Study of the prevalence and factors associated with vancomycin-induced nephrotoxicity
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Abstract
Vancomycin, a glycopeptide antibiotic, has a narrow therapeutic range and may cause acute kidney injury which increased length of hospitalization and mortality. Maharat Nakhon Ratchasima Hospital has established guidelines for prescribing drugs and monitoring laboratory parameters. However, vancomycin-induced nephrotoxicity has been reported and patients were required long-term dialysis. Objective: The purpose was to study the prevalence of vancomycin-induced nephrotoxicity. To determine factors associated with acute kidney injury in patients treated with vancomycin, clinical outcome and all-cause mortality in hospital of patients developed vancomycin-induced nephrotoxicity were the secondary objectives. Methods: The subjects in this retrospective cross-sectional descriptive study were patients aged 18 and above who received intravenous vancomycin and performed therapeutic drug monitoring at steady state. The data were collected from inpatient medical records of Maharat Nakhon Ratchasima Hospital from January 2019 to December 2021. Results: A total of 250 patients were included in the study. The prevalence of vancomycin-induced nephrotoxicity is 29.2%. Risk factors associated of nephrotoxicity were age (AOR=1.04, 95%CI: 1.01, 1.08), heart failure (AOR=32.71, 95%CI: 1.43, 746.97), treatment duration longer than 14 days (AOR=9.37, 95%CI: 2.42, 36.24) and concomitant medications such as colistin (AOR=7.32, 95%CI: 1.35, 39.62) and piperacillin/ tazobactam (AOR=20.27, 95%CI: 4.77, 86.24). After Discontinueation of vancomycin, 92.9 percent of patients had improvement and recovery of renal function. Vancomycin-induced nephrotoxicity group compared to vancomycin exposure without acute kidney injury was associated with greater all-cause mortality in hospital (P<0.001). Conclusion: Prevalence of vancomycin-induced nephrotoxicity is higher than other studies. Elderly, heart-failure patients and patients who received concomitant medications such as colistin and piperacillin/tazobactam and got more than 14-day treatment duration of vancomycin should be closely monitored in order to prevent vancomycin-induced nephrotoxicity.
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