Vancomycin-associated Nephrotoxicity and Risk Factors in Critically Ill Children Without Preexisting Renal Injury

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Pharmacology

Background:

• Critically ill children face higher risks of vancomycin-induced kidney damage.
• Previous reviews indicate elevated odds of nephrotoxicity in this vulnerable population.
• This study focuses on children without pre-existing renal impairment.

Purpose of the Study:

• To determine the incidence of vancomycin-associated nephrotoxicity in critically ill children.
• To identify risk factors for vancomycin-associated nephrotoxicity in this cohort.
• To assess the association between clinical factors and kidney injury using the pRIFLE score.

Main Methods:

• A cohort study of children in a pediatric intensive care unit (2011-2016).
• Inclusion criteria: vancomycin treatment without prior renal injury.
• Generalized estimating equation models analyzed clinical covariates and pRIFLE scores.

Main Results:

• 11.8% of patients experienced vancomycin-associated nephrotoxicity.
• Higher vancomycin doses were not significantly linked to poorer renal function.
• Concomitant furosemide (OR: 2.56) and amphotericin B (OR: 7.7) were associated with impaired renal function.

Conclusions:

• Vancomycin-associated nephrotoxicity incidence is 11.8% in critically ill children without prior renal injury.
• Furosemide and amphotericin B are significant predictors of worse kidney injury.
• Initial kidney injury status and assessment methods may impact observed nephrotoxicity rates.