Nephrotoxicity of vancomycin in patients with normal serum creatinine

Incidence of Acute Kidney Injury Among Patients Receiving the Combination of Vancomycin with Piperacillin‐Tazobactam or Meropenem

“…Another study assessing the risk of AKI with VAN/PTZ versus VAN/CEF revealed a greater risk of developing AKI with VAN doses between 3 and 4 g/day, but not with doses 4 g/day or greater (OR 1.6, CI 1.11–2.32, p=0.01, and OR 1.3, CI 0.5–3.05, p=0.6, respectively) . Steady‐state VAN trough concentrations of 15 μg/ml or greater were associated with a greater risk of developing AKI in several studies . Independent risk factors identified in other studies included dehydration, patient weight, concomitant use of acyclovir, amphotericin B, or loop diuretics, duration of VAN treatment 7 days or longer, longer duration of hospital stay, receipt of VAN loading dose, presence of two or more systemic inflammatory response syndrome criteria, and a documented gram‐positive infection …”

“…9 Steady-state VAN trough concentrations of 15 lg/ml or greater were associated with a greater risk of developing AKI in several studies. 10,22,33,[39][40][41][42][43][44][45] Independent risk factors identified in other studies included dehydration, patient weight, concomitant use of acyclovir, amphotericin B, or loop diuretics, duration of VAN treatment 7 days or longer, longer duration of hospital stay, receipt of VAN loading dose, presence of two or more systemic inflammatory response syndrome criteria, and a documented gram-positive infection. 9,22,24,31,39 Baseline characteristics, specifically the significantly higher mean Charlson Comorbidity Index in the MER group, may indicate a higher severity of illness than those who received PTZ.…”

Comparative Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin‐Tazobactam or Cefepime: A Retrospective Cohort Study

“…The initial vancomycin trough level was similar between the piperacillin‐tazobactam and cefepime groups (17.91 mg/L vs 15.12 mg/L, p=0.107). Vancomycin trough concentration of 15 mg/L or higher, in particular 20 mg/L or higher, has been associated with an increased incidence of nephrotoxicity . Similarly, duration of vancomycin longer than 7 days is a risk factor for nephrotoxicity .…”

“…Vancomycin trough concentration of 15 mg/L or higher, in particular 20 mg/L or higher, has been associated with an increased incidence of nephrotoxicity. 7,8,[38][39][40][41][42][43][44] Similarly, duration of vancomycin longer than 7 days is a risk factor for nephrotoxicity. 35,39,45,46 The duration of vancomycin in patients who developed nephrotoxicity was similar in the piperacillin-tazobactam versus cefepime groups (13.3 days vs 14.7 days, p=0.398) and was longer than durations seen in other studies.…”

Falsely elevated vancomycin plasma concentrations sampled from central venous implantable catheters (portacaths)

“…Vancomycin is a glycopeptide antibiotic used to treat infections caused by gram‐positive pathogens, including methicillin‐resistant Staphylococcus aureus (MRSA). The monitoring of steady‐state vancomycin plasma concentrations is recommended to reduce the risk of ototoxicity and nephrotoxicity and to ensure that target therapeutic plasma concentrations are achieved [1–3]. Most current recommendations suggest that vancomycin doses should be adjusted to achieve trough plasma concentrations from 5–20 mg l −1 , depending on the severity of the infection and the pathogen being treated [1, 3].…”