title: Nephrotoxicity comparison of two commercially available generic vancomycin products.
abstract: To date, no comparative clinical studies have investigated the effects of different vancomycin products on nephrotoxicity. The objective of this single-center, retrospective, matched-cohort study was to investigate the impact of two different vancomycin products on the development of nephrotoxicity. The study population included adults receiving a single vancomycin product, from either Pfizer or Hospira, for their entire course of therapy. Patients were matched based on underlying nephrotoxicity risk factors. Secondary outcomes included the need for renal replacement therapy, length of hospital stay, and in-hospital mortality. One-hundred forty-six matched pairs (n = 292) were included, and they had no significant differences in demographics, comorbid conditions, severity of illness, or vancomycin-associated nephrotoxicity risk factors. The frequency of nephrotoxicity was 8.9% in the Pfizer group and 11.0% in the Hospira group as defined by the 2009 consensus vancomycin guidelines (P = 0.56), 17.1% in the Pfizer group and 13.0% in the Hospira group as defined by the Acute Kidney Injury Network (AKIN) (P = 0.33), and 10.3% in the Pfizer group and 11.6% in the Hospira group as defined by RIFLE (risk, injury, failure, loss, and end-stage renal disease) criteria (P = 0.71). There were no differences between groups in regard to nephrotoxicity by any definition or in secondary outcomes. In multivariate analysis of overall nephrotoxicity risk factors, the type of vancomycin product was not independently associated with increased odds of developing nephrotoxicity according to the RIFLE criteria. Based on our results, there are no discernible differences between Pfizer and Hospira vancomycin products in the frequency of nephrotoxicity. Confirmation of these results with other types of vancomycin and different patient populations is warranted.
authors.affiliation: Department of Pharmacy Services, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA jesse.sutton@bhsi.com.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sutton
authors.affiliation: Department of Pharmacy Services, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Mynatt
authors.affiliation: Wayne State University School of Medicine, Division of Internal Medicine, Department of Infectious Diseases, Detroit, Michigan, USA.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.affiliation: Department of Pharmacy Services, Huron Valley Hospital, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Kyle P
authors.initials: KP
authors.lastname: Murray
authors.affiliation: Department of Pharmacy Services, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA Wayne State University School of Medicine, Division of Internal Medicine, Department of Infectious Diseases, Detroit, Michigan, USA Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rybak
authors.affiliation: Wayne State University School of Medicine, Division of Internal Medicine, Department of Infectious Diseases, Detroit, Michigan, USA Department of Pharmacy Services, Sinai-Grace Hospital, Detroit Medical Center, Detroit, Michigan, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Pogue
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D014640:Vancomycin