Serum Concentration of Vancomycin Is a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Septic Patients in Clinical and Surgical Wards

There have been few studies to evaluate the monitoring of plasmatic concentrations of vancomycin in septic patients and their association with acute kidney injury (AKI) and death. This study aimed to evaluate the prevalence of adequate, subtherapeutic, and toxic serum concentrations of vancomycin in...

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Bibliographic Details
Published in:Infection and drug resistance 2020-02, Vol.13, p.403-411
Main Authors: Zamoner, Welder, Gonçalves Pierri, Isabella, Zanchetta Cardoso Eid, Karina, Maria Bellaver de Almeida, Lais, Dos Santos, Adriano, Luís Balbi, André, Ponce, Daniela
Format: Article
Language:English
Subjects:
acute kidney injury
Antibacterial agents
Antibiotics
Chronic kidney failure
Clinical outcomes
Death
Diagnosis
Diseases
Health aspects
Hospitalization
Hospitals
Kidney diseases
Laboratories
Medical research
Mortality
nephrotoxicity
Original Research
Patients
Pregnant women
Risk factors
Sepsis
Studies
Vancomycin
Variables
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Summary:There have been few studies to evaluate the monitoring of plasmatic concentrations of vancomycin in septic patients and their association with acute kidney injury (AKI) and death. This study aimed to evaluate the prevalence of adequate, subtherapeutic, and toxic serum concentrations of vancomycin in hospitalized septic patients and to associate the adequacy of therapeutic monitoring with clinical outcomes. This was a cohort-unicentric study that evaluated septic patients aged >18 years using vancomycin admitted to clinical and surgical wards of a Brazilian university center from August 2016 to July 2017 in a daily and uninterrupted way. We excluded patients with AKI prior to the introduction of vancomycin or with AKI development 21.5 mg/L was a predictor of AKI, with area under the curve of 0.803 (95% CI 0.62-0.98, =0.005), preceding the diagnosis of AKI by at least 3 days. Of these patients, 20.7% died, and serum concentrations of vancomycin between the fourth and sixth days were identified as risk factors associated with negative outcomes. Serum concentration of vancomycin is an excellent predictor of AKI in patients admitted to wards, preceding the diagnosis of AKI by at least 72 hours. Toxic concentrations of vancomycin are associated with AKI, and AKI was a risk factor for death. Also, serum concentration of vancomycin >21.5 mg/L was the only variable associated with death in the Cox model.
ISSN:1178-6973
1178-6973
DOI:10.2147/IDR.S219989