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Published in: BMC Pediatrics 1/2017

Open Access 01-12-2017 | Research article

The association between vancomycin trough concentrations and acute kidney injury in the neonatal intensive care unit

Authors: Vidit Bhargava, Michael Malloy, Rafael Fonseca

Published in: BMC Pediatrics | Issue 1/2017

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Abstract

Background

Vancomycin has recently gained popularity as an empiric therapy for late onset sepsis in the NICU. Changes in resistance patterns in common organisms has resulted in targeting higher trough concentrations of vancomycin. Consequently, an increase in vancomycin associated nephrotoxicity has been speculated. The objective of this study is to compare the incidence of acute kidney injury (AKI) in neonates with serum vancomycin trough concentrations less than 10 mg/L, 10–15 mg/L, or greater than 15 mg/L.

Methods

A retrospective chart review of patients in the neonatal intensive care unit (NICU) was conducted to determine the incidence of AKI in neonates receiving vancomycin.

Results

The overall incidence of AKI was 2.7%. Comparison of the incidence of AKI in the three groups using Mantel-Haenszel Chi-Square test showed a statistically significant association between increasing vancomycin trough concentration and incidence of AKI.

Conclusion

There is a low incidence of AKI in neonates receiving vancomycin. However, there is a positive correlation between increasing vancomycin trough concentrations and an increasing serum creatinine.
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Literature
1.
go back to reference Klingenberg C, Aarag E, Ronnestad A, Sollid JE, Abrahamsen TG, Kjeldsen G, Flaegstad T. Coagulase-negative staphylococcal sepsis in neonates. Association between antibiotic resistance, biofilm formation and the host inflammatory response. Pediatr Infect Dis J. 2005;24(9):817–22.CrossRefPubMed Klingenberg C, Aarag E, Ronnestad A, Sollid JE, Abrahamsen TG, Kjeldsen G, Flaegstad T. Coagulase-negative staphylococcal sepsis in neonates. Association between antibiotic resistance, biofilm formation and the host inflammatory response. Pediatr Infect Dis J. 2005;24(9):817–22.CrossRefPubMed
2.
go back to reference Healy CM, Palazzi DL, Edwards MS, Campbell JR, Baker CJ. Features of invasive staphylococcal disease in neonates. Pediatrics. 2004;114(4):953–61.CrossRefPubMed Healy CM, Palazzi DL, Edwards MS, Campbell JR, Baker CJ. Features of invasive staphylococcal disease in neonates. Pediatrics. 2004;114(4):953–61.CrossRefPubMed
3.
go back to reference Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med. 2006;166(19):2138–44.CrossRefPubMed Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med. 2006;166(19):2138–44.CrossRefPubMed
4.
go back to reference Sakoulas G, Moise-Broder PA, Schentag J, Forrest A, Moellering Jr RC, Eliopoulos GM. Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol. 2004;42(6):2398–402.CrossRefPubMedPubMedCentral Sakoulas G, Moise-Broder PA, Schentag J, Forrest A, Moellering Jr RC, Eliopoulos GM. Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol. 2004;42(6):2398–402.CrossRefPubMedPubMedCentral
5.
go back to reference Capparelli EV, Lane JR, Romanowski GL, McFeely EJ, Murray W, Sousa P, Kildoo C, Connor JD. The influences of renal function and maturation on vancomycin elimination in newborns and infants. J Clin Pharmacol. 2001;41(9):927–34.CrossRefPubMed Capparelli EV, Lane JR, Romanowski GL, McFeely EJ, Murray W, Sousa P, Kildoo C, Connor JD. The influences of renal function and maturation on vancomycin elimination in newborns and infants. J Clin Pharmacol. 2001;41(9):927–34.CrossRefPubMed
6.
go back to reference Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71(10):1028–35.CrossRefPubMed Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71(10):1028–35.CrossRefPubMed
7.
go back to reference Moghal NE, Brocklebank JT, Meadow SR. A review of acute renal failure in children: incidence, etiology and outcome. Clin Nephrol. 1998;49(2):91–5.PubMed Moghal NE, Brocklebank JT, Meadow SR. A review of acute renal failure in children: incidence, etiology and outcome. Clin Nephrol. 1998;49(2):91–5.PubMed
8.
go back to reference Viswanathan S, Manyam B, Azhibekov T, Mhanna MJ. Risk factors associated with acute kidney injury in extremely low birth weight (ELBW) infants. Pediatr Nephrol. 2012;27(2):303–11.CrossRefPubMed Viswanathan S, Manyam B, Azhibekov T, Mhanna MJ. Risk factors associated with acute kidney injury in extremely low birth weight (ELBW) infants. Pediatr Nephrol. 2012;27(2):303–11.CrossRefPubMed
9.
go back to reference Pacifici GM, Allegaert K. Clinical pharmacokinetics of vancomycin in the neonate: a review. In: Clinics (Sao Paulo). 67th ed. 2012. p. 831–7. Pacifici GM, Allegaert K. Clinical pharmacokinetics of vancomycin in the neonate: a review. In: Clinics (Sao Paulo). 67th ed. 2012. p. 831–7.
10.
go back to reference Rybak MJ, Lomaestro BM, Rotschafer JC, Moellering Jr RC, Craig WA, Billeter M, Dalovisio JR, Levine DP. Therapeutic monitoring of vancomycin in adults summary of consensus recommendations from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Pharmacotherapy. 2009;29(11):1275–9.CrossRefPubMed Rybak MJ, Lomaestro BM, Rotschafer JC, Moellering Jr RC, Craig WA, Billeter M, Dalovisio JR, Levine DP. Therapeutic monitoring of vancomycin in adults summary of consensus recommendations from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Pharmacotherapy. 2009;29(11):1275–9.CrossRefPubMed
11.
go back to reference Frymoyer A, Guglielmo BJ, Hersh AL. Desired vancomycin trough serum concentration for treating invasive methicillin-resistant Staphylococcal infections. Pediatr Infect Dis J. 2013;32(10):1077–9.CrossRefPubMed Frymoyer A, Guglielmo BJ, Hersh AL. Desired vancomycin trough serum concentration for treating invasive methicillin-resistant Staphylococcal infections. Pediatr Infect Dis J. 2013;32(10):1077–9.CrossRefPubMed
12.
go back to reference Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18–55.CrossRefPubMed Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18–55.CrossRefPubMed
13.
go back to reference Bosso JA, Nappi J, Rudisill C, Wellein M, Bookstaver PB, Swindler J, Mauldin PD. Relationship between vancomycin trough concentrations and nephrotoxicity: a prospective multicenter trial. Antimicrob Agents Chemother. 2011;55(12):5475–9.CrossRefPubMedPubMedCentral Bosso JA, Nappi J, Rudisill C, Wellein M, Bookstaver PB, Swindler J, Mauldin PD. Relationship between vancomycin trough concentrations and nephrotoxicity: a prospective multicenter trial. Antimicrob Agents Chemother. 2011;55(12):5475–9.CrossRefPubMedPubMedCentral
14.
go back to reference Jeffres MN, Isakow W, Doherty JA, Micek ST, Kollef MH. A retrospective analysis of possible renal toxicity associated with vancomycin in patients with health care-associated methicillin-resistant Staphylococcus aureus pneumonia. Clin Ther. 2007;29(6):1107–15.CrossRefPubMed Jeffres MN, Isakow W, Doherty JA, Micek ST, Kollef MH. A retrospective analysis of possible renal toxicity associated with vancomycin in patients with health care-associated methicillin-resistant Staphylococcus aureus pneumonia. Clin Ther. 2007;29(6):1107–15.CrossRefPubMed
15.
go back to reference Prabaker KK, Tran TP, Pratummas T, Goetz MB, Graber CJ. Elevated vancomycin trough is not associated with nephrotoxicity among inpatient veterans. J Hosp Med. 2012;7(2):91–7.CrossRefPubMed Prabaker KK, Tran TP, Pratummas T, Goetz MB, Graber CJ. Elevated vancomycin trough is not associated with nephrotoxicity among inpatient veterans. J Hosp Med. 2012;7(2):91–7.CrossRefPubMed
16.
go back to reference Ringer SA. Acute Renal Failure in the Neonate. 2010. Ringer SA. Acute Renal Failure in the Neonate. 2010.
17.
go back to reference McKamy S, Hernandez E, Jahng M, Moriwaki T, Deveikis A, Le J. Incidence and risk factors influencing the development of vancomycin nephrotoxicity in children. J Pediatr. 2011;158(3):422–6.CrossRefPubMed McKamy S, Hernandez E, Jahng M, Moriwaki T, Deveikis A, Le J. Incidence and risk factors influencing the development of vancomycin nephrotoxicity in children. J Pediatr. 2011;158(3):422–6.CrossRefPubMed
18.
go back to reference Zappitelli M, Selewski DT, Askenazi DJ. Nephrotoxic Medication Exposure and Acute Kidney Injury in Neonates. 2012. Zappitelli M, Selewski DT, Askenazi DJ. Nephrotoxic Medication Exposure and Acute Kidney Injury in Neonates. 2012.
19.
go back to reference Fauconneau B, Favreliere S, Pariat C, Genevrier A, Courtois P, Piriou A, Bouquet S. Nephrotoxicity of gentamicin and vancomycin given alone and in combination as determined by enzymuria and cortical antibiotic levels in rats. Ren Fail. 1997;19(1):15–22.CrossRefPubMed Fauconneau B, Favreliere S, Pariat C, Genevrier A, Courtois P, Piriou A, Bouquet S. Nephrotoxicity of gentamicin and vancomycin given alone and in combination as determined by enzymuria and cortical antibiotic levels in rats. Ren Fail. 1997;19(1):15–22.CrossRefPubMed
20.
go back to reference Linder N, Edwards R, MeClead R, Mortensen ME, Walson P, Koren G. Safety of vancomycin with or without gentamicin in neonates. Neonatal Netw. 1993;12(8):27–30.PubMed Linder N, Edwards R, MeClead R, Mortensen ME, Walson P, Koren G. Safety of vancomycin with or without gentamicin in neonates. Neonatal Netw. 1993;12(8):27–30.PubMed
21.
go back to reference Nahata MC. Lack of nephrotoxicity in pediatric patients receiving concurrent vancomycin and aminoglycoside therapy. Chemotherapy. 1987;33(4):302–4.CrossRefPubMed Nahata MC. Lack of nephrotoxicity in pediatric patients receiving concurrent vancomycin and aminoglycoside therapy. Chemotherapy. 1987;33(4):302–4.CrossRefPubMed
22.
go back to reference Knoderer CA, Nichols KR, Lyon KC, Veverka MM, Wilson AC. Are Elevated Vancomycin Serum Trough Concentrations Achieved Within the First 7 Days of Therapy Associated With Acute Kidney Injury in Children? J Pediatric Infect Dis Soc. 2014;3(2):127–31.CrossRefPubMed Knoderer CA, Nichols KR, Lyon KC, Veverka MM, Wilson AC. Are Elevated Vancomycin Serum Trough Concentrations Achieved Within the First 7 Days of Therapy Associated With Acute Kidney Injury in Children? J Pediatric Infect Dis Soc. 2014;3(2):127–31.CrossRefPubMed
Metadata
Title
The association between vancomycin trough concentrations and acute kidney injury in the neonatal intensive care unit
Authors
Vidit Bhargava
Michael Malloy
Rafael Fonseca
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2017
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-017-0777-0

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