Vancomycin-associated Acute Kidney Injury In ChildrenICAAC 2012 (2012)
Background: In 2008, empiric vancomycin dosing in children at our hospital was changed from 40 to 60 mg/kg/day. Subsequently, an increased incidence of acute kidney injury (AKI) in patients receiving vancomycin was suspected. The objective of this study was to evaluate AKI in children receiving vancomycin and determine risk factors for AKI development.
Methods: Medical records of patients aged 30 days through 17 years who received vancomycin for at least 72 hours between January - December 2007 (40 mg/kg/day period) and January - December 2010 (60 mg/kg/day period) were reviewed. Patients with cystic fibrosis, an elevated baseline serum creatinine, or without a serum creatinine concentration obtained after receipt of vancomycin were excluded. Acute kidney injury was defined as an increase in serum creatinine from baseline of 50% or more.
Results: Eight hundred and fiftynine children (N = 859) with a median age of 3 years were included. Acute kidney injury occurred in 19.4% (n = 167) overall, with no difference between 2007 and 2010 (18.8% vs. 20%, respectively; p = 0.636). Patient demographics did not differ in children with and without AKI. More children with AKI were admitted to the intensive care unit (57.5% vs. 40.8%, p = < 0.05), but no other differences in nonvancomycin related AKI risk factors, including concomitant nephrotoxins, were observed. Acute kidney injury occurred more frequently in children achieving a first vancomycin trough concentration ≥ 15 mg/L (18.8 % vs. 9.6%, p = 0.006). A first vancomycin trough concentration ≥ 15 mg/L was also associated with increased mortality (OR: 3.4; 95% CI: 1.1 - 10). Regression analysis demonstrated that intensive care unit admission (OR: 1.86; 95% CI: 1.20 - 2.94) and a first vancomycin trough concentration ≥ 15 mg/L (OR: 2.18; 95%CI: 1.21 - 3.92) were significant AKI predictors.
Conclusions: Vancomycin-associated AKI in this pediatric population was not temporally associated with the hospital dosing changes. However, a first vancomycin serum trough concentration of ≥ 15 mg/L and intensive
care unit admission are predictors of AKI in children receiving vancomycin.
Publication DateFall September 11, 2012
LocationSan Francisco, California
Citation InformationChad A. Knoderer, Kristen R. Nichols, K. C. Lyon, M. M. Veverka, et al.. "Vancomycin-associated Acute Kidney Injury In Children" ICAAC 2012 (2012)
Available at: http://works.bepress.com/chad_knoderer/34/