The Serum Concentration of Vancomycin as a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Critically Ill Patients.

Welder Zamoner,Karina Zanchetta Cardoso Eid,Adriano Dos Santos,Lais Maria Bellaver De Almeida,Isabella Gonçalves Pierri,André Luis Balbi,Daniela Ponce

doi:10.3390/antibiotics11010112

Welder Zamoner, Karina Zanchetta Cardoso Eid + Show 5 more

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https://doi.org/10.3390/antibiotics11010112

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Abstract

The impact of serum concentrations of vancomycin is a controversial topic. Results: 182 critically ill patients were evaluated using vancomycin and 63 patients were included in the study. AKI occurred in 44.4% of patients on the sixth day of vancomycin use. Vancomycin higher than 17.53 mg/L between the second and the fourth days of use was a predictor of AKI, preceding AKI diagnosis for at least two days, with an area under the curve of 0.806 (IC 95% 0.624–0.987, p = 0.011). Altogether, 46.03% of patients died, and in the Cox analysis, the associated factors were age, estimated GFR, CPR, and vancomycin between the second and the fourth days. Discussion: The current 2020 guidelines recommend using Bayesian-derived AUC monitoring rather than trough concentrations. However, due to the higher number of laboratory analyses and the need for an application to calculate the AUC, many centers still use therapeutic trough levels between 15 and 20 mg/L. Conclusion: The results of this study suggest that a narrower range of serum concentration of vancomycin was a predictor of AKI in critically ill septic patients, preceding the diagnosis of AKI by at least 48 h, and it can be a useful monitoring tool when AUC cannot be used.

Highlights

The impact of the serum concentrations of vancomycin in hospitalized patients in intensive care units (ICU) is a controversial topic, and it is necessary to improve the knowledge of sepsis and the safe and effective use of vancomycin
The vast majority of patients (92%) had performed the serum vancomycin measurement, the number of serum concentrations dosages and the number of posologic adjustments were 3.87 and 1.84, respectively; 53.96% were in concentrations considered toxic, an Antibiotics 2022, 11, x FOR PEER REVIEW
We evaluated a specific population using vancomycin after ICU admission, and patients with AKI were excluded before introducing the antimicrobial agent, which could justify the different risk factors identified in other studies

Summary

Introduction

The impact of the serum concentrations of vancomycin in hospitalized patients in intensive care units (ICU) is a controversial topic, and it is necessary to improve the knowledge of sepsis and the safe and effective use of vancomycin. Sepsis is a frequent diagnosis in ICUs and corresponds to the primary etiology of acute kidney injury in this scenario with a high mortality [1,2,3,4,5]. Vancomycin is widely used in ICUs. Due to the pharmacokinetic changes of the critical patient related to the distribution, elimination, and metabolization of the drug, there is an increased risk of subtherapeutic concentrations, which may compromise the treatment and induce bacterial resistance. It is a drug whose main side effect is nephrotoxicity [5,6,7,8,9]

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