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More Frequent Premature Antibiotic Discontinuations and Acute Kidney Injury in the Outpatient Setting With Vancomycin

Daniel Tuerff1, Marina Nunez1

  • 1Wake Forest School of Medicine, Department of Internal Medicine, Section on Infectious Diseases, Winston-Salem, North Carolina, USA.

Journal of Clinical Pharmacology
|October 21, 2019
PubMed

Insights

Outpatient parenteral antimicrobial therapy with vancomycin is linked to higher rates of acute kidney injury (AKI) and early discontinuation compared to daptomycin. Female sex and higher vancomycin concentrations independently predicted AKI in patients receiving home treatment.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Outpatient parenteral antimicrobial therapy (OPAT) commonly uses vancomycin and daptomycin for gram-positive infections.
  • Vancomycin has a narrow therapeutic window, presenting challenges in outpatient settings.
  • Acute kidney injury (AKI) is a significant concern in patients receiving OPAT.

Purpose of the Study:

  • To compare the incidence of AKI and other adverse drug events between vancomycin and daptomycin in OPAT.
  • To identify risk factors for AKI in patients receiving vancomycin at home post-discharge.

Main Methods:

  • Retrospective assessment of 191 patients undergoing OPAT with vancomycin or daptomycin at home.
  • Analysis of adverse drug events, focusing on AKI.
  • Statistical analysis to identify independent predictors of AKI, including vancomycin trough concentrations and patient demographics.

Main Results:

  • AKI was the most frequent adverse drug event.
  • Vancomycin group showed higher rates of early antibiotic discontinuation and AKI compared to daptomycin.
  • Vancomycin use, female sex, and longer hospitalization independently predicted moderate-to-severe AKI.
  • In vancomycin recipients, increased trough concentrations post-discharge, higher concentrations in females, and higher concentrations in AKI patients were observed.
  • Female sex and higher vancomycin concentrations predicted AKI in the vancomycin group.

Conclusions:

  • Vancomycin OPAT is associated with increased premature antibiotic discontinuations and nephrotoxicity compared to daptomycin.
  • Increased vancomycin plasma concentrations post-discharge predict moderate-to-severe AKI.
  • Female patients receiving vancomycin have higher drug concentrations and an elevated risk of AKI.
Keywords:
acute kidney injurydaptomycinnephrotoxicityoutpatient parenteral antimicrobial therapyvancomycin

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