The Relationship Between Vancomycin Trough Concentrations and Nephrotoxicty: A Prospective, Multi-center Trial.
Antimicrob Agents Chemother. 2011 Sep 26;
Authors: Bosso JA, Nappi J, Rudisill C, Wellein M, Bookstaver PB, Swindler J, Mauldin PD
Abstract
Several single center studies have suggested that higher doses of vancomycin, aimed at producing trough concentrations > 15 mg/L, are associated with increased risk of nephrotoxicity. We prospectively assessed the relative incidence of nephrotoxicity in relation to trough concentration in patients with documented MRSA infections at 7 hospitals throughout South Carolina. Adult patients receiving vancomycin for at least 72 hr with at least one vancomycin trough concentration determined under steady-state conditions were prospectively studied. The relationship between vancomycin trough concentrations > 15 mg/mL and occurrence of nephrotoxicity was assessed using univariate and multivariate analyses, controlling for age, gender, race, dose, length of therapy, use of other nephrotoxins (including contrast media), ICU residence, episodes of hypotension, and comorbidities. Nephrotoxicity was defined as an increase in serum creatinine of 0.5 mg/dL or ? 50% increase from baseline for two consecutive measurements. Minimum inhibitory concentrations of vancomycin for the MRSA isolates were also determined. 288 patients were studied between February 2008 and June 2010 with approximately one-half having initial trough concentrations ? 15 mg/mL. Nephrotoxicity was observed in 42 patients (29.6%) with trough concentrations > 15 mg/mL and in 13 (8.9%) with troughs ? 15 mg/mL. Multivariate analysis revealed vancomycin troughs > 15 mg/mL and race (Black) as risk factors for nephrotoxicity in this population. Vancomycin trough concentrations > 15 mg/mL appear to be associated with a 3-fold increased risk of nephrotoxicity.
PMID: 21947388 [PubMed - as supplied by publisher]