Retrospective multicentre matched cohort study comparing safety and efficacy outcomes of intermittent-infusion versus
Nathan H Ma1, Sandra A N Walker1,2, Marion Elligsen1
1Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Background:
Patients with good renal function receiving intermittent-infusion vancomycin (IIV) may require total daily doses ≥4 g to achieve trough concentrations of 15-20 mg/L, increasing the risk of vancomycin-associated nephrotoxicity. Continuous-infusion vancomycin (CIV) may be associated with a lower risk of vancomycin-associated nephrotoxicity compared with IIV, but studies comparing safety of both dosing strategies are lacking.
Objectives:
To compare the risk of nephrotoxicity with CIV versus IIV when target concentration ranges were the same with both dosing modalities.
Methods:
A retrospective multicentre matched cohort study of admitted patients between 1 January 2010 and 31 December 2016 was completed. Adult patients who received ≥48 h of vancomycin with at least one steady-state vancomycin concentration were eligible. The primary outcome was to compare the rates of nephrotoxic risk and renal injury, defined by the RIFLE criteria, between CIV and IIV.
Results:
Of 2136 patients who received vancomycin during the study period, 146 CIV patients were eligible and matched to 146 IIV patients. After adjustment of potential confounders, CIV was found to have a lower odds of developing nephrotoxic risk (OR 0.42, 95% CI 0.21-0.98, P = 0.025) and renal injury (OR 0.19, 95% CI 0.05-0.59, P = 0.004).
Conclusions:
CIV is associated with a lower odds of nephrotoxicity compared with IIV when targeting the same concentration range and should be an alternative dosing strategy for patients who will receive prolonged therapy or require >4 g/day to achieve therapeutic levels.
Insights
Continuous-infusion vancomycin (CIV) is safer than intermittent-infusion vancomycin (IIV) for preventing kidney damage. CIV demonstrated a lower risk of nephrotoxicity in patients requiring high vancomycin doses.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- High daily doses of intermittent-infusion vancomycin (IIV) may exceed 4g, increasing nephrotoxicity risk.
- Continuous-infusion vancomycin (CIV) may offer a lower nephrotoxicity risk, but comparative safety data are limited.
Purpose of the Study:
- To compare nephrotoxicity risk between CIV and IIV.
- To evaluate safety outcomes when targeting the same vancomycin concentration ranges.
Main Methods:
- Retrospective, multicenter, matched cohort study (2010-2016).
- Included adult patients receiving vancomycin for ≥48 hours with steady-state concentrations.
- Primary outcome: comparison of nephrotoxic risk and renal injury rates (RIFLE criteria) between CIV and IIV groups.
Main Results:
- 146 CIV patients were matched with 146 IIV patients.
- CIV was associated with significantly lower odds of nephrotoxic risk (OR 0.42) and renal injury (OR 0.19) after confounder adjustment.
- P-values were <0.05 for both outcomes.
Conclusions:
- CIV is associated with reduced nephrotoxicity compared to IIV.
- CIV is a viable alternative dosing strategy for prolonged vancomycin therapy or when high daily doses are required.
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