|
KMID : 0869620120290030313
|
|
Journal of Korean Society of Hospital Pharmacists
2012 Volume.29 No. 3 p.313 ~ p.323
|
|
|
Risk Factors for Vancomycin Associated Nephrotoxicity in Patients Managed Through Therapeutic Drug Monitoring
|
|
Song Su-Jeong
Kim Min-Jung
Cho Yoon-Sook
Kim Hyang-Suk
Lee Hye-Sook
|
|
|
Abstract
|
|
|
Background : Recent guidelines recommend that vancomycin trough concentrations should be maintained above 10mg/L and 15-20mg/L for complicated infections. Several studies have suggested that higher trough values are associated with higher risk of nephrotoxicity. The aim of this study was to determine the incidence and risk factors for vancomycin associated nephrotoxicity, among patients managed through therapeutic drug monitoring (TDM).
Method : A retrospective study was conducted among adult patients who received vancomycin TDM service more than twice, at Seoul National University Hospital between July, 2009 and December, 2009. Patients were excluded, if they had a baseline serum creatinine level of 〉1.4mg/dl, were in ICU when they initiated vancomycin therapy, or received vancomycin with nephrotoxic agents during therapy. Vancomycin associated nephrotoxicity was defined as an increase in serum creatinine of 0.5mg/dl from the baseline, on at least two consecutive days. Risk factors for nephrotoxicity are classified into patient-related factors, underlying disease-related factors, drug-related factors, and TDM-related factors. Univariate and multivariate analyses were performed for comparison of the patients.
Results : The incidence of vancomycin associated nephrotoxicity is 21/173 (12.1%) in patients managed through vancomycin therapeutic monitoring. Patients with nephrotoxicity had higher average and 1st trough concentration (19.9mg/L vs. 12.2mg/L, p=0.005; 20.6mg/L vs. 19.9mg/L, p=0.015), than patients without nephrotoxicity. Vancomycin duration therapy of ≥14days (76.2% vs. 50%, p=0.024) were associated with increasing nephrotoxicity. Presence of underlying diseases (diabetes, heart failure, hepatic disease) was likely to be associated with development of nephrotoxicity, though this was not statistically significant.
Conclusions : Vancomycin trough concentration (≥15mg/L) and duration of therapy (≥14days) are identified to be significant predictors of nephrotoxicity. It is necessary to carry out more studies, focusing in particular on the association between vancomycin nephrotoxicity and underlying disease.
|
|
|
KEYWORD
|
|
|
vancomycin, TDM, nephrotoxicity, trough, underlying disease
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|