Vancomycin‐Associated Nephrotoxicity in Adult Medicine Patients: Incidence, Outcomes, and Risk Factors

Meaney, Calvin J.; Hynicka, Lauren M.; Tsoukleris, Mona

doi:10.1002/phar.1423

Cited by 91 publications

(96 citation statements)

References 26 publications

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“…To our knowledge, this is the largest study to date to examine the difference in AKI incidence among patients treated with VAN and FEP or PTZ. We found the AKI rate in patients treated with VAN-TZP to be 21.4%, whereas the range of the incidence found in the current literature is 9.5 to 34.8% (8)(9)(10)(11)(12)(13)(14)(15)(16). The AKI incidence in the VAN-FEP group was similar to previous reports of 12.5% (9,10).…”

Section: Discussionsupporting

confidence: 86%

Nephrotoxicity during Vancomycin Therapy in Combination with Piperacillin-Tazobactam or Cefepime

Rutter

Cox

Martin

et al. 2017

Antimicrob Agents Chemother

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Recent reports have demonstrated that vancomycin (VAN) may lead to an increase in the incidence of acute kidney injury (AKI) when it is combined with antipseudomonal beta-lactams. This study compared the incidence of AKI associated with VAN plus piperacillin-tazobactam (TZP) or cefepime (FEP). This was a retrospective, matched cohort study that was conducted at an academic medical center between September 2010 and September 2014 and that included adult patients without severe chronic or structural kidney disease, dialysis, pregnancy, cystic fibrosis, or a hospital transfer receiving TZP-VAN or FEP-VAN for at least 48 h. The primary outcome was the difference in the AKI incidence between the TZP-VAN and FEP-VAN groups, evaluated using the risk, injury, failure, loss of kidney function, and endstage kidney disease (RIFLE) criteria. Patients in the two groups were matched on the basis of age, sex, severity of illness, baseline creatinine clearance, hypotension, number of nephrotoxicity risk factors, and intravenous contrast exposure. In total, 4,193 patients met all inclusion criteria (3,605 received TZP-VAN and 588 received FEP-VAN). The unadjusted AKI incidence was 21.4% in patients receiving TZP-VAN, whereas it was 12.6% in patients receiving FEP-VAN (P Ͻ 0.001). After the patients were matched, 1,633 patients receiving TZP-VAN and 578 patients receiving FEP-VAN were evaluated. The AKI incidence remained higher in patients receiving TZP-VAN than in those receiving FEP-VAN (21.4% versus 12.5%, P Ͻ 0.0001). This trend remained true for all classifications of the RIFLE criteria. After controlling for remaining confounders, TZP-VAN therapy was associated with 2.18 times the odds of AKI than FEP-VAN therapy (95% confidence interval, 1.64 to 2.94 times) in logistic regression. AKI was significantly more common in patients receiving vancomycin in combination with piperacillin-tazobactam than in those receiving vancomycin in combination with cefepime. This finding reinforces the need for the judicious use of combination empirical antimicrobial therapy.

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Section: Discussionsupporting

confidence: 86%

Nephrotoxicity during Vancomycin Therapy in Combination with Piperacillin-Tazobactam or Cefepime

Rutter

Cox

Martin

et al. 2017

Antimicrob Agents Chemother

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“…This may be in part due to the poor ability of the HCAP criteria to predict pneumonia due to DRPs (15)(16)(17). The unnecessary use of extended-spectrum antibiotics is associated with negative collateral effects, including increased costs (12,18) and lengths of stay (12,19,20), drug toxicity (21)(22)(23)(24), Clostridium difficile infection (25), and resistance (26).…”

mentioning

confidence: 99%

Derivation and Multicenter Validation of the Drug Resistance in Pneumonia Clinical Prediction Score

Webb

Dascomb

Stenehjem

et al. 2016

Antimicrob Agents Chemother

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“…Concomitant piperacillin/tazobactam has also been postulated to increase the risk for nephrotoxic effects, but adequately designed, prospective studies are needed to validate these claims. [70][71][72] Although vancomycin was formerly administered at a fixed dose (eg, 1000 mg intravenously every 12 hours), current guidelines recommend individualized dosing based on the patient's weight, renal function, and Vancomycin dosing should be individualized on the basis of the patient's weight, renal function, and severity of illness to optimize the AUC:MIC ratio and reduce toxic effects. severity of illness to optimize efficacy and reduce toxic effects.…”

Section: Vancomycinmentioning

confidence: 99%

Application of Antibiotic Pharmacodynamics and Dosing Principles in Patients With Sepsis

Fleet

Mueller

2016

Critical Care Nurse

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Sepsis is associated with marked mortality, which may be reduced by prompt initiation of adequate, appropriate doses of antibiotic. Critically ill patients often have physiological changes that reduce blood and tissue concentrations of antibiotic and high rates of multidrug-resistant pathogens, which may affect patients' outcomes. All critical care professionals, including critical care nurses, should understand antibiotic pharmacokinetics and pharmacodynamics to ensure sound antibiotic dosing and administration strategies for optimal microbial killing and patients' outcomes. Effective pathogen eradication occurs when the dose of antibiotic reaches or maintains optimal concentrations relative to the minimum inhibitory concentration for the pathogen. Time-dependent antibiotics, such as β-lactams, can be given as extended or continuous infusions. Concentration-dependent antibiotics such as aminoglycosides are optimized by using high, once-daily dosing strategies with serum concentration monitoring. Vancomycin and fl uoroquinolones are dependent on both time and concentration above the minimum inhibitory concentration. (Critical Care Nurse. 2016;36[2]:22-32) S epsis is a major cause of morbidity and mortality in the United States, affecting more than 650 000 patients per year. The spectrum of sepsis to septic shock is associated with crude mortality rates of 20% to 70%. [1][2][3][4] From the onset of hypotension, the probability of survival is reduced by 12% for each hour of delay before administration of adequate empiric antibiotics. 5Hence, current guidelines advocate early administration of adequate, broad-spectrum, local antibiogram-based antibiotic therapy in appropriate doses to penetrate the suspected site of infection (eg, lungs, cerebral spinal fl uid, intra-abdominal fl uid).1 Physiological changes associated with sepsis can complicate antibiotic dosing, effectiveness, and safety.

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Vancomycin‐Associated Nephrotoxicity in Adult Medicine Patients: Incidence, Outcomes, and Risk Factors

Abstract: Vancomycin-associated nephrotoxicity is prevalent among internal medicine patients, with 5.36-fold higher odds if piperacillin-tazobactam is concomitantly administered.

Cited by 91 publications

References 26 publications

Nephrotoxicity during Vancomycin Therapy in Combination with Piperacillin-Tazobactam or Cefepime

Nephrotoxicity during Vancomycin Therapy in Combination with Piperacillin-Tazobactam or Cefepime

Derivation and Multicenter Validation of the Drug Resistance in Pneumonia Clinical Prediction Score

Application of Antibiotic Pharmacodynamics and Dosing Principles in Patients With Sepsis

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