title: Acute kidney injury during vancomycin therapy in critically ill children.
abstract: OBJECTIVE
  To determine the rate, risk factors, and outcome of vancomycin-associated acute kidney injury (AKI) in critically ill children.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  We reviewed the charts of children admitted to the pediatric intensive care unit during a 2-year period who were treated with vancomycin. Courses of vancomycin interrupted by 3 days or more were counted separately. Patients were excluded if they received vancomycin treatment for fewer than 3 days, had preexisting renal failure, or had incomplete serum creatinine (Scr ) data.
  
  
  RESULTS
  Demographic and laboratory data; vancomycin dose, duration, and concentrations; and concurrent use of nephrotoxic drugs were recorded. Acute kidney injury was defined as a decrease in estimated glomerular filtration rate of 50% or more from the beginning of vancomycin therapy. Descriptive statistics, step-wise logistic regression, and repeated measures ANOVA were used to analyze the data. A total of 284 patients were included, for a total of 391 courses of vancomycin (272 children and 119 infants). The mean duration of vancomycin therapy was 6.9 ± 4.5 days. Forty nine (17.2%) patients developed AKI during 61 (15.6%) courses. Elevated Scr concentrations returned to baseline after stopping vancomycin in 53 (87%) courses. Mortality was higher in children who developed AKI (p<0.001; Fisher's exact test). Administration of nephrotoxic drugs (odds ratio 2.23, Confidence Interval 1.27-3.93) and presence of high blood urea nitrogen (BUN):Scr ratio before vancomycin therapy (p<0.05) were associated with AKI. The BUN and Scr concentrations significantly increased during vancomycin therapy and decreased after vancomycin was discontinued (p<0.05).
  
  
  CONCLUSIONS
  In critically ill children, the development of reversible AKI during vancomycin therapy is associated with administration of nephrotoxic drugs and an elevated BUN: Scr ratio.
authors.affiliation: Division of Critical Care Medicine, Miami Children's Hospital, 3100 South West 62nd Avenue, Miami, FL 33155, USA. bala.totapally@mch.com
authors.forename: Balagangadhar R
authors.initials: BR
authors.lastname: Totapally
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Machado
authors.forename: Helen
authors.initials: H
authors.lastname: Lee
authors.forename: Ana
authors.initials: A
authors.lastname: Paredes
authors.forename: Andre
authors.initials: A
authors.lastname: Raszynski
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000293:Adolescent; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001806:Blood Urea Nitrogen; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D005919:Glomerular Filtration Rate; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin