Abstract
ObjectiveThe objective of this study was to investigate the current situation of vancomycin (VAN)-associated acute kidney injury (VA-AKI) in China and identify the risk factors for VA-AKI, as well as to comprehensively examine the risk related to concurrent drug use. Further, we assessed the outcomes of patients who developed VA-AKI and the risk factors for these outcomes. Finally, we aimed to provide suggestions for improving the prevention and treatment of VA-AKI in China.MethodsWe conducted a retrospective observational study of inpatients who had been treated with VAN between January 2013 and December 2013 at Peking University First Hospital. AKI was defined as an increase in SCr of ≥0.3 mg/dl (≥26.5 μmol/l) within 48 hours or an increase to ≥1.5 times the baseline certainly or presumably within the past 7 days. VA-AKI was defined as the development of AKI during VAN therapy or within 7 days following the termination of VAN therapy. In addition, we compared patients with NO-AKI, who did not develop AKI during their hospitalization, with those with VA-AKI.ResultsOf the 934 patients treated with VAN during their hospital stay, 740 were included in this study. Among those excluded, 38.1% (74/194) were excluded because of a lack of data on serum creatinine (SCr). Among the included patients, 120 had confirmed VA-AKI, with an incidence of 16.2% (120/740). Multiple logistic regression analysis revealed that an elevated baseline estimated glomerular filtration rate (eGFR) (odds ratio [OR] = 1.009; p = 0.017) and concomitant vasopressor therapy (OR = 2.942; p = 0.009), nitrate use (OR = 2.869; p = 0.007), imipenem-cilastatin treatment (OR = 4.708; p = 0.000), and contrast medium administration (OR = 6.609 p = 0.005) were independent risk factors for VA-AKI; in addition, the receipt of orthopedic/trauma/burn surgery (OR = 0.3575; p = 0.011) and concomitant compound glycyrrhizin use (OR = 0.290; p = 0.017) were independent protective factors for VA-AKI. Multiple logistic regression analysis also demonstrated that among the patients who developed VA-AKI, coronary heart disease (CHD) (OR = 12.6; p = 0.006) and concomitant vasopressor therapy (OR = 15.4; p = 0.001) were independent risk factors for death. We also evaluated the factors influencing improvement of renal function. Multiple logistic regression analysis demonstrated that CHD (OR = 8.858, p = 0.019) and concomitant contrast medium administration (OR = 9.779, p = 0.005) were independent risk factors and that simultaneous β-blocker treatment (OR = 0.124, p = 0.001) was an independent protective factor for improvement of renal function.ConclusionPatients treated with VAN received insufficient monitoring of SCr and inadequate therapeutic drug monitoring. We recommend that hospitals increase their investment in clinical pharmacists. An elevated baseline eGFR and concomitant vasopressor therapy, nitrate use, imipenem-cilastatin treatment, and contrast medium administration were independent risk factors for VA-AKI; in addition, orthopedic/trauma/burn surgery and concomitant compound glycyrrhizin use were independent protective factors for VA-AKI.
Highlights
Vancomycin (VAN), a glycopeptide antibiotic, was discovered in the 1950s
Multiple logistic regression analysis revealed that an elevated baseline estimated glomerular filtration rate and concomitant vasopressor therapy (OR = 2.942; p = 0.009), nitrate use (OR = 2.869; p = 0.007), imipenem-cilastatin treatment (OR = 4.708; p = 0.000), and contrast medium
Multiple logistic regression analysis demonstrated that coronary heart disease (CHD) (OR = 8.858, p = 0.019) and concomitant contrast medium administration (OR = 9.779, p = 0.005) were independent risk factors and that simultaneous β-blocker treatment (OR = 0.124, p = 0.001) was an independent protective factor for improvement of renal function
Summary
Vancomycin (VAN), a glycopeptide antibiotic, was discovered in the 1950s. The prescription of VAN has increased in parallel with the rising prevalence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection [1,2,3]. It is clinically important to confirm the risk factors for VA-AKI to help guide clinicians toward the more rational administration of VAN, with increased renal safety and the avoidance of AKI development. A recent national survey on AKI in China has revealed a serious condition issue with drug safety in the AKI population, as up to 70% of AKI patients had been exposed to potentially nephrotoxic drugs before or during their kidney injury. This finding raises a major issue, indicating that the healthcare system should increase the renal safety of drug treatments in China [7]. Several studies have shown that concomitant administration of VA-AKI: Cross-sectional study amphotericin B, tobramycin or tacrolimus, vasopressor agents or intravenous contrast medium may increase the risk of VA-AKI [5], few drug combinations were examined in these studies
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