title: Impact of administration of vancomycin or linezolid to critically ill patients with impaired renal function.
abstract: The aim of this study was to assess the impact of vancomycin (VAN) versus linezolid (LZD) on renal function in patients with renal failure (RF) admitted to intensive care units. This was a multicenter, retrospective, comparative cohort study. Renal failure patients were treated with VAN or LZD for proven or suspected infections by multiresistant Gram-positive cocci. Changes in plasma creatinine levels and creatinine clearance at the start and end of treatment were used as endpoints. A total of 147 patients were treated with VAN (group A, n = 68) or LZD (group B, n = 79). Group B included more patients with diabetes mellitus [9 (13.2%) vs. 25 (31.6%); p = 0.007], septic shock [39 (57.4%) vs. 60 (75.9%); p = 0.013] and greater RF (mean ClCr 42.24 ml/min vs. 37.57 ml/min; p = 0.04). Renal function improved in patients from both groups who did not require renal replacement therapy. A greater improvement was seen in group B [percent decrease in Cr (27.94 vs. 9.48; p = 0.02) and percent increase in ClCr (95.96 vs. 55.06; p = 0.05)]. In group A, nine patients (13.2%) experienced an antibiotic-related increase in RF, and antibiotic was discontinued in five patients due to adverse effects. It is reasonable to avoid use of VAN in critically ill patients with acute renal failure.
authors.affiliation: Department of Intensive Medicine, Hospital Clínico Universitario, Valencia, Spain. orcolomo@gmail.com
authors.forename: O
authors.initials: O
authors.lastname: Rodriguez Colomo
authors.forename: F
authors.initials: F
authors.lastname: Álvarez Lerma
authors.forename: M I
authors.initials: MI
authors.lastname: González Pérez
authors.forename: J-M
authors.initials: JM
authors.lastname: Sirvent
authors.forename: M
authors.initials: M
authors.lastname: García Simón
mesh_terms: D000081:Acetamides / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D000069349:Linezolid; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D023303:Oxazolidinones / Q000008:administration & dosage* / Q000009:adverse effects; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D003404:Creatinine; D000069349:Linezolid