Vancomycin-associated nephrotoxicity,
 a case control study

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Serval ID
serval:BIB_7571EAB40897
Type
A Master's thesis.
Publication sub-type
Master (thesis) (master)
Collection
Publications
Institution
Title
Vancomycin-associated nephrotoxicity,
 a case control study
Author(s)
Cerruti J.
Director(s)
Buclin T.
Codirector(s)
Widmer N.
Institution details
Université de Lausanne, Faculté de biologie et médecine
Publication state
Accepted
Issued date
2015
Genre
Maîtrise universitaire en médecine
Language
english
Number of pages
30
Abstract
Background: Vancomycin is a cornerstone antibiotic for the management of severe Gram positive infections. However, high doses of vancomycin are associated with a risk of nephrotoxicity. This study aimed to evaluate the relationship between the evolution of vancomycin trough concentration and the occurrence of nephrotoxicity, and to identify risk factors for both vancomycin-associated nephrotoxicity and vancomycin overexposure.
Methods: A total of 1240 patients records from our hospital therapeutic drug monitoring database between 2007 and 2011 were screened and grouped according to predefined criteria defining vancomycin overexposure (one or more occurrence of a trough level ≥ 20 mg/L) and treatment-related nephrotoxicity (rise of serum creatinine by ≥ 50% over baseline). A representative sample of 150 cases was selected for in depth analysis. Weighted logistic regression analyses were used to test associations between vancomycin overexposure, nephrotoxicity and other predictors of interest.
Results: Patients with high trough concentrations were found to be more likely to develop nephrotoxicity (odds ratio: 4.12; p <0.001). Specific risk factors, notably concomitant nephrotoxic treatments and comorbid conditions (heart failure), were found to independently increase the risk of either nephrotoxicity or vancomycin exposure. Finally, the exploration of temporal relationships between variations of vancomycin trough concentrations and creatinine levels were in line with circular causality with some antecedence of vancomycin on creatinine changes.
Conclusion: Our results confirm the important nephrotoxic potential of vancomycin and indicate that the utilisation of this drug deserves thorough individualization for conditions susceptible to increase its concentration exposure and reactive adjustment based on therapeutic drug monitoring.
Create date
07/02/2015 23:47
Last modification date
20/08/2019 14:32
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