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Kidney Week

Abstract: TH-PO057

AKI After Intravenous Vancomycin Compared to Other Common Intravenous Antibiotics

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Gaggl, Martina M., Gillings School of Global Public Health, Chapel Hill, United States
  • Stürmer, Til, UNC Gillings School of Global Publich Health, Chapel Hill, North Carolina, United States
  • Kshirsagar, Abhijit V., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Layton, J. Bradley, RTI Health Solutions, Research Triangle Park, North Carolina, United States
Background

Vancomycin is a mainstay treatment for Gram-positive infection, but it may be associated with nephrotoxicity and acute kidney injury (AKI). AKI contributes to short-term morbidity, mortality, and increased risk of chronic kidney disease (CKD). The study aimed to evaluate the 2-week risk of AKI after ≥3 days of intravenous (IV) vancomycin treatment compared to patients treated with a comparator using U.S. commercial claims data.

Methods

From Truven MaketScan claims data (United States), we identified patients with a first hospitalization with IV vancomycin or comparator treatments with similar clinical indications (table 1) for ≥3 days with a treatment onset ≤ five days after hospital admission (2000-2015). Patients with claims for prior AKI, CKD, or use of immunosuppressive medications were excluded. We estimated incidence rates (IR) and hazard ratios (HR) with cox-regression adjusted for age, sex, main diagnosis, surgical procedure, and 1-year history of comorbidities and co-medication.

Results

We identified 32,997 hospitalized patients with vancomycin or comparator mono-therapy. The mean age was 50 (±15) years and 60% were female. Covariates were evenly distributed across treatment cohorts. Vancomycin was used in 5,449 (17%) patients and in 83% a comparator. Overall, there were 129 cases of AKI, and the IR of AKI was 9.32 (95% CI: 7.84-11.07) per 100 person-years. The crude HR comparing vancomycin vs. comparators was 1.04 (95% CI: 0.85-1.90). After adjustment the HR for vancomycin vs. all comparators was 0.74 (95% CI 0.45-1.21). Similarly, separate adjusted models for individual comparators did not result in elevated HR for vancomycin.

Conclusion

Our study using US claims data did not demonstrate an association between treatment with vancomycin alone and an increased risk of AKI compared to other commonly used intravenous antibiotics in hospitalized patients.

Table 1.
 NCasesPerson-yearsIncidence rate* (95%CI)Crude HR (95%CI)Adjusted HR (95%CI)
Vancomycin (Index group)5,449222299.62(6.34-14.62)    
Comparators27,54810711569.25(7.66-11.18)1.04(0.85-1.90)0.74(0.45-1.21)
Cefazolin20,124588466.86(5.30-8.87)1.40(0.86-2.29)1.01(0.55-1.83)
Linezolid25161057.63(25.89-128.28)0.17(0.07-0.42)0.17(0.01-0.46)
Piperacillin3,8852516215.39(10.40-22.78)0.63(0.35-1.11)0.47(0.24-0.91)
Cefepime43321811.07(2.77-44.28)0.87(0.45-3.70)0.80(0.19-3.69)
Meropenem37971644.44(21.18-93.21)0.22(0.09-0.51)0.21(0.10-0.52)
Ertapenem2,2058938.65(4.32-17.29)1.11(0.51-2.50)0.47(0.19-1.17)
Daptomycin2711118.80(1.24-62.51)1.09(0.15-8.11)0.99(0.12-8.19)

*per 100 person-years