Incidence and Risk Factors for Vancomycin Nephrotoxicity in Acutely Ill Pediatric Patients

Area of Science:

• Pediatric Nephrology
• Clinical Pharmacology
• Infectious Diseases

Background:

• Vancomycin dosing trends raise concerns about nephrotoxicity risk.
• The precise incidence and risk factors for vancomycin-induced kidney injury in children are not well-defined.

Purpose of the Study:

• To determine the incidence of vancomycin nephrotoxicity in acutely ill hospitalized children.
• To identify risk factors associated with vancomycin-induced kidney injury in this population.

Main Methods:

• Retrospective cohort study at a single center (June 2012-June 2015).
• Included inpatients aged 3 months to <19 years receiving intravenous vancomycin for ≥48 hours.
• Nephrotoxicity defined as a ≥50% increase in serum creatinine from baseline; analyzed risk factors using univariate and multivariate methods.

Main Results:

• 12 out of 291 patients (4.1%) experienced moderate to severe vancomycin nephrotoxicity.
• Significant risk factors for nephrotoxicity included final vancomycin trough concentration ≥15 mg/dL (OR=3.49) and concurrent piperacillin/tazobactam use (OR=3.14).
• Serum creatinine normalized within a mean of 5.1 days in affected patients.

Conclusions:

• Moderate to severe vancomycin-associated nephrotoxicity is relatively uncommon and reversible in acutely ill children.
• Elevated vancomycin trough concentrations and co-administration of piperacillin/tazobactam are key risk factors for kidney injury.