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Published on: September 9, 2015
Relationship between vancomycin trough concentrations and nephrotoxicity: a prospective multicenter trial
John A Bosso1, Jean Nappi, Celeste Rudisill
1Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston and Columbia, South Carolina 29425, USA. bossoja@musc.edu
Antimicrobial Agents and Chemotherapy
|September 28, 2011
Summary
Higher vancomycin doses targeting trough concentrations above 15 mg/liter increase nephrotoxicity risk in methicillin-resistant Staphylococcus aureus infections. This study found a 3-fold increased risk, highlighting the need for careful dosing strategies.
Area of Science:
- Pharmacology
- Infectious Diseases
- Nephrology
Background:
- Previous studies suggest a link between high vancomycin doses and nephrotoxicity.
- Methicillin-resistant Staphylococcus aureus (MRSA) infections necessitate effective vancomycin treatment.
- Optimizing vancomycin dosing is crucial to balance efficacy and safety.
Purpose of the Study:
- To prospectively evaluate the incidence of nephrotoxicity in relation to vancomycin trough concentrations.
- To identify risk factors for vancomycin-associated nephrotoxicity in MRSA infections.
- To determine the threshold for vancomycin trough concentration associated with increased nephrotoxicity risk.
Main Methods:
- Prospective study of 288 adult patients with MRSA infections receiving vancomycin for ≥72 hours.
- Vancomycin trough concentrations were measured under steady-state conditions.
- Nephrotoxicity defined as a ≥0.5 mg/dl or ≥50% increase in serum creatinine; multivariate analysis controlled for confounding factors.
Main Results:
- Nephrotoxicity occurred in 29.6% of patients with vancomycin trough concentrations >15 mg/ml versus 8.9% with concentrations ≤15 mg/ml.
- Multivariate analysis identified vancomycin trough concentrations >15 mg/ml and black race as independent risk factors for nephrotoxicity.
- Vancomycin trough concentrations >15 mg/ml were associated with a 3-fold increased risk of nephrotoxicity.
Conclusions:
- Vancomycin trough concentrations >15 mg/ml are associated with a significantly increased risk of nephrotoxicity in patients with MRSA infections.
- Current dosing strategies aiming for higher trough concentrations may need re-evaluation to minimize renal injury.
- Race (black) emerged as an independent risk factor for nephrotoxicity in this population.
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