Abstract: FR-PO084
Supratherapeutic Vancomycin Levels: Risk Factors and Outcomes
Session Information
- AKI Clinical: Predictors
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Acute Kidney Injury
- 003 AKI: Clinical and Translational
Authors
- Zonozi, Reza, The Johns Hopkins University, Baltimore, Maryland, United States
- Wu, Aozhou, The Johns Hopkins University, Baltimore, Maryland, United States
- Shin, Jung-Im, The Johns Hopkins University, Baltimore, Maryland, United States
- Secora, Alex M, The Johns Hopkins University, Baltimore, Maryland, United States
- Coresh, Josef, The Johns Hopkins University, Baltimore, Maryland, United States
- Chang, Alex R., Geisinger Medical Center, Danville, Pennsylvania, United States
- Grams, Morgan, The Johns Hopkins University, Baltimore, Maryland, United States
Background
Vancomycin is a commonly administered intravenous (IV) antibiotic, and supratherapeutic levels of vancomycin may be an avoidable cause of nephrotoxicity. The objective of this study was to investigate the frequency of, risk factors for, and outcomes after elevated levels of vancomycin.
Methods
There were 31,316 hospitalizations in which IV vancomycin was given between 2008 and 2014 among 21,166 people in the Geisinger Health System, a large, integrated, tertiary, rural health care system.
Results
There were 12,713 hospitalizations with vancomycin monitoring, and 1.24% of these hospitalizations had a vancomycin level >50 mg/L. Among hospitalizations with >7 days duration of therapy, 2.65% had a vancomycin level >50 mg/L. The risk of vancomycin levels >50 mg/L was higher with younger age, female sex, black race, pre-hospitalization diuretic use, an ICU stay, sepsis, concurrent use of piperacillin-tazobactam, and higher doses of vancomycin (Table). Neither BMI nor eGFR was associated with vancomycin levels >50 mg/dL in adjusted analysis. Length of stay, acute kidney injury (AKI), and in-hospital mortality were all higher among persons with vancomycin levels >50 mg/L.
Conclusion
We identified modifiable risk factors for Vancomycin levels >50 mg/L, which were associated with greater in-hospital mortality, AKI, and length of stay.
Adjusted Incidence Rate Ratio (IRR) of High Vancomycin Levels (>50 mg/L)
Predictor | IRR (95% confidence interval) | P-value |
Age, per 10 years | 0.76 (0.68 to 0.84) | <0.001 |
Sex (female) | 1.40 (1.00 to 1.94) | 0.049 |
Race (Black) | 2.04 (1.00 to 4.15) | 0.049 |
eGFR | ||
Spline < 60 | 1.02 (0.86 to 1.21) | 0.85 |
Spline ≥ 60 | 1.09 (0.94 to 1.27) | 0.243 |
ICU | 1.90 (1.33 to 2.71) | <0.001 |
Sepsis | 1.75 (1.26 to 2.42) | 0.001 |
Use of pre-hospitalization diuretics | 1.48 (1.00 to 2.19) | 0.048 |
Concurrent use of piperacillin-tazobactam | 1.44 (1.04 to 2.00) | 0.029 |
Vancomycin dose (mg) | ||
≤1000 | 1 (ref) | - |
1000-1500 | 2.83 (1.74 to 4.59) | <0.001 |
1500-2000 | 3.02 (1.76 to 5.18) | <0.001 |
>2000 | 3.08 (1.75 to 5.44) | <0.001 |
Funding
- NIDDK Support