The association between vancomycin trough concentrations and acute kidney injury in the neonatal intensive care unit

Vidit Bhargava,Rafael Fonseca,Michael Malloy

doi:10.1186/s12887-017-0777-0

Vidit Bhargava, Rafael Fonseca + Show 1 more

Open Access

https://doi.org/10.1186/s12887-017-0777-0

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Abstract

BackgroundVancomycin has recently gained popularity as an empiric therapy for late onset sepsis in the NICU. Changes in resistance patterns in common organisms has resulted in targeting higher trough concentrations of vancomycin. Consequently, an increase in vancomycin associated nephrotoxicity has been speculated. The objective of this study is to compare the incidence of acute kidney injury (AKI) in neonates with serum vancomycin trough concentrations less than 10 mg/L, 10–15 mg/L, or greater than 15 mg/L.MethodsA retrospective chart review of patients in the neonatal intensive care unit (NICU) was conducted to determine the incidence of AKI in neonates receiving vancomycin.ResultsThe overall incidence of AKI was 2.7%. Comparison of the incidence of AKI in the three groups using Mantel-Haenszel Chi-Square test showed a statistically significant association between increasing vancomycin trough concentration and incidence of AKI.ConclusionThere is a low incidence of AKI in neonates receiving vancomycin. However, there is a positive correlation between increasing vancomycin trough concentrations and an increasing serum creatinine.

Highlights

Vancomycin has recently gained popularity as an empiric therapy for late onset sepsis in the neonatal intensive care unit (NICU)
Vancomycin is widely used as an empiric therapy for late onset sepsis, and in confirmed infections with coagulase negative Staphylococcus (CONS) and Methicillin resistant staphylococcus aureus (MRSA). [1, 2] vancomycin is used in the NICU even though limited information is available concerning the dosing, monitoring, and adverse effects of this medication in neonates
This study aims to measure the association between increasing trough concentrations and acute kidney injury (AKI) in neonates receiving vancomycin therapy

Summary

Introduction

Vancomycin has recently gained popularity as an empiric therapy for late onset sepsis in the NICU. The objective of this study is to compare the incidence of acute kidney injury (AKI) in neonates with serum vancomycin trough concentrations less than 10 mg/L, 10–15 mg/L, or greater than 15 mg/L. Late onset sepsis is a common concern in premature infants in neonatal intensive care unit (NICU). Vancomycin is widely used as an empiric therapy for late onset sepsis, and in confirmed infections with CONS and MRSA. Increasing antibiotic resistance among familiar pathogens in the NICU, as evidenced by higher minimum inhibitory concentrations (MICs), has resulted in targeting higher vancomycin trough concentrations. This study aims to measure the association between increasing trough concentrations and AKI in neonates receiving vancomycin therapy.

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