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J Antimicrob Chemother. 2014 Mar;69(3):805-8. doi: 10.1093/jac/dkt402. Epub 2013 Oct 9.

Risk factors for nephrotoxicity in patients receiving outpatient continuous infusions of vancomycin in an Australian tertiary hospital.

Author information

1
Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia (WA), Australia.

Abstract

OBJECTIVES:

To assess the risk factors for nephrotoxicity caused by vancomycin continuous infusion in a predominantly Caucasian outpatient population.

METHODS:

This was a retrospective cohort study of 155 patient episodes from December 2006 to December 2011.

RESULTS:

Vancomycin-associated nephrotoxicity (VN) occurred in 26 of 155 (17%) patient episodes. After adjustment for baseline renal function, maximum steady-state vancomycin concentrations ≥32 mg/L [OR 8.7 (95% CI 3.1-29.6), P < 0.001] and angiotensin receptor blockade [OR 9.78 (95% CI 3.1-39.4), P < 0.001] were independently associated with VN. The cumulative dose and duration of vancomycin therapy were not independent predictors of VN.

CONCLUSIONS:

Cessation of angiotensin receptor-blocking medications in selected patient groups, enhanced monitoring and establishing target steady-state concentrations <30 mg/L to avoid excessive vancomycin exposure may reduce the risk of VN.

KEYWORDS:

OPAT; angiotensin blockade; steady-state concentrations

PMID:
24107387
DOI:
10.1093/jac/dkt402
[Indexed for MEDLINE]
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