Vancomycin Nephrotoxicity

2014 ◽  
Vol 27 (6) ◽  
pp. 545-553 ◽  
Author(s):  
Kari A. Mergenhagen ◽  
Angela R. Borton
Keyword(s):  
Risk Factors ◽  
Renal Damage ◽  
Historical Context ◽  
Severity Of Illness ◽  
Total Daily Dose ◽  
Therapeutic Drug ◽  
Factors Associated ◽  
Concurrent Use ◽  
Daily Dose ◽  
Trough Levels

Vancomycin earned notoriety for its tendency to cause nephrotoxicity shortly after it was introduced into practice, though the impurities responsible for historically significant rates of nephrotoxicity are of minimal concern today. Increasing usage of vancomycin has provided evidence that the drug itself can be nephrotoxic, but the exact mechanism by which this occurs has not been determined. Various studies have identified risk factors associated with development of vancomycin-associated nephrotoxicity, including total daily dose > 4 grams, trough levels > 20 mg/L, therapy exceeding 6 days, concurrent use of other nephrotoxic agents, preexisting renal disease, obesity, hypotensive episodes, and increasing severity of illness. Preventative strategies beyond risk assessment and therapeutic drug monitoring have shown little promise. Most cases of nephrotoxicity are reversible with discontinuation of vancomycin, but permanent renal damage can occur. This article is intended to serve as a practical review of vancomycin-associated nephrotoxicity, including historical context, risk factors, and common methods to evaluate and define renal dysfunction.

PERFIL EPIDEMIOLÓGICO Y FACTORES DE RIESGO DE MORTALIDAD EN ADULTOS CON COVID-19: ESTUDIO RETROSPECTIVO.

2020 ◽  
Vol 31 (1) ◽  
Author(s):  
Dayami Martínez Sosa ◽  
Oswaldo Vásconez Hatt ◽  
Katherine Rosero Arboleda ◽  
Fabian Zurita Alvarado ◽  
Mónica Hernández Lojano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Course ◽  
Demographic Data ◽  
Severity Of Illness ◽  
Factors Associated ◽  
Related Risk ◽  
Factores De Riesgo ◽  
New Type ◽  
Epidemiological Characteristics

By the ending of 2019 a new type of coronavirus was identified named SARS-CoV 2, and now known to be the etiological agent of the acute respiratory syndrome coronavirus (SARS-CoV-2). Known as coronavirus 2019 disease or (COVID-19) constitutes a challenge for the world in many unknown aspects and problems in public health. In Ecuador the first reported of a confirmed appeared on February 29 2020, and in March 12 an emergency health status is declared. Objective: To determine the epidemiological characteristics and factors related to death and survival in patients with COVID-19. Design: The study is of transversal retrospective design, the patients chosen were those seen in the respiratory or suspicious of COVID-19 area of Hospital Vozandes Quito between March 2 and April 30. Demographic data and related risk factors for mortality were obtained using the EPI-1 individual form, epidemiological research files, the VI Epi system and electronic promptuary of patients. Results: 250 patients were obtained for this study, 87 of those were confirmed COVID-19, out those eight died and 79 were alive at the ending of the follow up. Regarding the severity of illness, 61% of the patients were classified as mild and 6 % critical (p =<0.001). Elevated values of CRP (OR 1 IC 95% 1.000 – 1.024), age about 55 years old to diagnosis (OR 42,040 IC 95% 36,320 – 47,760) and the presence of hiporexia (OR 24 IC 95% 1.183 – 504.413) were associated with higher mortality levels amongst COVID-19 positive patients. Conclusions The majority of COVID-19 cases showed no serious manifestations, were treated symptomatically and home isolation. Elevated values of CRP and the presence of hiporexia at the diagnosis are factors consistently with death. Future investigations are required to determine the risk factors associated with worst clinical course and prognosis.

scholarly journals Vancomycin Dosing in Pediatric Extracorporeal Membrane Oxygenation: Potential Impacts of New Technologies

2017 ◽  
Vol 22 (5) ◽  
pp. 358-363
Author(s):  
Kevin P. Lonabaugh ◽  
Kelly J. Lunsford ◽  
Gary Y. Fang ◽  
David A. Kaufman ◽  
Samuel D. Addison ◽  
...  
Keyword(s):  
Renal Function ◽  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
New Technologies ◽  
Total Daily Dose ◽  
Therapeutic Drug ◽  
Membrane Oxygenation ◽  
Drug Concentrations ◽  
Daily Dose ◽  
Serum Vancomycin

OBJECTIVES The objective of the current study was to evaluate the doses of vancomycin used to obtain therapeutic drug concentrations in pediatric patients on extracorporeal membrane oxygenation (ECMO), using new ECMO technologies. METHODS This was a single-center, retrospective study of patients treated with vancomycin while receiving ECMO using low-volume circuit technology. RESULTS A total of 28 patients were included in the analysis of the primary endpoint. Patients had a median age of 6 weeks (0–11 years) and a median weight of 3.45 kg (2.44–37.2 kg). Ultrafiltration was used in 89.3% of patients at initiation of ECMO regardless of baseline renal function, resulting in a median urine output of 2 mL/kg/hr at the time of the final vancomycin dose. Most patients started vancomycin at the same time as ECMO. The median total daily dose was 30 mg/kg/day. The median total daily dose in a subset of patients less than one year of age was 20 mg/kg/day. Nearly all patients had at least 1 therapeutic trough serum vancomycin concentration. A total of 16 patients completed their vancomycin course using an interval of every 12 hours or shorter. Half-life was calculated in a subset of 11 patients and the mean was found to be 12.3 ± 2.8 hours. CONCLUSIONS An initial dosing interval of every 12 hours to provide a total daily dose of 30 mg/kg/day is a possible option in pediatric patients on ECMO provided that renal function is normal at baseline. Monitoring of serum vancomycin concentrations for adjustment of dosing is required throughout therapy and is still warranted.

scholarly journals Risk factors for illness severity in patients with COVID-19 pneumonia: a prospective cohort study

2020 ◽  
Author(s):  
Nannan Zhang ◽  
Hairong Zhang ◽  
Yanhua Tang ◽  
Hao Zhang ◽  
Aiying Ma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disease Severity ◽  
Case Series ◽  
Severity Of Illness ◽  
Illness Severity ◽  
Laboratory Findings ◽  
Factors Associated ◽  
Detection And Identification ◽  
Disease Hospital ◽  
Novel Coronavirus

Abstract Background Although COVID-19 pneumonia is spreading internationally, knowledge regarding the factors associated with the illness severity of patients remains limited. We aimed to identify the factors associated with the disease severity of patients with COVID-19 pneumonia induced by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We prospectively enrolled a single-center case series of adult patients with COVID-19 admitted to the Infectious Disease Hospital of Jining, Jining City, Shandong Province, China, from January 24 to March 1, 2020. Demographics, clinical characteristics, and laboratory findings were compared to investigate the risk factors related with the disease severity of COVID-19 pneumonia patients. Results We included a total of 78 patients with COVID-19 pneumonia, of whom 6 had the severe type. As compared to a moderately ill cohort, our analysis showed that shortness of breath, fatigue, neutrophil percentages > 70%, neutrophil counts > 6.3 × 10 9 /L, lymphocyte percentages < 20%, lymphocyte counts < 1.0 × 10 9 /L, platelet < 100 × 10 9 /L, C-reactive protein (CRP) > 10 mg/L, neutrophil to platelet ratio (NPR) > 2.3, neutrophil to lymphocyte ratio (NLR) > 3.9, aspartate aminotransferase (AST) > 40 U/L, albumin < 40 g/L, lactate dehydrogenase (LDH) > 245 U/L, and glucose > 6.1 mmol/L were predictors of disease severity in COVID-19 pneumonia. In the sex-, age-, and comorbid illness-matched case-control study, neutrophil percentages > 70%, neutrophil counts > 6.3 × 10 9 /L, lymphocyte percentages < 20%, NPR > 2.3, NLR > 3.9, albumin < 40 g/L, and LDH > 245 U/L remained associated with the early detection and identification of severe patients. Conclusion We demonstrated that neutrophil percentages > 70%, neutrophil counts > 6.3×10 9 /L, lymphocyte percentages < 20%, NPR > 2.3, NLR > 3.9, albumin < 40 g/L, and LDH > 245 U/L might predict the severity of illness in patients with COVID-19 pneumonia.

Potential Risk Factors Associated With Progressive Renal Damage in Childhood Urological Diseases

1997 ◽  
pp. 1308-1311 ◽  
Author(s):  
John W. Brock ◽  
Mark Adams ◽  
Trey Hunley ◽  
A. Wada ◽  
Lisa Trusler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Potential Risk ◽  
Renal Damage ◽  
Factors Associated ◽  
Potential Risk Factors ◽  
Urological Diseases

scholarly journals Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024086 ◽  
Author(s):  
Kapil Gupta ◽  
Mahesh Nagappa ◽  
Arun Prasad ◽  
Lusine Abrahamyan ◽  
Jean Wong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Respiratory Depression ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Factors Associated ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Daily Dose ◽  
Morphine Equivalent

ObjectiveThis systematic review and meta-analysis aim to evaluate the risk factors associated with postoperative opioid-induced respiratory depression (OIRD).DesignSystematic review and meta-analysis.Data sourcesPubMed-MEDLINE, MEDLINE in-process, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed and Clinicaltrials.gov (January 1946 to November 2017).Eligibility criteriaThe inclusion criteria were: (1) adult patients 18 years or older who were administered opioids after surgery and developed postoperative OIRD (OIRD group); (2) all studies which reported both OIRD events and associated risk factors; (3) all studies with reported data for each risk factor on patients with no OIRD (control group) and (4) published articles in English language.Data analysisWe used a random effects inverse variance analysis to evaluate the existing evidence of risk factors associated with OIRD. Newcastle-Ottawa scale scoring system was used to assess quality of study.ResultsTwelve observational studies were included from 8690 citations. The incidence of postoperative OIRD was 5.0 cases per 1000 anaesthetics administered (95% CI: 4.8 to 5.1; total patients: 841 424; OIRD: 4194). Eighty-five per cent of OIRD occurred within the first 24 hours postoperatively. Increased risk for OIRD was associated with pre-existing cardiac disease (OIRD vs control: 42.8% vs 29.6%; OR: 1.7; 95% CI: 1.2 to 2.5; I2: 0%; p<0.002), pulmonary disease (OIRD vs control: 17.8% vs 10.3%; OR: 2.2; 95% CI: 1.3 to 3.6; I2: 0%; p<0.001) and obstructive sleep apnoea (OIRD vs control: 17.9% vs 16.5%; OR: 1.4; 95% CI: 1.2 to 1.7; I2: 31%; p=0.0003). The morphine equivalent daily dose of the postoperative opioids was higher in the OIRD group than in the control; (24.7±14 mg vs 18.9±13.0 mg; mean difference: 2.8; 95% CI: 0.4 to 5.3; I2: 98%; p=0.02). There was no significant association between OIRD and age, gender, body mass index or American Society of Anesthesiologists physical status.ConclusionPatients with cardiac, respiratory disease and/or obstructive sleep apnoea were at increased risk for OIRD. Patients with postoperative OIRD received higher doses of morphine equivalent daily dose.

scholarly journals Vancomycin-Associated Acute Kidney Injury in Critically Ill Adolescent and Young Adult Patients

2019 ◽  
Vol 33 (6) ◽  
pp. 749-753 ◽  
Author(s):  
William B. Hays ◽  
Emma Tillman
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Young Adult ◽  
Critically Ill ◽  
Kidney Injury ◽  
Adult Patients ◽  
Adolescent And Young Adult ◽  
Daily Dose ◽  
Vancomycin Trough ◽  
Trough Levels

Background: Risk factors for the development of vancomycin-associated acute kidney injury (AKI) have been evaluated in both pediatric and adult populations; however, no previous studies exist evaluating this in the critically ill adolescent and young adult patients. Objective: Identify the incidence of AKI and examine risk factors for the development of AKI in critically ill adolescents and young adults on vancomycin. Methods: This retrospective review evaluated the incidence of AKI in patients 15 to 25 years of age who received vancomycin, while admitted to an intensive care unit. Acute kidney injury in this population was defined as an increase in serum creatinine by 0.5 mg/dL or 50% from baseline. Patients who developed AKI were evaluated for specific risk factors compared to those who did not develop AKI. Results: A total of 50 patients (20 developed AKI) were included in the study. There was no difference in vancomycin daily dose or duration of vancomycin therapy. Maximum vancomycin trough (31.15 mg/dL vs 12.5 mg/dL, P = .006), percentage of patients with concurrent nephrotoxic medication (95% vs 60%, P = .012) and concurrent vasopressor (55% vs 23%, P = .029) were higher in those who developed AKI. Percentage of patients who underwent a procedure while on vancomycin (35% vs 6.7%, P = .021) was also higher within the AKI group. Conclusions: Vancomycin-associated AKI occurred in 40% of critically ill adolescent and young adult patients. These patients may be more likely to develop vancomycin-associated AKI if they had undergone a procedure, as well as in the presence of high vancomycin trough levels, concurrent nephrotoxic agents, and concurrent vasopressor therapy.

Factors Associated With Unplanned Extubation in Children: A Case–Control Study

2017 ◽  
Vol 35 (1) ◽  
pp. 74-81
Author(s):  
Paulo Sérgio Lucas da Silva ◽  
Marcelo Cunio Machado Fonseca
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Oxygenation Index ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Case Control ◽  
Admission Diagnosis ◽  
Unplanned Extubation ◽  
Factors Associated ◽  
Control Study

Purpose:Although several studies assess unplanned extubation (UE) in children, few have addressed determinants of UE and factors associated with reintubation in a case-controlled manner. We aimed to identify the risk factors and outcomes associated with UE in a pediatric intensive care unit.Methods:Cases of UE were randomly matched with control patients at a ratio of 1:4 for age, severity of illness, and admission diagnosis. For cases and controls, we also collected data associated with UE events, reintubation, and outcomes.Results:We analyzed 94 UE patients (0.75 UE per 100 intubation days) and found no differences in demographics between the 2 groups. Logistic regression revealed that patient agitation (odds ratio [OR]: 2.44; 95% confidence interval [CI]: 1.28-4.65), continuous sedation infusion (OR: 3.27; 95% CI: 1.70-6.29), night shifts (OR: 9.16; 95% CI: 4.25-19.72), in-charge nurse experience <2 years (OR: 2.38; 95% CI: 1.13-4.99), and oxygenation index (OI) >5 (OR: 76.9; 95% CI: 16.79-352.47) were associated with UE. Risk factors for reintubation after UE included prior level of sedation (COMFORT score < 27; OR: 7.93; 95% CI: 2.30-27.29), copious secretion (OR: 11.88; 95% CI: 2.20-64.05), and OI > 5 (OR: 9.32; 95% CI: 2.45-35.48).Conclusions:This case–control study showed that both patient- and nurse-associated risk factors were related to UE. Risk factors associated with reintubation included lower levels of consciousness, copious secretions, and higher OI. Further evidence-based studies, including a larger sample size, are warranted to identify predisposing factors in UEs.

scholarly journals 1108. Evaluation of Vancomycin Dosing in Adolescents

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S646-S646
Author(s):  
Ashley I Weaver ◽  
Genene A Wilson ◽  
Emily Belarski ◽  
Allison Nelson ◽  
Madan Kumar ◽  
...  
Keyword(s):  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Total Daily Dose ◽  
Therapeutic Drug ◽  
Obese Patients ◽  
Serum Concentrations ◽  
Daily Dose ◽  
Safety Endpoint ◽  
Secondary Endpoints ◽  
Higher Doses

Abstract Background Pediatric vancomycin dosing varies based on age and renal function. Recent literature suggests previously recommended doses of 45-60 mg/kg/day may be insufficient to achieve an AUC:MIC ratio of 400-600 mg-hr/L and higher doses of at least 60 mg/kg/day may be required. However, data to guide dosing in adolescents is limited. Methods A single-center, retrospective chart review of patients aged 12 to 18 years who received vancomycin and had therapeutic drug monitoring (TDM) performed between July 2017 to June 2020 were included. The primary endpoint was the median total daily dose (TDD) of vancomycin required to achieve therapeutic serum concentrations. Secondary endpoints were to characterize how factors such as age, weight, trough versus AUC monitoring, malignancy, and trauma may influence dosing. The safety endpoint was the development of acute kidney injury (AKI). Results 130 vancomycin courses in 86 patients were included. Baseline characteristics are presented in Table 1. Of the 130 vancomycin courses, 50 courses (38%) achieved therapeutic serum concentrations at a median TDD of 49.8 mg/kg/day (IQR 42 – 59.4). This was not statistically different from the sub- or supra-therapeutic groups (p=0.22). Based on age, the median TDD for 12-14 year olds was higher at 60 mg/kg/day (IQR 45-78.8; n=14) than for 15-16 and 17-18 year olds [45.3 mg/kg/day (IQR 41.1-51; n=15), 48 mg/kg/day (IQR 42-52; n=21), respectively]. Obese patients needed a median TDD of 43.5 mg/kg/day vs at least 51 mg/kg/day in healthy and overweight patients. Finally, AUC guided dosing resulted in a slightly lower overall median TDD vs trough guided dosing (45.8 mg/kg/day vs 50.5 mg/kg/day). Additional dose requirements based on age, weight, TDM and other characteristics are presented in Table 2. Of the 15 patients who developed AKI per pRIFILE criteria, 2 were classified as injury and 3 as failure. Table 2. Total Daily Dose Course Analysis Conclusion To achieve therapeutic levels, adolescents 12 to14 years old need higher empiric doses of 60 mg/kg/day compared to 45 mg/kg/day in 15 to 18 year olds. Obese patients, however, may require lower TDD than underweight, healthy, and overweight patients. Patients that receive AUC versus trough monitoring may also require lower TDD to achieve therapeutic concentrations. More data is needed to further evaluate our findings. Disclosures All Authors: No reported disclosures

scholarly journals Factors Associated with Prolonged Length of Stay in Intensive Care Unit: Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (1) ◽  
pp. 30
Author(s):  
Nashwa M. Radwan ◽  
Nagla E. Mahmoud ◽  
Amal H. Alfaifi ◽  
Khaled I. Alabdulkareem
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
English Language ◽  
Medical Condition ◽  
Severity Of Illness ◽  
Risk Of Bias ◽  
Prolonged Length ◽  
Factors Associated

Background: Prolonged length of Stay (PLOS) increases the risk of hospital-acquired infections and disrupts patient flowand access to care due to bed shortages. The extent to which PLOS is attributable to complications, patient characteristics, illness, or inefficienpractice style is unclear. Objectives: To determine risk factors associated with prolonged length of stay (PLOS) in intensive care unit. (ICU). Search methods: We searched the COCHRANE, MEDLINE, TRIP and EMBASE from 2010 till now. Selection criteria: We included all the studies published in English language from 2010 till now and investigated the PLOS in ICU after any medical condition. Data collection and analysis: Two authors independently assessed trials eligibility and risk of bias and extracted data. Review Manager 5.3 was utilized to manage the data. Main results: The review included 84719 participants from fourteen observational studies that had some degree of risk of bias and substantial heterogeneity. Post-operative sepsis/ septic shock and the severity of illness of the patients at hospital admission were the most common risk factors for PLOS (OR= 5.65, CI= 1.98, 16.08 and OR=3.95, CI= 1.67, 9.34 respectively), followed by emergency operation (OR= 2.68, CI= 1.56, 4.62), and comorbidities including renal failure and coronary heart disease (OR= 2.64, CI=1.26, 5.51 and OR=2.57, CI= 1.61, 4.10 respectively). Other variables associated with PLOS were respectively; pre-operative condition (OR=2.36, CI=1.28, 4.34), long term use of corticosteroids (OR= 2.03, CI= 1.81, 2.29 ), age >70 years (OR=1.89, CI=0.54, 2.32), operation duration >180 minutes (OR=1.86, CI=1.46, 2.38), most deprived condition (OR= 1.82, CI= 1.15, 2.89), diabetes (OR= 1.36, CI=1.18, 1.56), hypertension (OR=1.32, CI= 1.09, 1.62), smoking (OR=1.25, CI= 1.13, 1.39) and male sex (OR= 1.11, CI=1.06, 1.17). Authors conclusion: Identificationof risk factors associated with PLOS provides the opportunity for intervention to reduce the LOS and support efficient/optimause of hospital resources.

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