title: Nephrotoxicity of vancomycin in patients with methicillin-resistant Staphylococcus aureus bacteraemia.
abstract: OBJECTIVE
  Vancomycin and teicoplanin are the two most used glycopeptides for the treatment of methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is suspected to have more nephrotoxicity but this has not been clearly established. The aim of this study was to assess its nephrotoxicity by a consensus definition of acute kidney injury (AKI): the risk (R), injury (I), failure (F), loss and end-stage renal disease (RIFLE) classification.
  
  
  METHODS
  Patients with MRSA bacteraemia who were prescribed either vancomycin or teicoplanin between 2003 and 2008 were classified. Patients who developed AKI were classified by RIFLE criteria. Variables such as comorbidities, laboratory data and medical cost information were also obtained from the database. Outcomes determined were: (i) the rate of nephrotoxicity and mortality; and (ii) the association of nephrotoxicity with the length of hospital stay and costs.
  
  
  RESULTS
  The study included 190 patients (vancomycin 33, teicoplanin 157). Fifteen patients on vancomycin and 27 patients on teicoplanin developed AKI (P = 0.0004). In the vancomycin group, four, eight and three patients were classified to RIFLE criteria R, I and F, respectively. In the teicoplanin group, 17, nine and one patient were classified to RIFLE criteria R, I and F, respectively. Kaplan-Meier analysis showed significant difference in time to nephrotoxicity for the vancomycin group compared to the teicoplanin group. No significant differences were found between the groups in terms of total mortality, length of hospital stay and costs.
  
  
  CONCLUSIONS
  The study data suggest that vancomycin is associated with a higher likelihood of nephrotoxicity using the RIFLE classification.
authors.affiliation: Department of Pharmacy, Wan Fang Hospital College of Pharmacy School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.
authors.forename: Wan-Chen
authors.initials: WC
authors.lastname: Shen
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chiang
authors.forename: Hsiang-Yin
authors.initials: HY
authors.lastname: Chen
authors.forename: Tso-Hsiao
authors.initials: TH
authors.lastname: Chen
authors.forename: Fang-Lan
authors.initials: FL
authors.lastname: Yu
authors.forename: Chao-Hsiun
authors.initials: CH
authors.lastname: Tang
authors.forename: Yuh-Mou
authors.initials: YM
authors.lastname: Sue
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000191:economics / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics; D016470:Bacteremia / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D017334:Teicoplanin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D014640:Vancomycin