Vancomycin-Associated Nephrotoxicity in Adult Medicine Patients: Incidence, Outcomes, and Risk Factors

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Abstract

Objective

The prevalence of vancomycin-associated nephrotoxicity (VAN) is reported to vary from 1.0–42.6%, with most data from critically ill patients. Evaluation of VAN among internal medicine patients is lacking. Our objectives were to determine the incidence, time-course, outcomes, and risk factors of VAN in adult internal medicine patients.

Design

Retrospective cohort.

Setting

Tertiary care academic medical center.

Patients

A total of 125 adult internal medicine patients receiving vancomycin treatment with mean baseline creatinine clearance of 84.6 ± 27.6 ml/min.

Intervention

Vancomycin treatment for a minimum of 72 hours.

Measurements and Main Results

Nephrotoxicity, defined as an increase in serum creatinine of 0.5 mg/dl or 50% above baseline (whichever was larger), occurred in 17 (13.6%) of 125 patients. No patients with VAN progressed to Loss or End stage as defined by the RIFLE criteria. The incidence rate of VAN was 0.02 cases/day of vancomycin treatment. Nephrotoxicity developed at a median of 4.5 days (interquartile range [IQR] 2.2–4.9) peaked at 5.7 days (IQR: 3.8–9.6), and resolved in 70.6% of the cases within 16.5 days (IQR: 6.0–17.8) after onset. On multivariable logistic regression analysis, after controlling for hypotensive episodes, Charlson Comorbidity Index, and baseline creatinine clearance, concomitant use of piperacillin-tazobactam was associated with increased VAN (adjusted odds ratio 5.36, 95% confidence interval 1.41–20.5).

Conclusions

Vancomycin-associated nephrotoxicity is prevalent among internal medicine patients, with 5.36-fold higher odds if piperacillin-tazobactam is concomitantly administered.

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