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)
PredictorIRR (95% confidence interval)P-value
Age, per 10 years0.76 (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 < 601.02 (0.86 to 1.21)0.85
Spline ≥ 601.09 (0.94 to 1.27)0.243
ICU1.90 (1.33 to 2.71)<0.001
Sepsis1.75 (1.26 to 2.42)0.001
Use of pre-hospitalization diuretics1.48 (1.00 to 2.19)0.048
Concurrent use of piperacillin-tazobactam1.44 (1.04 to 2.00)0.029
Vancomycin dose (mg)  
≤10001 (ref)-
1000-15002.83 (1.74 to 4.59)<0.001
1500-20003.02 (1.76 to 5.18)<0.001
>20003.08 (1.75 to 5.44)<0.001

Funding

  • NIDDK Support