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Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Nephrology

Background:

  • Vancomycin is a primary treatment for methicillin-resistant Staphylococcus aureus (MRSA) but has been associated with nephrotoxicity.
  • Nephrotoxicity concerns sometimes lead to vancomycin substitution with linezolid.
  • This study investigated the comparative nephrotoxic effects of vancomycin and linezolid in intensive care unit (ICU) patients.

Purpose of the Study:

  • To compare the incidence of increased creatinine levels and need for hemodialysis (HD) in patients treated with vancomycin versus linezolid for gram-positive (GP) infections.
  • To evaluate risk factors for nephrotoxicity in critically ill patients receiving these antibiotics.

Main Methods:

  • Retrospective cohort study of surgical patients in a single ICU (2001-2008) treated with vancomycin or linezolid for GP infections.
  • Patients were managed under a cycling antibiotic protocol and followed until hospital discharge.
  • Multivariable logistic regression was used to analyze outcomes, including creatinine increase and need for HD.

Main Results:

  • A total of 545 patients and 1,046 GP infections were analyzed (571 vancomycin, 475 linezolid).
  • Higher Acute Physiology and Chronic Health Evaluation II scores and initial creatinine levels predicted increased creatinine and need for HD.
  • Linezolid showed a protective effect against creatinine increase, particularly when vancomycin trough levels exceeded 20.

Conclusions:

  • Vancomycin demonstrates minimal nephrotoxicity, comparable to linezolid, when appropriate dosing strategies are employed.
  • These findings are relevant for critically ill patients with complex gram-positive infections.
  • Appropriate vancomycin dosing is crucial to maintain its safety profile.