822. Relationship between Vancomycin Area Under the Concentration-Time Curve (AUC) and Nephrotoxicity in Adults
Session: Poster Abstract Session: Use of PK/PD to optimize existing antibiotics and antifungals
Thursday, October 5, 2017
Room: Poster Hall CD
  • VancoAUCNephrotoxIDWeek Poster.pdf (459.4 kB)
  • Background: While recent data correlate vancomycin’s ratio of the area under the 24 hour time-concentration curve (AUC0−24h) to the pathogen’s minimal inhibitory concentration (MIC) of > 400 mg*h/L with a favorable clinical outcome, data are sparse to correlate vancomycin AUC0−24h to nephrotoxicity.  Our primary objective was to evaluate the relationship between vancomycin AUC0−24h and nephrotoxicity.

    Methods: This single-center, retrospective cohort study was conducted at a large US tertiary-care hospital. Adults hospitalized between 08/01/13 and 08/31/14 with normal baseline renal function receiving intravenous vancomycin ≥ 72 hours were included. Vancomycin AUC0−24h was calculated for each subject utilizing computer-based Bayesian pharmacokinetic methods (BestDose™).  Subjects were divided into AUC0−24h of < 700 and > 700 mg*h/L groups.  The primary endpoint of nephrotoxicity (defined as a 50% relative increase or > 0.5 mg/dl absolute increase in SCr over at least 2 consecutive days) was compared between exposure groups. Secondary objectives were to compare the incidence of nephrotoxicity with and without the following risk factors: sepsis, concomitant nephrotoxins, vancomycin troughs > 20 mg/L or doses ≥ 4 g/day, and Charlson Comorbidity Index scores.

    Results: Table 1. Multivariate Model of Nephrotoxicity and Clinical Characteristics  

    Conclusion: A significant increase in nephrotoxicity was observed in patients with a vancomycin AUC0−24h ≥ 700 mg*h/L. Given that this exposure threshold is within the target for efficacy for organisms with elevated MICs, further studies should be conducted to better delineate the AUC0−24h values associated with nephrotoxicity.

    David Allen, PharmD, BCPS1, Mary Townsend, PharmD, AAHIVP2,3 and Richard Drew, PharmD, MS, FCCP, FIDP2,4, (1)Inova Fairfax Hospital, Falls Church, VA, (2)Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, (3)Durham VA Medical Center, Durham, NC, (4)Duke University Hospital, Durham, NC


    D. Allen, None

    M. Townsend, None

    R. Drew, None

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