The association between vancomycin trough concentrations and acute kidney injury in the neonatal intensive care unit

Bhargava, Vidit; Malloy, Michael H.; Fonseca, Rafael

doi:10.1186/s12887-017-0777-0

Cited by 38 publications

(33 citation statements)

References 22 publications

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“…There have been studies on the risk factors for VA-AKI in the past [22][23][24]. Like previous studies, a positive correlation between VA-AKI and increasing vancomycin trough concentrations and baseline serum creatinine was found in this study.…”

Section: Discussionsupporting

confidence: 85%

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

et al. 2020

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Background:To study the incidence of vancomycin-associated acute kidney injury (VA-AKI) in Hong Kong and identify risk factors for VA-AKI. Method: Patients with vancomycin prescription and blood level measurement in 2012-2016 were identified using the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System. Acute kidney injury was defined using KDIGO criteria. Patients without creatinine measurements, steady-state trough vancomycin level or who had vancomycin treatment < 3 days were excluded. Results were analyzed using SPSS version 22.0. Logistic regression was used to identify the predictors for VA-AKI. Odds ratio and 95% confidence interval were estimated. Results: One thousand four hundred fifty patients were identified as VA-AKI from 12,758 records in Hong Kong in 2012-2016. The incidence was respectively 10.6, 10.9, 11.3, 12.2, 11.2% from 2012 to 2016. The incidence of VA-AKI was 16.3, 12.2, 11.3 and 6.2% in patients aged 1-12, 12-60, elderly aged > 60 and newborn and infants, respectively. Baseline creatinine, serum trough vancomycin level, systematic disease history including respiratory failure, hypertension, congestive heart failure, chronic renal failure, anemia and type II diabetes, and concomitant diuretics, piperacillin-tazobactam (PTZ) and meropenem prescription were significantly higher in VA-AKI patients older than 12 years. Logistic regression showed that older age group, higher baseline creatinine, serum trough vancomycin level, respiratory failure, chronic renal failure and congestive heart failure, concomitant diuretics, PTZ and meropenem prescription, and longer hospital stay were all associated with increased risk of VA-AKI. Conclusion: The incidence of VA-AKI in Hong Kong is low but shows no decline. Patients with higher baseline creatinine, multi-organ diseases and multiple drugs administration should have their vancomycin level monitored to decrease the risk of VA-AKI.

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Section: Discussionsupporting

confidence: 85%

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

et al. 2020

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“…25 Previous studies have shown modest associations between vancomycin dose or trough concentrations and acute kidney injury. [26][27][28] No differences in the total vancomycin daily dose administered or in the achieved trough concentration were observed between less and more aggressive dosing strategies and toxicity in our study. However, as seen in our study and with other vancomycin nomograms targeting higher trough concentrations, risk of supratherapeutic trough concentrations are increased.…”

Section: Discussioncontrasting

confidence: 51%

The Effectiveness of a Vancomycin Dosing Guideline in the Neonatal Intensive Care Unit for Achieving Goal Therapeutic Trough Concentrations

Reilly

Ding

Rower

et al. 2019

The Journal of Clinical Pharma

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Concern for bacterial resistance and treatment failure with vancomycin trough concentrations < 10 μg/mL have led guidelines to increase goal concentrations. There is a paucity of data evaluating vancomycin dosage necessary to achieve goals in the neonatal intensive care unit (NICU). We aimed to evaluate the implementation of a new vancomycin dosing guideline in improving trough target attainment. This retrospective study evaluated neonates in the NICU treated with vancomycin between January 2009 and December 2015. Therapeutic trough concentration attainment (10-20 μg/mL) was compared between neonates receiving vancomycin per old versus new dosing guidelines. Vancomycin trough concentrations, modeled pharmacodynamic target attainment, and nephrotoxicity were compared between groups. A total of 212 vancomycin trough concentrations (n = 91 old and n = 121 new guideline) were evaluated in 182 unique neonates. The mean ± standard deviation trough concentration achieved was 18.0 ± 7.3 μg/mL vs 8.9 ± 4.8 μg/mL in the new and old guidelines, respectively (P < .01). The new guideline resulted in a higher percentage of neonates achieving trough concentrations of 10 to 20 μg/mL (62% vs 29%; P < .01) and decreased the percentage of neonates with subtherapeutic trough concentrations (9% vs 69%; P < .01). Pharmacokinetic modeling identified postmenstrual age, days of life, and urine output as predictors of vancomycin clearance and resultant trough and area under the curve values (P < .01 for all). Trough concentrations >10 μg/mL ensured area under the curve /minimum inhibitory concentration >400 in >90% of neonates when bacteria minimum inhibitory concentration was ࣘ 1 μg/mL. Nephrotoxicity was similar between groups (8.3% vs 7.7%; P = .99). In conclusion, a vancomycin nomogram designed to achieve trough concentration of 10 to 20 μg/mL improves pharmacodynamic target attainment in neonates in the NICU.

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“…Similarly, a retrospective study conducted by Bhargava et al concluded that there is a positive correlation between increasing vancomycin trough concentrations and increasing serum creatinine levels. Vancomycin trough concentrations above 15 mg/liter were found to be associated with a higher incidence of acute kidney injury in neonates (23). Trough concentrations lower than 10 mg/liter should also be avoided because of an increased risk of selecting for vancomycin-intermediate or vancomycin-resistant isolates (24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Relationship between Vancomycin Trough Concentration and 24-Hour Area under the Concentration-Time Curve in Neonates

Tseng

Lim

Chen

et al. 2018

Antimicrob Agents Chemother

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Bacterial sepsis is a major cause of morbidity and mortality in neonates, especially those involving methicillin-resistant (MRSA). Guidelines by the Infectious Diseases Society of America recommend the vancomycin 24-h area under the concentration-time curve to MIC ratio (AUC/MIC) of >400 as the best predictor of successful treatment against MRSA infections when the MIC is ≤1 mg/liter. The relationship between steady-state vancomycin trough concentrations and AUC values (mg·h/liter) has not been studied in an Asian neonatal population. We conducted a retrospective chart review in Singapore hospitals and collected patient characteristics and therapeutic drug monitoring data from neonates on vancomycin therapy over a 5-year period. A one-compartment population pharmacokinetic model was built from the collected data, internally validated, and then used to assess the relationship between steady-state trough concentrations and AUC A Monte Carlo simulation sensitivity analysis was also conducted. A total of 76 neonates with 429 vancomycin concentrations were included for analysis. Median (interquartile range) was 30 weeks (28 to 36 weeks) for postmenstrual age (PMA) and 1,043 g (811 to 1,919 g) for weight at the initiation of treatment. Vancomycin clearance was predicted by weight, PMA, and serum creatinine. For MRSA isolates with a vancomycin MIC of ≤1, our major finding was that the minimum steady-state trough concentration range predictive of achieving an AUC/MIC of >400 was 8 to 8.9 mg/liter. Steady-state troughs within 15 to 20 mg/liter are unlikely to be necessary to achieve an AUC/MIC of >400, whereas troughs within 10 to 14.9 mg/liter may be more appropriate.

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The association between vancomycin trough concentrations and acute kidney injury in the neonatal intensive care unit

Cited by 38 publications

References 22 publications

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

The Effectiveness of a Vancomycin Dosing Guideline in the Neonatal Intensive Care Unit for Achieving Goal Therapeutic Trough Concentrations

Evaluating the Relationship between Vancomycin Trough Concentration and 24-Hour Area under the Concentration-Time Curve in Neonates

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