Program Schedule

396
What is the Best Predictor for Vancomycin Nephrotoxicity?

Session: Poster Abstract Session: PK/PD Studies
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Vancposter1.pdf (824.8 kB)
  • Background: The best way to study the association between vancomycin trough (VT) and nephrotoxicity (NT) is not clear. The goal of this study is to explore this association using 3 predictors. 

    Methods: This is a retrospective, observational cohort study of adult patients who received vancomycin for ≥ 72 hours at the University of Kansas Medical Center between 9/7/2011 and 2/7/2012. The study included both inpatient and outpatient data. NT was defined as: ≥ 50% or ≥ 0.5 mg/dl increase in serum creatinine from baseline on 2 consecutive measurements. Data collected included 3 main predictors: average VT, first VT, VT preceding acute renal failure (VTPARF) and other possible risk factors for NT. We divided the patients into 4 groups (1 to 4): [VT < 10 µg/ml, 10 µg/ml ≤ VT < 15 µg/ml (reference group), 15 µg/ml ≤ VT ≤ 20 µg/ml and VT > 20 µg/ml]. We analyzed the data using average VT and first VT. We also compared the VTPARF to the average VT in patients with no ARF.

    Results: The study included 474 patients, 63/474 developed ARF (13.29%). The incidence of ARF in groups (1-4) was: 2/114 (1.75%), 9/180 (5%), 31/122 (25.4%) and 21/49 (42.85%) using the average VT. It was: 17/194 (8.76%), 22/155 (14.19%), 10/66 (15.15%) and 14/42 (33.33%) using the first VT. Compared to reference group (2), ARF incidence was significantly higher in group 3 (p-value = 0.0001), group 4 (p-value = 0.001) by average VT and only in group 4 (p-value = 0.014) by first VT. Among patients with ARF 30/62 (48.39%) had VTPARF ≥ 15 µg/ml versus 119/411 (28.95%) of patients with no acute renal failure using the average VT (p-value = 0.004). ARF incidence was associated with baseline Cr ≥ 1.5 mg/dl (p-value = 0.03). There was a tendency toward increased nephrotoxicity in patients with morbid obesity (p-value = 0.056). There was no observed association with other possible risk factors for NT.

    Conclusion: Average VT ≥ 15 µg/ml and first VT > 20 µg/ml are associated with increased NT. Patients with acute renal failure had significantly more VTPARF ≥ 15 µg/ml compared to patients with no ARF (average VT). This study suggests that VT ≥ 15 µg/ml is likely more nephrotoxic than lower levels. The only concomitant risk factor that was associated with NT was baseline Cr ≥ 1.5 mg/dl.

    Kassem Hammoud, MD1, Neil Goodloe, MD2, Wael Haidar, MD3, Michael Brimacombe, PhD4 and Wissam El Atrouni, MD1, (1)Internal Medicine/Infectious Diseases, University of Kansas Medical Center, Kansas City, KS, (2)Cox Health System, Springfield, MO, Uruguay, (3)Adena Health Care, Chillicothe, OH, (4)Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS

    Disclosures:

    K. Hammoud, None

    N. Goodloe, None

    W. Haidar, None

    M. Brimacombe, None

    W. El Atrouni, None

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