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Incidence and risk factors of acute kidney injury associated with continuous intravenous high-dose vancomycin in critically ill patients: A retrospective cohort study
For vancomycin therapy of severe infections, the Infectious Diseases Society of America recommends high vancomycin trough levels, whose potential for inducing nephrotoxicity is controversial. We evaluated the incidence and risk factors of acute kidney injury (AKI) in critically ill patients given co...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319501/ https://www.ncbi.nlm.nih.gov/pubmed/28207512 http://dx.doi.org/10.1097/MD.0000000000006023 |
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author | Lacave, Guillaume Caille, Vincent Bruneel, Fabrice Palette, Catherine Legriel, Stéphane Grimaldi, David Eurin, Mathilde Bedos, Jean-Pierre |
author_facet | Lacave, Guillaume Caille, Vincent Bruneel, Fabrice Palette, Catherine Legriel, Stéphane Grimaldi, David Eurin, Mathilde Bedos, Jean-Pierre |
author_sort | Lacave, Guillaume |
collection | PubMed |
description | For vancomycin therapy of severe infections, the Infectious Diseases Society of America recommends high vancomycin trough levels, whose potential for inducing nephrotoxicity is controversial. We evaluated the incidence and risk factors of acute kidney injury (AKI) in critically ill patients given continuous intravenous vancomycin with target serum vancomycin levels of 20 to 30 mg/L. We retrospectively studied 107 continuous intravenous vancomycin treatments of ≥48 hours’ duration with at least 2 serum vancomycin levels ≥20 mg/L in critically ill patients. Nephrotoxicity was defined according to the Kidney Disease Improving Global Outcomes Clinical Practice Guideline for AKI (ie, serum creatinine elevation by ≥26.5 μmoL/L or to ≥1.5 times baseline). Risk factors for AKI were identified by univariate and multivariate analyses. AKI developed in 31 (29%) courses. Higher serum vancomycin levels were associated with AKI (P < 0.01). Factors independently associated with AKI were highest serum vancomycin ≥40 mg/L (odds ratio [OR], 3.75; 95% confidence interval [CI], 1.40–10.37; P < 0.01), higher cumulative number of organ failures (OR, 2.63 95%CI, 1.42–5.31; P < 0.01), and cirrhosis of the liver (OR, 5.58; 95%CI, 1.08–31.59; P = 0.04). In this study, 29% of critically ill patients had AKI develop during continuous intravenous vancomycin therapy targeting serum levels of 20 to 30 mg/L. Serum vancomycin level ≥40 mg/L was independently associated with AKI. |
format | Online Article Text |
id | pubmed-5319501 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-53195012017-03-02 Incidence and risk factors of acute kidney injury associated with continuous intravenous high-dose vancomycin in critically ill patients: A retrospective cohort study Lacave, Guillaume Caille, Vincent Bruneel, Fabrice Palette, Catherine Legriel, Stéphane Grimaldi, David Eurin, Mathilde Bedos, Jean-Pierre Medicine (Baltimore) 3900 For vancomycin therapy of severe infections, the Infectious Diseases Society of America recommends high vancomycin trough levels, whose potential for inducing nephrotoxicity is controversial. We evaluated the incidence and risk factors of acute kidney injury (AKI) in critically ill patients given continuous intravenous vancomycin with target serum vancomycin levels of 20 to 30 mg/L. We retrospectively studied 107 continuous intravenous vancomycin treatments of ≥48 hours’ duration with at least 2 serum vancomycin levels ≥20 mg/L in critically ill patients. Nephrotoxicity was defined according to the Kidney Disease Improving Global Outcomes Clinical Practice Guideline for AKI (ie, serum creatinine elevation by ≥26.5 μmoL/L or to ≥1.5 times baseline). Risk factors for AKI were identified by univariate and multivariate analyses. AKI developed in 31 (29%) courses. Higher serum vancomycin levels were associated with AKI (P < 0.01). Factors independently associated with AKI were highest serum vancomycin ≥40 mg/L (odds ratio [OR], 3.75; 95% confidence interval [CI], 1.40–10.37; P < 0.01), higher cumulative number of organ failures (OR, 2.63 95%CI, 1.42–5.31; P < 0.01), and cirrhosis of the liver (OR, 5.58; 95%CI, 1.08–31.59; P = 0.04). In this study, 29% of critically ill patients had AKI develop during continuous intravenous vancomycin therapy targeting serum levels of 20 to 30 mg/L. Serum vancomycin level ≥40 mg/L was independently associated with AKI. Wolters Kluwer Health 2017-02-17 /pmc/articles/PMC5319501/ /pubmed/28207512 http://dx.doi.org/10.1097/MD.0000000000006023 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | 3900 Lacave, Guillaume Caille, Vincent Bruneel, Fabrice Palette, Catherine Legriel, Stéphane Grimaldi, David Eurin, Mathilde Bedos, Jean-Pierre Incidence and risk factors of acute kidney injury associated with continuous intravenous high-dose vancomycin in critically ill patients: A retrospective cohort study |
title | Incidence and risk factors of acute kidney injury associated with continuous intravenous high-dose vancomycin in critically ill patients: A retrospective cohort study |
title_full | Incidence and risk factors of acute kidney injury associated with continuous intravenous high-dose vancomycin in critically ill patients: A retrospective cohort study |
title_fullStr | Incidence and risk factors of acute kidney injury associated with continuous intravenous high-dose vancomycin in critically ill patients: A retrospective cohort study |
title_full_unstemmed | Incidence and risk factors of acute kidney injury associated with continuous intravenous high-dose vancomycin in critically ill patients: A retrospective cohort study |
title_short | Incidence and risk factors of acute kidney injury associated with continuous intravenous high-dose vancomycin in critically ill patients: A retrospective cohort study |
title_sort | incidence and risk factors of acute kidney injury associated with continuous intravenous high-dose vancomycin in critically ill patients: a retrospective cohort study |
topic | 3900 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319501/ https://www.ncbi.nlm.nih.gov/pubmed/28207512 http://dx.doi.org/10.1097/MD.0000000000006023 |
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