Methods: In a single center retrospective cohort study, we evaluated adult (≥18 years old) patients with Creatinine Clearance (CrCl) ≥40 mL/min who received a minimum of 96 hours of VAN plus PTZ. Nephrotoxicity as defined by the RIFLE criteria was the primary endpoint of this study. A sample size of 272 patients was calculated to detect a 15% difference between groups. Chi-square, Fisher’s exact and Mann-Whitney U tests were used for data analysis. All values are given as median [Interquartile Range].
Results: A total of 280 patients (140 patients in each group) were evaluated. Overall, patient age was 67 [54-77] years, weight was 75 [61-88] kg, CrCl was 75 [55-107] mL/min, and these variables were comparable between EI and SI groups. Receipt of vasopressors and VAN maximum trough >20 mg/L at any point during combination therapy were more common in EI Group (17% vs. 8% in SI Group, P=0.03; 45% vs. 29% in SI Group, P=0.009), respectively. Duration of combination therapy was 5 [4-6] days in both groups, P=0.4. Overall, 17.5% (49/280) of patients developed nephrotoxicity; 17.9% (25/140) in EI Group vs. 17.1% (24/140) in SI Group, P=1. Time to nephrotoxicity was 4 [3-6] days. In logistic regression, a VAN trough >20 mg/L at any point during therapy was an independent predictor of nephrotoxicity (Odds Ratio 3.2; 95% CI 1.5-6.9, P=0.002) after adjustment for receipt of vasopressors, chronic liver disease and PTZ EI administration.
Conclusion: Our findings suggest comparable nephrotoxicity among patients who received VAN in combination with PTZ EI vs. PTZ SI. Close monitoring of VAN trough levels during combination therapy is warranted.
M. R. Scipione, None
E. Louie, None
J. Papadopoulos, None
Y. Dubrovskaya, None
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