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High Single‐dose Vancomycin Loading Is Not Associated With Increased Nephrotoxicity in Emergency Department Sepsis Patients
Author(s) -
Rosini Jamie M.,
Davis Joshua J.,
Muenzer Jeffrey,
Levine Brian J.,
Papas Mia A.,
Comer Dominique,
Arnold Ryan
Publication year - 2016
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12934
Subject(s) - medicine , nephrotoxicity , vancomycin , creatinine , emergency department , loading dose , dosing , sepsis , confidence interval , renal function , retrospective cohort study , toxicity , staphylococcus aureus , psychiatry , biology , bacteria , genetics
Objective Vancomycin loading doses are recommended; however, the risk of nephrotoxicity with these doses is unknown. The primary objective of this study was to compare nephrotoxicity in emergency department ( ED ) sepsis patients who received vancomycin at high doses (>20 mg/kg) versus lower doses (≤20 mg/kg). Methods A retrospective cohort study was performed in three academic ED s. Inclusion criteria were age ≥ 18 years, intravenous vancomycin order, and hospital admission. Exclusion criteria were no documented weight, hemodialysis‐dependent, and inadequate serum creatinine ( SC r) values for the measured outcome. Analyses compared the incidence of nephrotoxicity for patients who received vancomycin at high dose (>20 mg/kg) versus low dose (≤20 mg/kg). Results A total of 2,131 consecutive patients prescribed vancomycin over 6 months were identified. Of these, 1,330 patients had three SC r values assessed for the primary outcome. High‐dose initial vancomycin was associated with a significantly lower rate of nephrotoxicity (5.8% vs. 11.1%). After age, sex, and initial SC r were adjusted for, the risk of high‐dose vancomycin compared to low‐dose was decreased for the development of nephrotoxicity (relative risk = 0.60; 95% confidence interval = 0.44 to 0.82). Conclusion Initial dosing of vancomycin > 20 mg/kg was not associated with an increased rate of nephrotoxicity compared with lower doses. Findings from this study support compliance with initial weight‐based vancomycin loading doses.