Late-Occurring Vancomycin-Associated Acute Kidney Injury in Children Receiving Prolonged Therapy

• Published in: The Annals of pharmacotherapy 2015-10, Vol.49 (10), p.1113-1119
• Main Authors: Knoderer, Chad A., Gritzman, Allison L., Nichols, Kristen R., Wilson, Amy C.
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - epidemiology; Adolescent; Age Factors; Anti-Bacterial Agents - adverse effects; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Incidence; Infant; Inpatients; Male; Time Factors; Vancomycin - adverse effects
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1177/1060028015594190

Background: Acute kidney injury (AKI) in patients receiving vancomycin has been associated with trough concentrations ≥15 mg/L and longer therapy duration. The objective of this study was to determine the incidence and factors associated with late AKI in children receiving ≥8 days of vancomycin therapy. Methods: Children aged 30 days to 17 years who were admitted to our institution and received intravenous vancomycin for at least 8 days during January to December of 2007 and 2010 and had a suspected or proven gram-positive infection were included. Late AKI was categorized as AKI occurring after the first 7 days of therapy and within 48 hours following vancomycin discontinuation. The primary outcome was incidence of late AKI as determined by modified pRIFLE criteria. Results: One-hundred sixty-seven patients were included, with a median (interquartile range) age (years) and weight (kg) of 2 (1-7) and 12.5 (8.9-23.8). Late AKI was identified in 12.6% (21/167). A higher percentage of late AKI patients received concomitant treatment with intravenous acyclovir, amphotericin products, or piperacillin-tazobactam. Age