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The Serum Concentration of Vancomycin as a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Critically Ill Patients

The impact of serum concentrations of vancomycin is a controversial topic. Results: 182 critically ill patients were evaluated using vancomycin and 63 patients were included in the study. AKI occurred in 44.4% of patients on the sixth day of vancomycin use. Vancomycin higher than 17.53 mg/L between...

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Autores principales: Zamoner, Welder, Eid, Karina Zanchetta Cardoso, de Almeida, Lais Maria Bellaver, Pierri, Isabella Gonçalves, dos Santos, Adriano, Balbi, André Luis, Ponce, Daniela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8772755/
https://www.ncbi.nlm.nih.gov/pubmed/35052989
http://dx.doi.org/10.3390/antibiotics11010112
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author Zamoner, Welder
Eid, Karina Zanchetta Cardoso
de Almeida, Lais Maria Bellaver
Pierri, Isabella Gonçalves
dos Santos, Adriano
Balbi, André Luis
Ponce, Daniela
author_facet Zamoner, Welder
Eid, Karina Zanchetta Cardoso
de Almeida, Lais Maria Bellaver
Pierri, Isabella Gonçalves
dos Santos, Adriano
Balbi, André Luis
Ponce, Daniela
author_sort Zamoner, Welder
collection PubMed
description The impact of serum concentrations of vancomycin is a controversial topic. Results: 182 critically ill patients were evaluated using vancomycin and 63 patients were included in the study. AKI occurred in 44.4% of patients on the sixth day of vancomycin use. Vancomycin higher than 17.53 mg/L between the second and the fourth days of use was a predictor of AKI, preceding AKI diagnosis for at least two days, with an area under the curve of 0.806 (IC 95% 0.624–0.987, p = 0.011). Altogether, 46.03% of patients died, and in the Cox analysis, the associated factors were age, estimated GFR, CPR, and vancomycin between the second and the fourth days. Discussion: The current 2020 guidelines recommend using Bayesian-derived AUC monitoring rather than trough concentrations. However, due to the higher number of laboratory analyses and the need for an application to calculate the AUC, many centers still use therapeutic trough levels between 15 and 20 mg/L. Conclusion: The results of this study suggest that a narrower range of serum concentration of vancomycin was a predictor of AKI in critically ill septic patients, preceding the diagnosis of AKI by at least 48 h, and it can be a useful monitoring tool when AUC cannot be used.
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spelling pubmed-87727552022-01-21 The Serum Concentration of Vancomycin as a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Critically Ill Patients Zamoner, Welder Eid, Karina Zanchetta Cardoso de Almeida, Lais Maria Bellaver Pierri, Isabella Gonçalves dos Santos, Adriano Balbi, André Luis Ponce, Daniela Antibiotics (Basel) Article The impact of serum concentrations of vancomycin is a controversial topic. Results: 182 critically ill patients were evaluated using vancomycin and 63 patients were included in the study. AKI occurred in 44.4% of patients on the sixth day of vancomycin use. Vancomycin higher than 17.53 mg/L between the second and the fourth days of use was a predictor of AKI, preceding AKI diagnosis for at least two days, with an area under the curve of 0.806 (IC 95% 0.624–0.987, p = 0.011). Altogether, 46.03% of patients died, and in the Cox analysis, the associated factors were age, estimated GFR, CPR, and vancomycin between the second and the fourth days. Discussion: The current 2020 guidelines recommend using Bayesian-derived AUC monitoring rather than trough concentrations. However, due to the higher number of laboratory analyses and the need for an application to calculate the AUC, many centers still use therapeutic trough levels between 15 and 20 mg/L. Conclusion: The results of this study suggest that a narrower range of serum concentration of vancomycin was a predictor of AKI in critically ill septic patients, preceding the diagnosis of AKI by at least 48 h, and it can be a useful monitoring tool when AUC cannot be used. MDPI 2022-01-15 /pmc/articles/PMC8772755/ /pubmed/35052989 http://dx.doi.org/10.3390/antibiotics11010112 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Zamoner, Welder
Eid, Karina Zanchetta Cardoso
de Almeida, Lais Maria Bellaver
Pierri, Isabella Gonçalves
dos Santos, Adriano
Balbi, André Luis
Ponce, Daniela
The Serum Concentration of Vancomycin as a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Critically Ill Patients
title The Serum Concentration of Vancomycin as a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Critically Ill Patients
title_full The Serum Concentration of Vancomycin as a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Critically Ill Patients
title_fullStr The Serum Concentration of Vancomycin as a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Critically Ill Patients
title_full_unstemmed The Serum Concentration of Vancomycin as a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Critically Ill Patients
title_short The Serum Concentration of Vancomycin as a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Critically Ill Patients
title_sort serum concentration of vancomycin as a diagnostic predictor of nephrotoxic acute kidney injury in critically ill patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8772755/
https://www.ncbi.nlm.nih.gov/pubmed/35052989
http://dx.doi.org/10.3390/antibiotics11010112
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