Vancomycin-Induced Acute Kidney Injury in Intensive Care Patients: A Target Trial Emulation Study Using Multicenter...

Area of Science:

• Nephrology
• Critical Care Medicine
• Pharmacology

Background:

• The nephrotoxicity of vancomycin in adult intensive care patients is debated due to prior study limitations.
• Target trial emulation offers a robust framework to assess drug-induced adverse events.

Purpose of the Study:

• To estimate the 14-day risk of acute kidney injury (AKI) associated with vancomycin initiation versus alternative antibiotics in ICU patients.
• To address the controversy surrounding vancomycin's nephrotoxic potential using a rigorous emulation method.

Main Methods:

• A target trial was emulated using routinely collected data from 15 Dutch ICUs (2010-2019).
• Vancomycin was compared against a panel of minimally nephrotoxic antibiotics (clindamycin, linezolid, teicoplanin, meropenem, cefazolin, daptomycin).
• Acute kidney injury (AKI) was defined by KDIGO serum creatinine criteria, with confounding adjusted via inverse probability weighting.

Main Results:

• In 1809 ICU admissions, vancomycin was linked to a higher 14-day AKI risk (28% vs. 17%; risk difference 11%).
• No significant difference in AKI risk was observed at 2 days (10% vs. 10%; risk difference 0%).

Conclusions:

• Vancomycin use is associated with an increased risk of AKI in ICU patients compared to alternative antibiotics.
• Implementing vancomycin-induced AKI prevention strategies, including therapeutic drug monitoring and considering alternatives, is recommended.