

References 16 publications

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“…1 Estimates of the incidence of AKI associated with vancomycin in pediatrics range from 5% to 27.2%. [4][5][6][7][8][9] However, evidence is conflicting regarding the relationship between PICU admission, vancomycin use, and AKI. McKamy et al 4 studied children on vancomycin in all hospital wards (n = 167) and defined AKI as a 50% baseline increase in serum creatinine (SCr) or an increase of 0.5 mg/dL.…”

Section: Pediatric Acute Kidney Injury and Vancomycinmentioning

confidence: 99%

Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

Bonazza

Bresee

Kraft

et al. 2016

The Journal of Pediatric Pharmacology and Therapeutics

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BACKGROUND:Published information evaluating frequency of and risk factors for vancomycin-induced acute kidney injury (AKI) in the pediatric intensive care unit (PICU) population is conflicting. OBJECTIVES: The primary objective was to describe the proportion of our PICU patients who developed AKI with intravenous (IV) vancomycin. The secondary objective was to describe the associated potential risk factors. METHODS: Pediatric patients (0-18 years) who received their first IV vancomycin dose in the PICU were evaluated in this retrospective chart review. AKI was defined based on Pediatric-Modified RIFLE (pRIFLE) criteria. Patient demographics, vancomycin trough concentrations, concomitant nephrotoxins, and estimated creatinine clearance changes were analyzed. RESULTS: Of 265 patients included, the primary outcome of AKI (defined by meeting any pRIFLE criteria) occurred in 62 (23.4%) patients (48 category R, 11 category I, 3 category F). Patients who received vancomycin treatment for ≥ 5 days were more likely to develop AKI (unadjusted odds ratio [uOR]: 2.52; 95% confidence interval [CI]: 1.11-5.73), as were patients with a maximum vancomycin trough level ≥ 20 mg/L (OR: 2.99; 95% CI: 1.54-5.78) and patients on 1 (uOR: 2.29; 95% CI: 1.12-4.66) or more concurrent nephrotoxin (uOR: 3.11; 95% CI: 1.43-6.77). Among nephrotoxins, patients receiving furosemide concomitantly with vancomycin were more likely to develop AKI (uOR: 3.47; 95% CI: 1.92-6.27). After adjustment, only furosemide was a significant predictor of risk of AKI/AKI (adjusted OR: 3.52; 95% CI: 1.88-6.62). The study was limited by its retrospective and observational design, and confounding variables. CONCLUSIONS: Patients who were receiving vancomycin with concurrent furosemide were at highest risk of developing AKI.INDEX TERMS: acute kidney injury, critical illness, drug monitoring, pediatrics, vancomycin J Pediatr Pharmacol Ther 2016;21(6): [486][487][488][489][490][491][492][493]

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Section: Pediatric Acute Kidney Injury and Vancomycinmentioning

confidence: 99%

Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

Bonazza

Bresee

Kraft

et al. 2016

The Journal of Pediatric Pharmacology and Therapeutics

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“…While there is much debate and perseveration regarding renal injury associated with vancomycin, our data from our previous [15] and current investigation suggests the incidence and risk is not greater than that associated with other β-lactam antimicrobials, which are commonly used in pediatric intensive care units and don't engender the same debate or concern for renal injury. As previously mentioned, there have been two investigations evaluating whether vancomycin trough levels are associated with renal injury across an entire pediatric population and three specifically evaluating varying pediatric ICU populations [14][15][16][17][18]. While ICU admission and vancomycin troughs ≥15 mcg/mL were identified as risk factors, thus far, none of the three investigations of pediatric ICU patients validate the finding of increased renal injury with vancomycin trough levels ≥15 mcg/mL [15,16,18].…”

Section: Discussionmentioning

confidence: 99%

“…In pediatric patients, some investigations have been undertaken. McKamy et al evaluated the incidence and risk factors for vancomycin induced renal injury in children who were older than 1 week to 19 years [14]. The authors suggested that higher vancomycin troughs in addition to admission to the intensive care unit were potential risk factors for renal injury [15].…”

Section: Discussionmentioning

confidence: 99%

“…The current adult literature suggests an increased incidence of renal injury with increasing vancomycin trough levels, especially when other risk factors are present including: intensive care unit admission, prolonged duration of vancomycin therapy, concurrent nephrotoxic medications, increased age, and obesity [6,[11][12][13]. There is some level of disagreement in the pediatric literature evaluating risk factors for renal injury with higher vancomycin trough concentrations as compared with the adult literature [6,[11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial Renal Injury in a Pediatric Intensive Care Unit: β-Lactams vs. Vancomycin

2014

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Vancomycin trough (Vt) concentrations of 15-20 mcg/mL have been associated with an increased rate of renal injury in adults. Current data in pediatrics suggests Vts of 15-20 mcg/mL do not increase the risk of renal injury in children admitted to a pediatric intensive care unit (PICU). The primary objective was to determine if a difference exists in the incidence of renal injury in PICU patients receiving a β-lactam as compared with vancomycin therapy with Vts of 15-20 mcg/mL. This was a retrospective cohort study conducted within a PICU within a freestanding tertiary care pediatric hospital. The records of children admitted to the PICU between 10/2008-6/2009 who received vancomycin for ≥48 h targeting higher Vt concentrations of ≥15 mcg/mL for pneumonia, bacteremia, and meningitis were reviewed. This cohort (V group) was compared to children admitted from July 2009-July 2013 who received cefepime or piperacillin/tazobactam for ≥72 h (B group). Serum creatinine values were collected from 48 h before until 48 h after discontinuation of therapy for calculation of estimated glomerular filtration rate. Renal injury was categorized according to pRIFLE. 57 and 112 patients were included in the V and B groups, respectively. OPEN ACCESSPharmacy 2014, 2 277The mean (SD) therapeutic dose of vancomycin was 63.5(17.3) mg/kg/day and the mean (SD) trough was 17.8(3.1). The mean (SD) dose of cefepime was 51(26) mg/kg/dose with an every 8 h interval. The mean (SD) dose of piperacillin/tazobactam was 77(22) mg/kg/dose with an every 6 h interval. The mean (SD) PRISM scores were 10.9(10.2), 4.24(6.4) for the V and B groups, respectively (p < 0.001). Five of 57 and 10 of 112 patients in the V and B groups, respectively, were classified as having injury according to pRIFLE. No patient was classified as having a degree of renal injury greater than the pRIFLE injury. The incidence of renal injury was 8.8% in the V group and 8.9% in the B group, respectively (p = 1). Our observations suggest that maintaining Vt concentrations ≥15 mcg/mL is not associated with an increased rate of renal injury as compared with β-lactam monotherapy in a PICU population.

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“…Nephrotoxicity was defined as an increase in the serum creatinine (SCr) of at least 0.5 mg/dL or a 50% increase in baseline SCr on, at least, two consecutive days [9,15].…”

Section: Vancomycin Monitoringmentioning

confidence: 99%

Is vancomycin monitoring of real value in pediatric cancer patients?

Imam¹,

Khaled²,

Abdelrahim³

et al. 2017

Med-Science

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Vancomycin is not nephrotoxic by itself but many patients using it with other nephrotoxic agents show nephrotoxicity to some extent. Whether to monitor or not to monitor vancomycin needs further study. The aim of the present study was to investigate the significance of monitoring vancomycin serum levels in pediatric patients treated from different malignancies. 150 newly diagnosed pediatric patients, with various types of malignancy treated with different nephrotoxic agents including vancomycin, were recruited in the study. All patients had normal renal functions at the start of the study and were divided into three groups; Group I included 50 (21 females) patients received vancomycin without monitoring (VWOM group); Group II included 50 (19 females) patients received vancomycin with monitoring (VWM group); Group III (Control group) included 50 (23 females) patients received vancomycin-free antimicrobial agents (VF group). Vancomycin trough level was determined only for VWM group. The effectiveness of monitoring was estimated by the ability to achieve more rapid response, decrease hospital stay and nephrotoxicity and its effect on total dose of vancomycin. There was a significant decrease in nephrotoxicity in VWM and VF groups, 9 subjects (18%), compared to 15 subjects (30%) in VWOM group (p=0.016). The time needed to show a response achievement was significantly decreased in VWM group compared to VWOM group with mean (SD) of 6.5 (2.5) and 8.7 (3.6) days, respectively (p=0.015). That led to shorter hospital stay in VWM group compared to VWOM group with mean (SD) of 10.1 (3.4) and 12.4 (4.2) days, respectively (p=0.003). Monitoring vancomycin level was important in the examined high risk groups of pediatric cancer patients studied.

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Incidence and Risk Factors Influencing the Development of Vancomycin Nephrotoxicity in Children

Cited by 169 publications

References 16 publications

Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

Antimicrobial Renal Injury in a Pediatric Intensive Care Unit: β-Lactams vs. Vancomycin

Is vancomycin monitoring of real value in pediatric cancer patients?

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