Pharmacy, Health Sciences & Exercise Science

Safety Outcomes in Children Receiving Vancomycin Therapy

Presenter Information

Allison Gritzman, Butler University

Document Type

Oral Presentation

Location

Indianapolis, IN

Subject Area

Pharmacy, Health Sciences & Exercise Science

Start Date

11-4-2014 8:30 AM

End Date

11-4-2014 10:00 AM

Description

Introduction: Vancomycin, a commonly used antibiotic to treat methicillin resistant Staphylococcus aureus infections, has been associated with acute kidney injury (AKI). Traditional IV dosing has been 40 mg/kg/day to target serum trough concentrations of 5-10 mg/L. Following a recommendation to increase target serum trough concentrations to 10-20 mg/L, children often empirically require 60 mg/kg/day. The incidence of AKI may increase with high vancomycin doses and higher trough concentrations. This is a follow-up of a study that examined 860 patients, and found that 164 of them had early AKI during the first 7 days of their vancomycin course. This project specifically examined those 164 patients to evaluate long-term AKI from day 8 and beyond. The objective of this study was to determine the long-term safety outcomes of vancomycin therapy in children.

Methods: This was a retrospective cohort study of 164 children aged 1 through 18 years who received IV vancomycin from January through December of 2007 and 2010 at a free-standing pediatric hospital and developed AKI with the first 7 treatment days. Patients were included if they received IV vancomycin for at least 72 hours for suspected or proven gram positive infection. Previously recorded demographic data, vancomycin trough concentrations, serum creatinine concentrations, and vancomycin dosing information of this cohort were utilized in this study. Serum creatinine and trough concentrations were collected for day 8 of vancomycin therapy through 10 days following vancomycin discontinuation. AKI was defined as an increase in serum creatinine concentrations by ≥ 50% from baseline values. Long-term AKI was defined as any AKI beyond the first 7 days of treatment.

Results: Patients had a median age of 4.8 years. Overall, 37 patients (22.6%) developed long-term AKI. Of the 50 patients who received vancomycin for at least 8 days, 12 (24%) developed long-term AKI. Concomitant nephrotoxins were administered in 92.7% of patients during their vancomycin course. Patients received a mean (SD) vancomycin dose of 43.3 (15.5) mg/kg/day. Trough serum concentrations were obtained in 85 (52%) patients and a median (IQR) trough concentration of 10.8 (7.9 – 13.9) mg/L. Acute kidney injury developed in 45.5% vs. 23.8% (p = 0.055) of patients with and without any serum trough concentration ≥ 15 mg/L, respectively. There were no differences observed in AKI development in patients admitted to the intensive care unit (ICU) when compared to those not needing ICU care (58.3% vs. 54.1%; p = 0.648).

Conclusions: These findings demonstrate that a child who experiences AKI within the 1st 7 days of vancomycin therapy may not always develop late AKI. Late AKI developed in 22.6% of children meeting criteria for AKI within the first 7 days of vancomycin therapy which suggest that early renal function changes may not persist.

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Apr 11th, 8:30 AM Apr 11th, 10:00 AM

Safety Outcomes in Children Receiving Vancomycin Therapy

Indianapolis, IN

Introduction: Vancomycin, a commonly used antibiotic to treat methicillin resistant Staphylococcus aureus infections, has been associated with acute kidney injury (AKI). Traditional IV dosing has been 40 mg/kg/day to target serum trough concentrations of 5-10 mg/L. Following a recommendation to increase target serum trough concentrations to 10-20 mg/L, children often empirically require 60 mg/kg/day. The incidence of AKI may increase with high vancomycin doses and higher trough concentrations. This is a follow-up of a study that examined 860 patients, and found that 164 of them had early AKI during the first 7 days of their vancomycin course. This project specifically examined those 164 patients to evaluate long-term AKI from day 8 and beyond. The objective of this study was to determine the long-term safety outcomes of vancomycin therapy in children.

Methods: This was a retrospective cohort study of 164 children aged 1 through 18 years who received IV vancomycin from January through December of 2007 and 2010 at a free-standing pediatric hospital and developed AKI with the first 7 treatment days. Patients were included if they received IV vancomycin for at least 72 hours for suspected or proven gram positive infection. Previously recorded demographic data, vancomycin trough concentrations, serum creatinine concentrations, and vancomycin dosing information of this cohort were utilized in this study. Serum creatinine and trough concentrations were collected for day 8 of vancomycin therapy through 10 days following vancomycin discontinuation. AKI was defined as an increase in serum creatinine concentrations by ≥ 50% from baseline values. Long-term AKI was defined as any AKI beyond the first 7 days of treatment.

Results: Patients had a median age of 4.8 years. Overall, 37 patients (22.6%) developed long-term AKI. Of the 50 patients who received vancomycin for at least 8 days, 12 (24%) developed long-term AKI. Concomitant nephrotoxins were administered in 92.7% of patients during their vancomycin course. Patients received a mean (SD) vancomycin dose of 43.3 (15.5) mg/kg/day. Trough serum concentrations were obtained in 85 (52%) patients and a median (IQR) trough concentration of 10.8 (7.9 – 13.9) mg/L. Acute kidney injury developed in 45.5% vs. 23.8% (p = 0.055) of patients with and without any serum trough concentration ≥ 15 mg/L, respectively. There were no differences observed in AKI development in patients admitted to the intensive care unit (ICU) when compared to those not needing ICU care (58.3% vs. 54.1%; p = 0.648).

Conclusions: These findings demonstrate that a child who experiences AKI within the 1st 7 days of vancomycin therapy may not always develop late AKI. Late AKI developed in 22.6% of children meeting criteria for AKI within the first 7 days of vancomycin therapy which suggest that early renal function changes may not persist.