Article Text

PDF
PKP-013 Nephrotocixity associated with continous vancomycin infusion
  1. J Martinez Casanova,
  2. M De Antonio-Cuscó,
  3. N Carballo Martinez,
  4. M Marín-Casino
  1. Hospital del Mar, Pharmacy Department, Barcelona, Spain

Abstract

Background Continuous vancomycin infusion (CVI) is frequently used to achieve therapeutic levels (15–25 mg/L) in patients in whom, related to their physiological characteristics (young, obese or critical patient), intermittent infusion (II) would need higher doses than those recommended (>4 g/day). Latest guidelines suggest a target of 15–20 mg/L but there is controversy over vancomycin associated nephrotoxicity in CVI.

Purpose To determine the frequency of nephrotoxicity associated with CVI and to identify risk factors.

Material and methods A retrospective cohort study was performed in a 400 bed tertiary university hospital from January 2013 to August 2016. Patients included adults treated with CVI. Dose recommended to achieve steady state concentration (Css) was 15–20 µg/mL. Data collected: demographics, body mass index (BMI), type of infection, treatment duration, vancomycin Css and AUC, dose recommended, initial and final renal function (SCr) and glomerular filtration rate (GFR) using CKD-EPI, nephrotoxicity defined by RIFLE criteria (risk, injury, failure, loss and end stage renal disease), nephrotoxic drugs and others causes of nephrotoxicity. Pharmacokinetic analysis: Bayesian estimation compartmental model (PKS System Abbott). Data are shown as median (Q1–Q3). Statistical analysis: SPSS Statistics Base 22.0.

Results 38 patients were included: 25 (65.8%) men, 55 (43–64) years, 78 (70–89) kg, BMI 26 (24–32) kg/m2, critically ill 7 (18.4%). Type of infection: bone 22 (57.9%), diabetic foot 4 (10.5%), bacteraemia 4 (10.5%), CNS 4 (10.5%), abdominal 2 (5.3%) and others 2 (5.3%). Treatment duration: 9 (6–13) days. Css: 23.4 (19.6–28.1) µg/mL. AUC: 506 (435–575) µg×h/mL. Recommended dose: 3.2 (2.8–3.5) g/day. Renal function: Scr initial 0.53 (0.41–0.73) mg/dL, final 0.58 (0.47–0.78) mg/dL. GFR initial 113 (102–129) mL/min, final 107 (98–121) mL/min. Nephrotoxicity: 1 (3.8%). RIFLE 1-0-0-0-0. Risk factor: leg amputation. Nephrotoxicity was reversible. Adverse effects: phlebitis 1 (3.8%) with dropout due to adverse effect.

Conclusion CVI allows therapeutic levels (15–20 mg/L) to be to achieved, especially in bone infections. Despite an increased steady state concentration, nephrotoxicity was negligible with therapeutic drug monitoring. Phlebitis can make it difficult to administrate CVI.

References and/or acknowledgements Rybak M, Lomaestro B, Rotschafer JC, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm2009;66:82–98.

No conflict of interest

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.