Analysis of occurrence and risk factors of vancomycin-associated acute kidney injury in patients in the pediatric intensive care unit

Abstract

Objective To understand the occurrence of vancomycin-associated acute kidney injury (AKI) in patients in the pediatric intensive care unit (PICU) and explore the risk factors. Methods Medical records data of children in the PICU receiving vancomycin treatment, treatment course>48 h, and having vancomycin trough concentration monitoring data in the First Affiliated Hospital of Sun Yat-sen University from January 2013 to July 2017 were collected from the hospital information system and retrospectively analyzed. Occurrence of AKI was judged based on Pediatric-Modified RIFLE (pRIFLE) criteria. The children were divided into the AKI group and non-AKI group. The risk factors of vancomycin-associated AKI were analyzed using the multivariable logistic regression model. Results A total of 170 patients were entered in this study. Of them, 104 patients were male and 66 were female with ages from 5 days to 15.4 years and the median age was 1.3 years. Thirty-six patients (21.05%) developed AKI, including 31 patients (18.24%) with risk of kidney injury, 4 patients (2.35%) with kidney injury, and 1 patient (0.59%) with kidney failure, no patient with kidney loss and end-stage kidney disease. The results of multivariate logistic regression analysis showed that the elevated estimated creatinine clearance (OR=1.010, P<0.001), more than 5 kinds of concomitant nephrotoxic drugs (OR=2.808, P=0.019), average vancomycin trough level ≥17 mg/L (OR=10.426, P<0.001), combined with carbapenems antibacterial drugs (OR=4.263, P=0.013), and combined with voriconazole injection (OR=3.165, P=0.038) were all the independent risk factors of AKI occurrence. Conclusions The incidence of vancomycin-associated AKI was 21.18% in PICU patients in our hospital. Vancomycin trough level ≥17 mg/L and more than 5 kinds of concomitant nephrotoxic drugs would increase risk of AKI in PICU patients. Key words: Vancomycin; Intensive care units, pediatric; Acute kidney injury; Risk factors