Nephrotoxicity in Patients with Vancomycin Trough Concentrations of 15–20 μg/ml in a Pediatric Intensive Care Unit

Cies, Jeffrey J.; Shankar, Venkat

doi:10.1002/phar.1227

Cited by 34 publications

(58 citation statements)

References 38 publications

(78 reference statements)

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“…For the B cohort, none of the factors were found to be associated with renal injury (Table 4). The multivariable logistic regression analysis has been previously reported [15]. As none of the variables of interest were found to be statistically significant in univariable analysis, multivariable regression was not conducted for the B cohort.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 177 children in the pediatric intensive care unit received vancomycin between November 2008 and June 2009 [15]. Of these, 120 were excluded: 91 for a non-study disease state and 29 who did not have a Vt concentration.…”

Section: Resultsmentioning

confidence: 99%

“…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]. Similarly, Knoderer et al suggest that ICU admission and initial vancomycin trough levels ≥15 mcg/mL were associated with renal injury [17].…”

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%

“…There were no restrictions related to age or dosing regimen received. The B cohort was compared to a previously described cohort of patients that received vancomycin for at least 48 h targeting higher vancomycin trough (Vt) concentrations of 15-20 mcg/mL for pneumonia, bacteremia, and meningitis [15]. There were no restrictions related to age or dosing regimen received.…”

Section: Study Design and Patient Populationmentioning

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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Study Design and Patient Populationmentioning

confidence: 99%

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

2014

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Association of Acute Kidney Injury With Concomitant Vancomycin and Piperacillin/Tazobactam Treatment Among Hospitalized Children

et al. 2017

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IMPORTANCE β-Lactam antibiotics are often coadministered with intravenous (IV) vancomycin hydrochloride for children with suspected serious infections. For adults, the combination of IV vancomycin plus piperacillin sodium/tazobactam sodium is associated with a higher risk of acute kidney injury (AKI) compared with vancomycin plus 1 other β-lactam antibiotic. However, few studies have evaluated the safety of this combination for children. OBJECTIVE To assess the risk of AKI in children during concomitant therapy with vancomycin and 1 antipseudomonal β-lactam antibiotic throughout the first week of hospitalization. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study focused on children hospitalized for 3 or more days who received IV vancomycin plus 1 other antipseudomonal β-lactam combination therapy at 1 of 6 large children's hospitals from January 1, 2007, through December 31, 2012. The study used the Pediatric Health Information System Plus database, which contains administrative and laboratory data from 6 pediatric hospitals in the United States. Patients with underlying kidney disease or abnormal serum creatinine levels on hospital days 0 to 2 were among those excluded. Patients 6 months to 18 years of age who were admitted through the emergency department of the hospital were included. Data were collected from July 2015 to March 2016. Data analysis took place from April 2016 through July 2017. (Exact dates are not available because the data collection and analysis processes were iterative.) MAIN OUTCOMES AND MEASURESThe primary outcome was AKI on hospital days 3 to 7 and within 2 days of receiving combination therapy. Acute kidney injury was defined using KDIGO criteria and was based on changes in serum creatinine level from hospital days 0 to 2 through hospital days 3 to 7. Multiple logistic regression was performed using a discrete-time failure model to test the association between AKI and receipt of IV vancomycin plus piperacillin/tazobactam or vancomycin plus 1 other antipseudomonal β-lactam antibiotic.RESULTS A total of 1915 hospitalized children who received combination therapy were identified. Of the 1915 patients, a total of 866 (45.2%) were female and 1049 (54.8%) were male, 1049 (54.8%) were identified as white in race/ethnicity, and the median (interquartile range) age was 5.6 (2.1-12.7) years. Among the cohort who received IV vancomycin plus 1 other antipseudomonal β-lactam antibiotic, 157 patients (8.2%) had antibiotic-associated AKI. This number included 117 of 1009 patients (11.7%) who received IV vancomycin plus piperacillin/tazobactam combination therapy. After adjustment for age, intensive care unit level of care, receipt of nephrotoxins, and hospital, IV vancomycin plus piperacillin/ tazobactam combination therapy was associated with higher odds of AKI each hospital day compared with vancomycin plus 1 other antipseudomonal β-lactam antibiotic combination (adjusted odds ratio, 3.40; 95% CI, 2.26-5.14).CONCLUSIONS AND RELEVANCE Coadministration of IV vancomycin and piperacillin/...

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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

et al. 2015

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Nephrotoxicity in Patients with Vancomycin Trough Concentrations of 15–20 μg/ml in a Pediatric Intensive Care Unit

Abstract: 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.

Cited by 34 publications

References 38 publications

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

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

Association of Acute Kidney Injury With Concomitant Vancomycin and Piperacillin/Tazobactam Treatment Among Hospitalized Children

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

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