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Nephrotoxicity in Patients with Vancomycin Trough Concentrations of 15–20 μg/ml in a Pediatric Intensive Care Unit
Author(s) -
Cies Jeffrey J.,
Shankar Venkat
Publication year - 2013
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1227
Subject(s) - medicine , vancomycin , nephrotoxicity , pediatric intensive care unit , intensive care unit , pneumonia , cohort , retrospective cohort study , dosing , meningitis , bacteremia , trough concentration , intensive care medicine , pediatrics , antibiotics , kidney , staphylococcus aureus , biology , bacteria , microbiology and biotechnology , genetics
Study Objectives To determine if a higher serum vancomycin ( V t) target trough concentration of 15–20 μg/ml or greater is associated with an increased rate of vancomycin‐induced nephrotoxicity in children admitted to a pediatric intensive care unit ( PICU ), and to determine risk factors for developing vancomycin‐induced nephrotoxicity. Design Retrospective cohort study. Setting A PICU within a freestanding tertiary care pediatric hospital. Patients A total of 113 patients received vancomycin for at least 48 hours The high–trough cohort (H group [57 patients]) received vancomycin therapy between November 2008 and June 2009 for pneumonia, bacteremia, or meningitis that was managed by a clinical pharmacist who directed dosage adjustments driven by a novel algorithm to attain a target Vt concentration of 15–20 μg/ml or greater; the control group ( C group [56 patients]) received vancomycin therapy during the preceding 10 months (between January and October 2008) for pneumonia or meningitis using standard dosing guidelines with lower target V t concentrations of 5–15 μg/ml. Measurements and Main Results The highest grade of renal dysfunction according to the Common Terminology Criteria for Adverse Events criteria, v.4.0, was recorded. The mean ± SD Vt was 17.8 ± 3.1 and 8.4 ± 3.1 in the H and C groups, respectively (p<0.001). The rate of grade 1 nephrotoxicity was not significantly different between groups (8.8% in the H group vs 5.4% in the C group; p=0.72). No patient in either group developed a higher grade of renal dysfunction. In the univariable analysis, duration of vancomycin therapy (odds ratio [ OR ] 1.32, 95% confidence interval [ CI] 1.01–1.02, p=0.003), use of extracorporeal membrane oxygenation ( OR 1.32, 95% CI 1.13–1.75, p=0.003), and vasopressor use ( OR 1.41, 95% CI 1.11–1.37, p<0.001) were associated with nephrotoxicity. In the multivariable analysis, vasopressor use ( OR 11.1, 95% CI 1.4–85, p=0.021) and duration of therapy were associated with nephrotoxicity ( OR 1.19, 95% CI 1.04–1.37, p=0.011). Conclusion Our observations suggest that maintaining Vt concentrations 15 µg/ml or greater is not associated with an increased rate of nephrotoxicity in a PICU population.