Incidence and risk factors influencing the development of vancomycin nephrotoxicity in children.
OBJECTIVE
To determine the incidence of vancomycin-associated nephrotoxicity in children and to examine potential risk factors for nephrotoxicity, including average serum trough concentrations ≥ 15 mg/L.


METHODS
Patients ≥ 1 week old to ≤ 19 years with normal baseline serum creatinine values who received vancomycin for ≥ 48 hours between December 2007 and April 2009 were retrospectively evaluated. Nephrotoxicity was defined as a serum creatinine increase of ≥ 0.5 mg/dL or ≥ 50% baseline increase over 2 days. Patients with average serum trough concentrations ≥ 15 mg/L were compared with a lower trough group.


RESULTS
Nephrotoxicity occurred in 14% of 167 patients. More patients who attained high average (≥ 15 mg/L) rather than low average (<15 mg/L) vancomycin troughs had nephrotoxicity (28% versus 7.3%, P = .0001). Using multivariable regression analysis, patients with high troughs and those receiving furosemide in the intensive care unit were more likely to have nephrotoxicity (OR, 3.27 [95% CI, 1.19 to 8.95], P = .021, and odds ratio, 9.45 [95% confidence interval, 3.44 to 26.00], P < .0001, respectively).


CONCLUSIONS
Renal function and serum troughs in children receiving vancomycin, especially those with targeted troughs of ≥ 15 mg/L, in intensive care, and receiving furosemide, should be closely monitored.
McKamy
Susan
S
Miller Children's Hospital, 2801 Atlantic Avenue, PO Box 1428, Long Beach, CA 90801, USA. smckamy@memorialcare.org
Hernandez
Elvin
E
Jahng
Maximillian
M
Moriwaki
Tiffany
T
Deveikis
Audra
A
Le
Jennifer
J
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D015415:Biomarkers / Q000097:blood; D002140:California; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000009:adverse effects* / Q000493:pharmacokinetics; D055815:Young Adult
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D004232:Diuretics; D014640:Vancomycin; D005665:Furosemide; D003404:Creatinine