Rapid removal of vancomycin by continuous veno-venous hemofiltration.
We describe a 14-year-old girl with staphylococcal (coagulase-negative) ventriculo-peritoneal shunt infection, who developed oliguric acute renal failure and was found to have a serum vancomycin concentration of 250 microg/ml. Since only about 10%-50% of vancomycin is bound to protein in blood, we employed continuous veno-venous hemofiltration (CVVH) with a high ultrafiltration rate (1,800 ml/h) for increased convective clearance to remove vancomycin, which may have contributed to the acute renal failure. At the end of 38 h of CVVH, the vancomycin concentration had decreased in an exponential manner to 27 microg/ml. Over the subsequent 3-4 days, her renal function improved and the vancomycin concentration decreased further to <5 microg/ml. In conclusion, we believe that a high serum vancomycin concentration may be nephrotoxic and demonstrate that CVVH can be used effectively to remove vancomycin in children with acute renal failure.
Shah
M
M
Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas 75237-9063, USA.
Quigley
R
R
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000097:blood* / Q000627:therapeutic use; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology; D014640:Vancomycin / Q000009:adverse effects* / Q000097:blood* / Q000627:therapeutic use; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D014640:Vancomycin