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Abstract

Introduction: Serum vancomycin trough (Vt) concentrations of 15–20 mcg/mL have been associated with an increased rate of vancomycin-induced nephrotoxicity in adults. Current data in pediatrics suggests Vts of 15-20 mcg/mL do not increase the incidence of nephrotoxicity in children admitted to a pediatric intensive care unit (PICU). Comparing the incidence of nephrotoxicity in PICU patients receiving a β-lactam as compared with vancomycin could provide insight regarding whether targeting Vt of 15–20 mcg/mL have an effect on nephrotoxicity in a PICU cohort. Methods: The medical records of all children admitted to the PICU between November 2008 and June 2009 who received vancomycin for at least 48 hours targeting higher Vt concentrations of 15– 20 mcg/mL for pneumonia, bacteremia, and meningitis were reviewed. This high-trough concentration cohort (V group) was compared to children admitted from July 2009 through July 2013 who received either cefepime (CEF) or piperacillin/tazobactam (TZP) for ≥ 72 hours (C and P groups, respectively). Serum creatinine (SCr) values were collected from 48 hours before the start of therapy, when available, until 48 hours after the discontinuation of therapy. Nephrotoxicity was categorized according to pRIFLE criteria. Results: 57, 86, and 29 patients met inclusion criteria and were included in the V, C and P groups, respectively. The median (range) age was 2 (0.08-18), 1 (0.02-20), and 2.5 (0.07-17) years in the V, C and P groups, respectively. The mean (SD) therapeutic dose of vancomycin was 63.5 (17) mg/kg/day and the mean (SD) trough was 17.8 (3.1). The mean (SD) dose of CEF was 51 (26) mg/kg/dose and the most common interval was 8 hours. The mean (SD) dose of TZP was 76 (22) mg/kg/dose and the most common interval was 6 hours. 5 of 57, 7 of 86and 3 of 29 in the V,C and P groups respectively were classified in the injury classification of the pRIFLE nomogram, yielding an incidence of nephrotoxicity of 8.8%, 8.1%, and 10.3 % in the V, C and P groups, respectively. Conclusions: Our observations suggest that maintaining Vt concentrations 15 mcg/mL or greater is not associated with an increased rate of nephrotoxicity as compared with β-lactam monotherapy in a PICU population.