title: Vancomycin-associated nephrotoxicity in the critically ill: a retrospective multivariate regression analysis*.
abstract: OBJECTIVE
  To evaluate the influence of vancomycin dose, serum trough concentration, and dosing strategy on the evolution of acute kidney injury in critically ill patients.
  
  
  METHODS
  Retrospective, single-center, observational study.
  
  
  METHODS
  University Hospital ICU, Birmingham, UK.
  
  
  METHODS
  All critically ill patients receiving vancomycin from December 1, 2004, to August 31, 2009.
  
  
  METHODS
  None.
  
  
  RESULTS
  The prevalence of new onset nephrotoxicity was reported using Risk, Injury, Failure, Loss, End-stage renal disease criteria, and independent factors predictive of nephrotoxicity were identified using logistic regression analysis. Complete data were available for 1,430 patients. Concomitant vasoactive therapy (odds ratio = 1.633; p < 0.001), median serum vancomycin (odds ratio = 1.112; p < 0.001), and duration of therapy (odds ratio = 1.041; p ≤ 0.001) were significant positive predictors of nephrotoxicity. Intermittent infusion was associated with a significantly greater risk of nephrotoxicity than continuous infusion (odds ratio = 8.204; p ≤ 0.001).
  
  
  CONCLUSIONS
  In a large dataset, higher serum vancomycin concentrations and greater duration of therapy are independently associated with increased odds of nephrotoxicity. Furthermore, continuous infusion is associated with a decreased likelihood of nephrotoxicity compared with intermittent infusion. This large dataset supports the use of continuous infusion of vancomycin in critically ill patients.
authors.affiliation: 1Burns Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. 2Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 3Department of Anaesthesia and Critical Care, University Hospital Birmingham, Birmingham, United Kingdom.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hanrahan
authors.forename: Georgina
authors.initials: G
authors.lastname: Harlow
authors.forename: James
authors.initials: J
authors.lastname: Hutchinson
authors.forename: Joel M
authors.initials: JM
authors.lastname: Dulhunty
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.forename: Tony
authors.initials: T
authors.lastname: Whitehouse
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000401:mortality; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D003404:Creatinine