Augmented Renal Clearance Associated with Vancomycin Clearance in Pediatric Hemato-Oncology and Stem Cell Transplantation Patients

Tiene Bauters,Barbara De Moerloose,Ann Raes,Petra Schelstraete,Catharina Dhooge,Victoria Bordon,Geneviève Laureys

doi:10.1016/j.bbmt.2018.12.340

Tiene Bauters, Barbara De Moerloose + Show 5 more

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https://doi.org/10.1016/j.bbmt.2018.12.340

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Abstract

Background Vancomycin (VCM) is a renally cleared glycopeptide commonly used against (pre-emptive/documented) infections caused by gram-positive species. Therapeutic drug monitoring is strongly recommended to achieve target trough serum concentrations. Augmented renal clearance (ARC) has been reported in children with malignancies and has been associated with subtherapeutic antibiotic concentrations. Aim Investigation of ARC prevalence and risk factors in a pediatric hematology-oncology (PHO) and Stem Cell Transplantation (SCT) center. Methods A 2-year, single-center, retrospective study. The ARC was defined as glomerular filtration of > 130 ml/min/1.73m² (modified Schwartz formula). A VCM ‘episode' was defined as the period from start till stop of VCM therapy. Approval of the local ethical committee was obtained. Results Sixty-eight patients (29/68; 43%) males; mean age 7.6 year (+/- 5.2y) representing 102 VCM-episodes, with hematological malignancies (47/68; 69.1%), solid tumors (10/68; 14.7%) and ‘others' (SCT/non-SCT indications) (11/68; 16.2%). ARC was observed in 55/102 episodes (53.9%) before start and 51/102 (50.0%) at stop of VCM therapy. Neutropenia and especially febrile neutropenia were identified as risk factor for ARC (p = 0.044 and 0.013, respectively). Of 68 patients, 16 underwent SCT (1 autologous, 22 allogeneic), representing 23 episodes of VCM. ARC was observed in 11/23 (47.8%) before start and 3/23 (13.0%) episodes after stop of VCM therapy. A significant trend toward decreasing filtration at stop of VCM therapy (p Discussion ARC is commonly present in pediatric PHO/SCT patients. Febrile neutropenia is identified as a significant risk factor for ARC. SCT patients commonly have a state of ARC, which significantly decreases over time during VCM therapy. This inverse correlation highlights the need for close monitoring of VCM in order to maintain adequate therapeutic levels in SCT patients.

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