Vancomycin and nephrotoxicity

Just another myth?

Stephen W. Davies, Christopher A. Guidry, Robin T. Petroze, Tjasa Hranjec, Robert G. Sawyer

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

BACKGROUND: Vancomycin is considered the drug of choice for methicillin-resistant Staphylococcus aureus infection; however, it has also been linked with nephrotoxicity in the past, sometimes leading to its substitution with linezolid.We hypothesized that patients treated with vancomycin for gram-positive (GP) infectionswould have an increased incidence of rise in creatinine and need for hemodialysis (HD) compared with patients receiving linezolid. METHODS: This was a retrospective cohort study of a prospectively maintained database of all surgical patients treated with either vancomycin or linezolid for GP infections in a single intensive care unit from 2001 to 2008 and managed under a cycling antibiotic protocol. Patients were followed up until hospital discharge. Categorical and continuous variables were evaluated. Multivariable logistic regression was performed. RESULTS: A total of 545 patients were treated for 1,046 GP infections (571 with vancomycin, 475 with linezolid) over 7 years. Patient demographics were similar between groups; however, the vancomycin group was associated with a longer treatment course (16.2 [0.5] days vs. 14.3 [0.5] days; p = 0.022). Unadjusted outcomes were similar between groups. Multivariable analysis revealed that Acute Physiology and Chronic Health Evaluation II score predicted an increase in creatinine levels greater than 1.0 following antibiotic therapy (relative risk [RR], 3.01; 95% confidence interval [CI], 1.22Y7.42) and subsequent need for HD(RR, 3.07; 95% CI, 1.23Y7.62). In addition, initial creatinine level predicted an increase in creatinine levels greater than 1.0 following antibiotic therapy (RR, 4.36; 95% CI, 1.46Y12.99) and subsequent need for HD (RR, 10.83; 95% CI, 3.19Y36.77). Linezolid was found to be protective regarding rise in creatinine levels greater than 1.0 following antibiotic therapy; however, this was only experienced when vancomycin trough levels greater than 20 were encountered (RR, 5.4;95% CI, 1.19Y24.51). CONCLUSION: These data suggest that vancomycin is minimally nephrotoxic and has a similar nephrotoxic profile as compared with linezolid when appropriate dosing is used, even among critically ill patients with complex infections.

Original languageEnglish (US)
Pages (from-to)830-835
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number5
DOIs
StatePublished - Nov 2013

Fingerprint

Linezolid
Vancomycin
Creatinine
Confidence Intervals
Anti-Bacterial Agents
Renal Dialysis
Infection
APACHE
Therapeutics
Methicillin-Resistant Staphylococcus aureus
Critical Illness
Intensive Care Units
Cohort Studies
Retrospective Studies
Logistic Models

Keywords

  • Critical care
  • Gram-positive infections
  • Linezolid
  • Nephrotoxicity
  • Vancomycin

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Davies, S. W., Guidry, C. A., Petroze, R. T., Hranjec, T., & Sawyer, R. G. (2013). Vancomycin and nephrotoxicity: Just another myth? Journal of Trauma and Acute Care Surgery, 75(5), 830-835. https://doi.org/10.1097/TA.0b013e3182a74b70

Vancomycin and nephrotoxicity : Just another myth? / Davies, Stephen W.; Guidry, Christopher A.; Petroze, Robin T.; Hranjec, Tjasa; Sawyer, Robert G.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 5, 11.2013, p. 830-835.

Research output: Contribution to journalArticle

Davies, SW, Guidry, CA, Petroze, RT, Hranjec, T & Sawyer, RG 2013, 'Vancomycin and nephrotoxicity: Just another myth?', Journal of Trauma and Acute Care Surgery, vol. 75, no. 5, pp. 830-835. https://doi.org/10.1097/TA.0b013e3182a74b70
Davies, Stephen W. ; Guidry, Christopher A. ; Petroze, Robin T. ; Hranjec, Tjasa ; Sawyer, Robert G. / Vancomycin and nephrotoxicity : Just another myth?. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 5. pp. 830-835.
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abstract = "BACKGROUND: Vancomycin is considered the drug of choice for methicillin-resistant Staphylococcus aureus infection; however, it has also been linked with nephrotoxicity in the past, sometimes leading to its substitution with linezolid.We hypothesized that patients treated with vancomycin for gram-positive (GP) infectionswould have an increased incidence of rise in creatinine and need for hemodialysis (HD) compared with patients receiving linezolid. METHODS: This was a retrospective cohort study of a prospectively maintained database of all surgical patients treated with either vancomycin or linezolid for GP infections in a single intensive care unit from 2001 to 2008 and managed under a cycling antibiotic protocol. Patients were followed up until hospital discharge. Categorical and continuous variables were evaluated. Multivariable logistic regression was performed. RESULTS: A total of 545 patients were treated for 1,046 GP infections (571 with vancomycin, 475 with linezolid) over 7 years. Patient demographics were similar between groups; however, the vancomycin group was associated with a longer treatment course (16.2 [0.5] days vs. 14.3 [0.5] days; p = 0.022). Unadjusted outcomes were similar between groups. Multivariable analysis revealed that Acute Physiology and Chronic Health Evaluation II score predicted an increase in creatinine levels greater than 1.0 following antibiotic therapy (relative risk [RR], 3.01; 95{\%} confidence interval [CI], 1.22Y7.42) and subsequent need for HD(RR, 3.07; 95{\%} CI, 1.23Y7.62). In addition, initial creatinine level predicted an increase in creatinine levels greater than 1.0 following antibiotic therapy (RR, 4.36; 95{\%} CI, 1.46Y12.99) and subsequent need for HD (RR, 10.83; 95{\%} CI, 3.19Y36.77). Linezolid was found to be protective regarding rise in creatinine levels greater than 1.0 following antibiotic therapy; however, this was only experienced when vancomycin trough levels greater than 20 were encountered (RR, 5.4;95{\%} CI, 1.19Y24.51). CONCLUSION: These data suggest that vancomycin is minimally nephrotoxic and has a similar nephrotoxic profile as compared with linezolid when appropriate dosing is used, even among critically ill patients with complex infections.",
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N2 - BACKGROUND: Vancomycin is considered the drug of choice for methicillin-resistant Staphylococcus aureus infection; however, it has also been linked with nephrotoxicity in the past, sometimes leading to its substitution with linezolid.We hypothesized that patients treated with vancomycin for gram-positive (GP) infectionswould have an increased incidence of rise in creatinine and need for hemodialysis (HD) compared with patients receiving linezolid. METHODS: This was a retrospective cohort study of a prospectively maintained database of all surgical patients treated with either vancomycin or linezolid for GP infections in a single intensive care unit from 2001 to 2008 and managed under a cycling antibiotic protocol. Patients were followed up until hospital discharge. Categorical and continuous variables were evaluated. Multivariable logistic regression was performed. RESULTS: A total of 545 patients were treated for 1,046 GP infections (571 with vancomycin, 475 with linezolid) over 7 years. Patient demographics were similar between groups; however, the vancomycin group was associated with a longer treatment course (16.2 [0.5] days vs. 14.3 [0.5] days; p = 0.022). Unadjusted outcomes were similar between groups. Multivariable analysis revealed that Acute Physiology and Chronic Health Evaluation II score predicted an increase in creatinine levels greater than 1.0 following antibiotic therapy (relative risk [RR], 3.01; 95% confidence interval [CI], 1.22Y7.42) and subsequent need for HD(RR, 3.07; 95% CI, 1.23Y7.62). In addition, initial creatinine level predicted an increase in creatinine levels greater than 1.0 following antibiotic therapy (RR, 4.36; 95% CI, 1.46Y12.99) and subsequent need for HD (RR, 10.83; 95% CI, 3.19Y36.77). Linezolid was found to be protective regarding rise in creatinine levels greater than 1.0 following antibiotic therapy; however, this was only experienced when vancomycin trough levels greater than 20 were encountered (RR, 5.4;95% CI, 1.19Y24.51). CONCLUSION: These data suggest that vancomycin is minimally nephrotoxic and has a similar nephrotoxic profile as compared with linezolid when appropriate dosing is used, even among critically ill patients with complex infections.

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