388. Nephrotoxicity in Intensive Care Unit (ICU) Patients with Hospital-Acquired Pneumonia (HAP)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: New guidelines for treatment of HAP recommend target trough serum vancomycin (VAN) concentrations of 15-20 mg/L. However, the safety of higher trough VAN concentrations has not been sufficiently studied. The objective of this study was to describe the occurrence of nephrotoxicity in HAP patients treated in accordance with current guidelines.
Methods: We developed a prospective ICU HAP performance improvement project at 4 institutions based on the 2005 ATS/IDSA guidelines (IMPACT HAP study). Nephrotoxicity was defined as a serum creatinine increase greater than 0.5 mg/dL (or ≥50% increase from baseline) in at least 2 consecutive measurements.
Results: There were 536 ICU patients with HAP, and 86 (16%) met criteria for nephrotoxicity. There was no statistical difference seen in age, sex, baseline renal and cardiac disease, percentage of patients treated with vancomycin, mean VAN trough levels, length of stay (LOS) in the hospital and ventilator days. More patients with HAP that developed nephrotoxicity had mean VAN trough concentrations ≥15 mg/L (P=0.002), received aminoglycosides (P=0.0002), received both vancomycin and aminoglycosides (P<0.0001), and had longer ICU stays (P=0.003). Logistic regression analyses showed mean VAN trough levels ≥15 mg/L to be independently associated with nephrotoxicity (OR= 2.41; 95% CI=1.45-3.99).
Conclusion: VAN serum trough concentrations ≥15 mg/L are independently associated with nephrotoxicity. Patients with nephrotoxicity were more likely to receive aminoglycosides, and had longer ICU LOS. Patients with MRSA HAP who are treated with VAN according to national guidelines should be closely monitored for the development of VAN-induced nephrotoxicity.
Scott Devine, RPh, MPH, PhD1, Kimbal Ford, PharmD2, Nadia Haque, Pharm, D3, Carol Moore, PharmD4, Paola Osaki Kiyan, MD5, Paula Peyrani, MD, Julio A. Ramirez, MD, Katherine Reyes, MD4, Ernesto Scerpella, MD7, Verna Welch, PhD, MPH8, Marcus Zervos, MD3 and  N. Z. Haque, None..
P. Osaki Kiyan, None..
K. Reyes, None..
C. L. Moore, None. 
P. Peyrani,
Pfizer Inc. Role(s): Research Relationship, Received: Research Support.
J. A. Ramirez,
Pfizer Inc. Role(s): Grant Investigator, Research Relationship, Received: Research Support.
V. L. Welch,
Pfizer Inc Role(s): Employee, Received: Salary.
S. T. Devine,
Pfizer Inc Role(s): Employee, Received: Salary.
E. G. Scerpella,
Pfizer Inc Role(s): Employee, Received: Salary.
K. D. Ford,
Pfizer Inc Role(s): Employee, Received: Salary.
M. J. Zervos,
Pfizer Inc Role(s): Consultant, Grant Investigator, Research Relationship, Speaker's Bureau, Received: Research Grant, Speaker Honorarium.
Cubist Role(s): Consultant, Grant Investigator, Research Relationship, Speaker's Bureau, Received: Speaker Honorarium.
Astellas Role(s): Consultant, Grant Investigator, Research Relationship, Received: Consulting Fee., (1)Pfizer Inc, Saint Louis, MO, (2)Pfizer Inc, Georgetown, KY, (3)Infectious Disease, Henry Ford Hospital, Detroit, MI, (4)Henry Ford Hospital, Detroit, MI, (5)Henry Ford Hospital, (6)Pfizer Inc, Miami, FL, (7)Pfizer Inc, Snellville, GA