title: Supratherapeutic vancomycin levels after trauma predict acute kidney injury and mortality.
abstract: BACKGROUND
  High-dose vancomycin is increasingly prescribed for critically ill trauma patients at risk for methicillin-resistant Staphylococcus aureus pneumonia. Although trauma patients have multiple known risk factors for acute kidney injury (AKI), a link between vancomycin and AKI or mortality has not been established. We hypothesize that high vancomycin trough concentration (VT) after trauma is associated with AKI and increased mortality.
  
  
  METHODS
  This was a retrospective analysis from a single institution Level I trauma center. Data were reviewed for all adult trauma patients who were admitted between 2006 and 2010. Patients were included if they received intravenous vancomycin, had serum creatinine levels before and after vancomycin administration, and had at least one recorded VT. Patients were stratified by VT into four groups: VT1 = 0-10 mg/L, VT2 = 10.1-15 mg/L, VT3 = 15.1-20 mg/L, VT4 >20 mg/L. Multivariable logistic regression was performed to determine the association between VT, AKI, and mortality.
  
  
  RESULTS
  Of the 6781 trauma patients reviewed, 263 (3.9%) fit inclusion criteria. Ninety-seven (36.9%) patients developed AKI and 25 (9.5%) died. AKI and mortality increased progressively with VT. Ninety-one patients (34.6%) had troughs >20 mg/L and VT4 was independently associated with AKI (AOR 4.7, P < 0.01) and mortality (AOR 4.8, P = 0.05).
  
  
  CONCLUSIONS
  AKI is common in trauma patients who receive intravenous vancomycin. A supratherapeutic trough level of >20 mg/L is an independent predictor of AKI and mortality in trauma patients.
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. Eric.Ley@cshs.org
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
authors.forename: Douglas Z
authors.initials: DZ
authors.lastname: Liou
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Singer
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Marissa
authors.initials: M
authors.lastname: Srour
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Margulies
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000401:mortality*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000401:mortality; D014193:Trauma Centers / Q000706:statistics & numerical data; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects; D014947:Wounds and Injuries / Q000401:mortality*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Acute kidney injury; Mortality; Supratherapeutic; Trauma; Vancomycin