Related Experiment Video
Updated: Jan 24, 2026
An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery
Published on: February 17, 2018
Utilizing the Patient Care Process to Minimize the Risk of Vancomycin-Associated Nephrotoxicity
Ashley R Selby1,2, Ronald G Hall3,4,5,6
1Department of Pharmacy Practice, Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy, Dallas, TX 75235, USA. Ashley.Selby@ttuhsc.edu.
Abstract:
Vancomycin-associated acute kidney injury (AKI) is a popular topic in the medical literature with few clear answers. While many studies evaluate the risk of AKI associated with vancomycin, few data are high quality and/or long in duration of follow-up. This review takes the clinician through an approach to evaluate a patient for risk of AKI. This evaluation should include patient assessment, antibiotic prescription, duration, and monitoring. Patient assessment involves evaluating severity of illness, baseline renal function, hypotension/vasopressor use, and concomitant nephrotoxins. Evaluation of antibiotic prescription includes evaluating the need for methicillin-resistant Staphylococcus aureus (MRSA) coverage and/or vancomycin use. Duration of therapy has been shown to increase the risk of AKI. Efforts to de-escalate vancomycin from the antimicrobial regimen, including MRSA nasal swabs and rapid diagnostics, should be used to lessen the likelihood of AKI. Adequate monitoring includes therapeutic drug monitoring, ongoing fluid status evaluations, and a continual reassessment of AKI risk. The issues with serum creatinine make the timely evaluation of renal function and diagnosis of the cause of AKI problematic. Most notably, concomitant piperacillin-tazobactam can increase serum creatinine via tubular secretion, resulting in higher rates of AKI being reported. The few studies evaluating the long-term prognosis of AKI in patients receiving vancomycin have found that few patients require renal replacement therapy and that the long-term risk of death is unaffected for patients surviving after the initial 28-day period.
Insights
Vancomycin-associated acute kidney injury (AKI) risk can be managed by assessing patient illness severity, renal function, and nephrotoxin exposure. De-escalating vancomycin and monitoring drug levels can reduce AKI likelihood and improve patient outcomes.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Vancomycin-associated acute kidney injury (AKI) is a significant clinical concern.
- High-quality, long-term data on vancomycin-induced AKI are limited.
- Current literature offers few definitive answers regarding vancomycin's nephrotoxicity.
Purpose of the Study:
- To provide clinicians with a structured approach for evaluating vancomycin-associated AKI risk.
- To highlight key factors influencing vancomycin nephrotoxicity.
- To discuss strategies for mitigating AKI in patients receiving vancomycin.
Main Methods:
- Review of existing literature on vancomycin and AKI.
- Emphasis on patient assessment: severity of illness, baseline renal function, hypotension, and nephrotoxin co-administration.
- Evaluation of antibiotic prescribing practices, including necessity and duration of vancomycin therapy.
- Discussion of monitoring strategies: therapeutic drug monitoring and fluid status assessment.
- Consideration of factors complicating AKI diagnosis, such as serum creatinine changes due to piperacillin-tazobactam.
Main Results:
- Patient factors like illness severity, renal function, and concurrent nephrotoxins increase AKI risk.
- Longer vancomycin duration is associated with higher AKI rates.
- De-escalation strategies, including MRSA nasal swabs and rapid diagnostics, can reduce AKI risk.
- Piperacillin-tazobactam may falsely elevate serum creatinine, complicating AKI assessment.
- Long-term studies show few patients require renal replacement therapy, and 28-day survival is not significantly impacted.
Conclusions:
- A comprehensive approach to vancomycin therapy, including risk assessment, judicious use, and monitoring, is crucial for preventing AKI.
- Strategies to shorten vancomycin duration and de-escalate therapy are vital.
- Despite AKI, long-term prognosis for survivors is generally favorable, with low rates of renal replacement therapy.
Related Concept Videos
01:13Patient-centered Care
01:24Nursing Process for Patient and Caregiver Teaching II: Planning and Implementation
01:24Nursing Process for Patient and Caregiver Teaching I: Assessment and Diagnosis
It is critical to determine the patient's learning needs during the assessment. Determination of learning needs compounds data...
01:12Relative Risk
01:20Nursing Process for Patient and Caregiver Teaching III: Evaluation and Documentation
Nurses can use several methods to evaluate patient outcomes. For example, oral questions can assess cognitive learning,...
01:21Interdisciplinary Care: The Health Care Team-I
Physicians
The physician's primary responsibility is to diagnose illness and direct the medical or surgical treatment of the condition. The authority to admit patients to a healthcare agency or institution and practice care within that setting is granted to physicians by the healthcare agency or institution...