Vancomycin-induced nephrotoxicity: mechanism, incidence, risk factors and special populations. A literature review

Elyasi, Sepideh; Khalili, Hossein; Dashti‐Khavidaki, Simin; Mohammadpour, Amirhooshang

doi:10.1007/s00228-012-1259-9

Cited by 365 publications

(335 citation statements)

References 74 publications

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“…Although some have proposed the routine addition of vancomycin to the preoperative antibiotic regimen, we and others have shown that the addition of this additional drug did not reduce the incidence of SSI compared with a single drug regimen [33,36,39]. Additionally, vancomycin overuse can result in adverse events including nephrotoxicity, ototoxicity, and the development of resistant organisms [2,13,40]. Therefore, the purposes of this study are to (1) compare risk of developing AKI between patients receiving prophylactic cefazolin versus without the addition of vancomycin; (2) compare the severity and recovery of AKI in these cohorts; and (3) determine the independent risk factors for AKI in patients undergoing primary hip and knee arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the effectiveness and superiority of the addition of vancomycin to the standard prophylactic regimen in infection prevention continues to be debated [33,36,37,39]. Finally, exposure to vancomycin has been shown to be a risk factor for the development of resistant organisms, hearing loss, and acute kidney injury (AKI) [2,13,14,40]. Therefore, the purposes of this study are to (1) compare risk of developing AKI between patients receiving prophylactic cefazolin with versus without the addition of vancomycin; (2) compare the severity and recovery of AKI in these cohorts; and (3) determine the independent risk factors for AKI in patients undergoing primary hip and knee arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

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Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Courtney

Melnic

Zimmer

et al. 2015

Clinical Orthopaedics &Amp; Related Research

104

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Background With increasing prevalence of methicillinresistant Staphylococcus aureus (MRSA) in patients undergoing hip and knee arthroplasty, some have advocated a dual-antibiotic regimen including vancomycin as prophylaxis against surgical site infections. However, routine administration of vancomycin may result in impaired renal functions in susceptible patients. Questions/purposes The purpose of this study was to determine whether patients receiving antibiotic prophylaxis with cefazolin and vancomycin have a higher risk of postoperative acute kidney injury (AKI) compared with patients receiving cefazolin alone before elective primary hip and knee arthroplasty. We also aimed to compare severity and recovery of AKI in these two cohorts and to determine independent risk factors for AKI. Methods We retrospectively evaluated a series of 1828 patients undergoing primary hip and knee arthroplasty over a 2-year period who received either cefazolin (n = 500) or cefazolin and vancomycin (n = 1328) as perioperative antibiotic prophylaxis. During the study period, a perceived high prevalence of MRSA infections at our institution led some surgeons to add vancomycin to the prophylactic antibiotic regimen. The patient characteristics, case mix, and preoperative renal function and baseline creatinine clearance were similar between the two groups. We defined AKI according to the published Acute Kidney Injury Network (AKIN) criteria, and the risk of AKI in both groups was compared. We also compared the proportions of patients by AKIN severity stage and assessed recovery as defined by creatinine levels showing kidney function reaching 50% baseline. The American Society of Anesthesiologists (ASA) classification, preoperative chronic kidney disease, intraoperative fluid requirements, and estimated blood loss were recorded. We analyzed the data using a multivariate logistic regression model to identify potential independent risk factors, including dual antibiotic therapy. Results Patients receiving dual antibiotics were more likely to develop AKI compared with those receiving cefazolin alone (13% versus 8%, p = 0.002). Dual-antibiotic prophylaxis also was associated with greater severity; patients in the dual antibiotic group had higher rates of Grade II and III acute kidney injury (3% versus 0%, p = 0.003). There was no difference in the rate of return to baseline renal function (2 ± 1.4 days versus 3 ± 3.4 days; mean difference, 0.5 days; 95% confidence interval [CI], À0.2 to 1.2 days; p = 0.155). Controlling for confounding variables, dual antibiotic prophylaxis (adjusted odds ratio [OR], 1.82; 95% CI, 1.25-2.64; p = 0.002), ASA class

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Courtney

Melnic

Zimmer

et al. 2015

Clinical Orthopaedics &Amp; Related Research

104

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“…Vancomycin is a broad-spectrum antibiotic known to be effective against the USA300 strain of MRSA (80), the same strain used in our studies. It is used selectively prior to surgery (54), as it has been suggested to induce renal toxicity; however, this is not known to happen after single-dose administration (81). Vancomycin has also been shown to increase mast cell degranulation (82), which is associated with delayed-type hypersensitivity and renal toxicity (83).…”

Section: Discussionmentioning

confidence: 99%

Propofol Sedation Exacerbates Kidney Pathology and Dissemination of Bacteria during Staphylococcus aureus Bloodstream Infections

Visvabharathy

Freitag

2017

Infect Immun

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Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for large numbers of postsurgical nosocomial infections across the United States and worldwide. Propofol anesthesia is widely used in surgery and in intensive care units, and recent evidence indicates that even brief exposure to propofol can substantially increase host susceptibility to microbial infection. Here, we delineate the impact of propofol sedation on MRSA bloodstream infections in mice in the presence and absence of prophylactic antibiotic treatment. Consistent with previous reports, brief periods of anesthesia with propofol were sufficient to significantly increase bacterial burdens and kidney pathology in mice infected with MRSA. Propofol exposure increased neutrophilic infiltrates into the kidney and enhanced bacterial dissemination throughout kidney tissue. Propofol sedation reduced populations of effector phagocytes and mature dendritic cells within the kidney and led to the apparent expansion of myeloid-derived suppressor cell-like populations. When propofol was coadministered with vancomycin prophylaxis, it dramatically increased kidney abscess formation and bacterial dissemination throughout kidney tissue at early times post-S. aureus infection compared to antibiotic-treated but nonsedated animals. Taken together, our data indicate that short-term sedation with propofol significantly increases the severity of bloodstream MRSA infection, even when administered in conjunction with vancomycin prophylaxis.KEYWORDS MRSA, anesthesia, bacterial pathogenesis, immune suppression, kidney abscess, macrophages, monocytes, vancomycin N osocomial infections are common complications that follow surgery or prolonged stays in intensive care units (ICU) of hospitals (1-5) and which result in large increases in patient morbidity and mortality in addition to elevated health care costs (6). The causative agents of nosocomial infection are often bacteria (4, 7), and Staphylococcus aureus is one of the most frequently isolated pathogens in this regard (8). Antibiotic treatment of S. aureus infections can be complicated by the prevalence of methicillin-resistant S. aureus (MRSA) strains in hospitals and increasingly in community settings (9, 10). Patients often require multiple antibiotics or use of broad-spectrum antibiotics to eradicate infection (11). Despite numerous measures taken to ensure sterility and limit spread of MRSA from health care workers to patients in hospitals (12, 13), the rate of infection remains high (14,15). While significant effort is generally focused on enforcing aseptic technique as a method to prevent infection, there may be additional factors that influence the frequency and/or severity of nosocomial infections (16).Propofol is one of the most common anesthetic agents used in the induction and maintenance of anesthesia prior to surgery, both in the intensive care unit (ICU) and in routine outpatient procedures (17)(18)(19)(20). This is in part due to its low incidence of anesthesia-related side effects and the shor...

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“…Th e American Th oracic Society and the Infectious Diseases Society of America recommend vancomycin trough levels between 15 and 20 mg/L for hospital and ventilatorassociated pneumonias, bacteremia, endocarditis, osteomyelitis, and meningitis ( 7 ). Treatment with vancomycin beyond 1 week increases the incidence of nephrotoxicity from 6% to 21%, and the incidence is close to 30% with more than 2 weeks of therapy ( 2 ). Once-weekly monitoring of trough concentration is recommended in stable patients ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors for vancomycin-associated nephrotoxicity can be divided into three classifi cations: vancomycin exposurerelated factors, host-related factors, and the use of concurrent nephrotoxins ( 1,2,8 ). Vancomycin exposure-related factors include larger vancomycin exposures, such as troughs >15 mg/L and prolonged duration of treatment.…”

Section: Discussionmentioning

confidence: 99%

Acute Renal Failure Due to Vancomycin Toxicity in the Setting of Unmonitored Vancomycin Infusion

Vora¹

2016

Baylor University Medical Center Proceedings

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Vancomycin-induced nephrotoxicity: mechanism, incidence, risk factors and special populations. A literature review

Cited by 365 publications

References 74 publications

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Propofol Sedation Exacerbates Kidney Pathology and Dissemination of Bacteria during Staphylococcus aureus Bloodstream Infections

Acute Renal Failure Due to Vancomycin Toxicity in the Setting of Unmonitored Vancomycin Infusion

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