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

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

Pharmacotherapy, 2014-07, Vol.34 (7), p.653-661 [Periódico revisado por pares]

Boston, MA: Blackwell Publishing Ltd

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  • Título:
    Vancomycin-Associated Nephrotoxicity in Adult Medicine Patients: Incidence, Outcomes, and Risk Factors
  • Autor: Meaney, Calvin J. ; Hynicka, Lauren M. ; Tsoukleris, Mona G.
  • Assuntos: Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - adverse effects ; Biological and medical sciences ; Cohort Studies ; Female ; Humans ; Incidence ; infectious disease ; internal medicine ; Kidney Diseases - chemically induced ; Kidney Diseases - diagnosis ; Kidney Diseases - epidemiology ; Male ; Medical sciences ; Middle Aged ; nephrotoxicity ; Pharmacology. Drug treatments ; piperacillin/tazobactam ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; vancomycin ; Vancomycin - adverse effects ; Young Adult
  • É parte de: Pharmacotherapy, 2014-07, Vol.34 (7), p.653-661
  • Notas: ArticleID:PHAR1423
    istex:69775790519D29CEFA5AA6D50A056B4D3B5EF9D3
    ark:/67375/WNG-5CVWVK68-H
    The authors declare no potential or actual conflicts of interest.
    There were no sources of funding for this research.
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    SourceType-Scholarly Journals-1
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  • Descrição: Objective The prevalence of vancomycin‐associated nephrotoxicity (VAN) is reported to vary from 1.0–42.6%, with most data from critically ill patients. Evaluation of VAN among internal medicine patients is lacking. Our objectives were to determine the incidence, time‐course, outcomes, and risk factors of VAN in adult internal medicine patients. Design Retrospective cohort. Setting Tertiary care academic medical center. Patients A total of 125 adult internal medicine patients receiving vancomycin treatment with mean baseline creatinine clearance of 84.6 ± 27.6 ml/min. Intervention Vancomycin treatment for a minimum of 72 hours. Measurements and Main Results Nephrotoxicity, defined as an increase in serum creatinine of 0.5 mg/dl or 50% above baseline (whichever was larger), occurred in 17 (13.6%) of 125 patients. No patients with VAN progressed to Loss or End stage as defined by the RIFLE criteria. The incidence rate of VAN was 0.02 cases/day of vancomycin treatment. Nephrotoxicity developed at a median of 4.5 days (interquartile range [IQR] 2.2–4.9) peaked at 5.7 days (IQR: 3.8–9.6), and resolved in 70.6% of the cases within 16.5 days (IQR: 6.0–17.8) after onset. On multivariable logistic regression analysis, after controlling for hypotensive episodes, Charlson Comorbidity Index, and baseline creatinine clearance, concomitant use of piperacillin‐tazobactam was associated with increased VAN (adjusted odds ratio 5.36, 95% confidence interval 1.41–20.5). Conclusions Vancomycin‐associated nephrotoxicity is prevalent among internal medicine patients, with 5.36‐fold higher odds if piperacillin‐tazobactam is concomitantly administered.
  • Editor: Boston, MA: Blackwell Publishing Ltd
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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