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The potential risk factors of nephrotoxicity during vancomycin therapy in Chinese adult patients
  1. Yulin Wang1,2,
  2. Jian Yang1,
  3. Haiyan Zhan1,2,
  4. Shuxiao Zhang1,2,
  5. Yin Deng1,2
  1. 1Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
  2. 2Wuhan University School of Pharmaceutical Sciences, Wuhan, Hubei, China
  1. Correspondence to Dr Jian Yang, Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan 430060, China; 1409718181{at}qq.com

Abstract

Objective To evaluate potential risk factors that may make patients susceptible to nephrotoxicity in those concomitantly receiving vancomycin in the hospital.

Methods This was a single-centre retrospective analysis of patients treated with vancomycin for gram-positive or mixed infections in the Renmin Hospital of Wuhan University from January 2017 to May 2018. All of them were treated for ≥48 hours and had no kidney disease. Nephrotoxicity refers to acute kidney diseases and disorders after the use of vancomycin, and includes acute kidney injury. Univariate analysis and binary logistic regression analysis with the forward stepwise method were used to assess the risk factors associated with nephrotoxicity.

Results Of the 790 patients treated with vancomycin, only 257 patients met the inclusion criteria, and 40 (15.6%) subjects developed nephrotoxicity. Significant differences (p<0.05) were seen in the number of combined antimicrobials (p=0.012), dose adjustment (p<0.001), more than three antimicrobials (p=0.015), monitoring trough concentrations (p=0.001), furosemide (p<0.001), torasemide (p<0.001), cefoperazone sodium tazobactam sodium (p=0.039), voriconazole (p=0.012) and ganciclovir (p=0.008). Regression analysis further indicated that furosemide (OR 7.983, p<0.001) and torasemide (OR 3.496, p<0.001) were risk factors for vancomycin nephrotoxicity. Diabetes mellitus (OR 3.062, p=0.035), voriconazole (OR 3.515, p=0.020) and fluconazole (OR 3.326, p=0.018) might be also risk factors.

Conclusion Fluconazole and voriconazole might be potential risk factors for vancomycin nephrotoxicity, besides furosemide and torasemide. It is not recommended to use imipenem cilastatin sodium and vancomycin at the same time. If necessary, meropenem may be safer. Appropriate combination drugs, cautious initial dose or timely dose adjustment might reduce the occurrence of nephrotoxicity when using vancomycin.

  • therapeutic drug monitoring
  • adverse effects
  • clinical pharmacy
  • toxicology
  • study design
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