Factors associated with vancomycin nephrotoxicity in the critically ill. Anaesth Intensive Care Sept 2015.
Vancomycin is commonly used to treat methicillin-resistant Staphylococcus aureus (MRSA). Recently there has been an increase in the prevalence of MRSA with reduced susceptibility to vancomycin. Serum concentrations of <10mg/l is associated with the emergence of vancomycin-resistant Staphylococcus aureus. Current consensus guidelines recommend a target serum vancomycin trough concentration between 15 and 20 mg/l, compared to a historical target of 5 to 10mg/l. Vancomycin related nephrotoxicity is common and has been reported in up to 40% of recipients. This single centre retrospective study of 159 patients who received vancomycin showed that 8.8% manifested new onset AKI. Multivariate logistic regression analysis showed mean trough concentration, APACHE II score and simultaneous aminoglycoside prescription as significant predictors of AKI. These data suggest high trough vancomycin serum concentrations are associated with greater odds of AKI in the critically ill.