%0 Journal Article
%T Incidence and Risk Factors for Vancomycin Nephrotoxicity in Acutely Ill Pediatric Patients
%A B. Joseph Guglielmo
%A Henock Woldu
%J Journal of Pharmacy Technology
%@ 1549-4810
%D 2018
%R 10.1177/8755122517747088
%X Background: Particularly with the current increased vancomycin dosing trends, the true risk of the agent¡¯s nephrotoxicity is not well characterized and remains of concern. Objective: To determine the incidence of vancomycin nephrotoxicity in acutely ill hospitalized children and to secondarily characterize the risk factors for this complication. Methods: A single-center retrospective cohort study conducted at UCSF Benioff Children¡¯s Hospital from June 2012 to June 2015. Inpatients 3 months to <19 years who received intravenous vancomycin for ¡Ý48 hours were included. The primary outcome was incidence of nephrotoxicity, defined as an increase in serum creatinine by ¡Ý50% from baseline. Univariate and multivariate analyses were conducted to identify risk factors for vancomycin nephrotoxicity. Results: A total of 291 patients (272 nonnephrotoxic and 19 nephrotoxic) were included in the analysis. Of the 19 patients, 12 (4.1%) were found to have moderate to severe toxicity. The median duration of therapy was 3 (3-5) and 4 (3-6) days for the group with ¡°no nephrotoxicity¡± and ¡°nephrotoxicity,¡± respectively. The mean time for the serum creatinine to return to normal in patients with nephrotoxicity was 5.1 days. In the multivariate analysis, only final trough concentration ¡Ý15mg/dL (odds ratio = 3.49, 95% confidence interval = 1.2-10.1; P = .021) and receipt of piperacillin/tazobactam (odds ratio = 3.14, 95% confidence interval = 1.02-9.6; P = .046) were significantly associated with nephrotoxicity. Conclusion: The rate of moderate to severe vancomycin-associated nephrotoxicity in acutely ill children is relatively uncommon and reversible. Kidney injury is associated with increased vancomycin trough concentrations and concomitant receipt of nephrotoxins, particularly piperacillin/tazobactam
%K vancomycin
%K pediatrics
%K nephrotoxicity
%K therapeutic drug monitoring
%K antibiotics
%U https://journals.sagepub.com/doi/full/10.1177/8755122517747088