title: Late-Occurring Vancomycin-Associated Acute Kidney Injury in Children Receiving Prolonged Therapy.
abstract: BACKGROUND
  Acute kidney injury (AKI) in patients receiving vancomycin has been associated with trough concentrations ≥15 mg/L and longer therapy duration. The objective of this study was to determine the incidence and factors associated with late AKI in children receiving ≥8 days of vancomycin therapy.
  
  
  METHODS
  Children aged 30 days to 17 years who were admitted to our institution and received intravenous vancomycin for at least 8 days during January to December of 2007 and 2010 and had a suspected or proven gram-positive infection were included. Late AKI was categorized as AKI occurring after the first 7 days of therapy and within 48 hours following vancomycin discontinuation. The primary outcome was incidence of late AKI as determined by modified pRIFLE criteria.
  
  
  RESULTS
  One-hundred sixty-seven patients were included, with a median (interquartile range) age (years) and weight (kg) of 2 (1-7) and 12.5 (8.9-23.8). Late AKI was identified in 12.6% (21/167). A higher percentage of late AKI patients received concomitant treatment with intravenous acyclovir, amphotericin products, or piperacillin-tazobactam. Age <1 year was the only factor independently associated with late AKI development (odds ratio = 4.4; 95% confidence interval = 1.3-15.4).
  
  
  CONCLUSIONS
  Late AKI occurred in nearly 13% of children receiving ≥8 days of vancomycin therapy. This study suggests that vancomycin trough concentrations are not associated with late AKI, but that age <1 year and concomitant administration of certain nephrotoxins may be factors associated with increased risk.
authors.affiliation: Butler University, Indianapolis, IN, USA cknodere@butler.edu.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Knoderer
authors.affiliation: Butler University, Indianapolis, IN, USA.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Gritzman
authors.affiliation: Butler University, Indianapolis, IN, USA Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Nichols
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Wilson
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007297:Inpatients; D008297:Male; D013997:Time Factors; D014640:Vancomycin / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: nephrotoxicity; pediatrics; pharmacodynamics; pharmacokinetics; vancomycin