title: Randomized Controlled Trial to Determine the Efficacy of Early Switch From Vancomycin to Vancomycin Alternatives as a Strategy to Prevent Nephrotoxicity in Patients With Multiple Risk Factors for Adverse Renal Outcomes (STOP-NT).
abstract: BACKGROUND
  Use of alternative antimicrobials to vancomycin is a potential strategy to reduce acute kidney injury (AKI) in high-risk patients, but current data do not support widespread adoption of this practice.
  
  
  OBJECTIVE
  To determine the efficacy of early switch to a nonnephrotoxic alternative for prevention of AKI in high-risk patients who receive vancomycin.
  
  
  METHODS
  This was an IRB-approved, prospective randomized controlled trial in a single, tertiary care academic medical center. Patients initially prescribed vancomycin between October 2011 to April 2013 with at least 2 risk factors for AKI were included. Treatment randomization was stratified by indication for therapy. Patients were randomized to continuation of dose-optimized vancomycin or early switch to an alternative antimicrobial agent. The primary end point was nephrotoxicity by consensus guideline definition adjudicated by blinded review; the secondary end point was AKI network-defined AKI.
  
  
  RESULTS
  A total of 103 patients were randomized; 100 were included in the modified intent-to-treat population, 51 in the vancomycin group and 49 in the alternative group. The incidence of nephrotoxicity was 6.1% in the alternative therapy arm and 9.8% in the vancomycin group ( P = 0.72). The incidence of AKI was 32.7% in the alternative therapy group and 31.4% in the vancomycin group ( P = 0.89).
  
  
  CONCLUSIONS
  No significant difference in nephrotoxicity or AKI was detected among patients treated with alternative antimicrobials compared with vancomycin. The use of alternative antimicrobial therapy instead of vancomycin solely for the purpose of preventing AKI in high-risk patients does not appear to be warranted.
authors.affiliation: 1 Henry Ford Hospital Department of Pharmacy Services, Detroit, MI, USA.|2 Wayne State University, Detroit, MI, USA.|3 Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Carreno
authors.affiliation: 2 Wayne State University, Detroit, MI, USA.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Kenney
authors.affiliation: 4 Henry Ford Hospital Department of Public Health Sciences, Detroit, MI, USA.
authors.forename: George
authors.initials: G
authors.lastname: Divine
authors.affiliation: 5 Henry Ford Hospital, Division of Infectious Diseases, Detroit, MI, USA.|6 Georgia Regents University, Augusta, GA, USA.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Vazquez
authors.affiliation: 1 Henry Ford Hospital Department of Pharmacy Services, Detroit, MI, USA.|2 Wayne State University, Detroit, MI, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Davis
mesh_terms: D000046:Academic Medical Centers; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D057915:Drug Substitution / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000139:chemically induced / Q000453:epidemiology; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: acute kidney injury; ceftaroline; daptomycin; linezolid; nephrotoxicity; vancomycin