Nephrotoxic medication, high trough serum vancomycin predict VIN in kids

The concomitant use of nephrotoxic medication along with elevated trough levels of serum vancomycin appear to worsen the risk of vancomycin-induced nephrotoxicity (VIN) in paediatric patients, a recent study has found.

The researchers conducted a retrospective, observational, single-centre study of 476 paediatric patients (mean age 8.3 years) who had received vancomycin for more than 48 hours. Twenty-two patients (4.6 percent) developed acute kidney injury during vancomycin treatment, two cases of which were identified as kidney failure.

Most VIN episodes resolved to normalcy, though one patient progressed to chronic kidney disease (CKD) stage 2.

VIN patients were on vancomycin treatment for much longer (13.7 vs 9.8 days; p=0.018) and were admitted for significantly more days (45.4 vs 25.2 days; p=0.0001). Concomitant use of nephrotoxic medications such as furosemide (40.9 percent vs 21.2 percent; p=0.0367) and piperacillin/tazobactam (PIP/TAZ; 22.7 percent vs 4.4 percent; p=0.0038), as well as maximum trough vancomycin level (23.5 vs 18.6 µg/mL; p=0.013) were likewise higher in VIN patients.

Multivariable logistic regression analysis confirmed that a longer hospitalization duration (odds ratio [OR], 1.008; p=0.0434) and concomitant use of PIP/TAZ (OR, 4.407; p=0.0128) were significant predictors of VIN.

Receiver operating characteristic curve analysis identified an optimal cutoff for maximum trough vancomycin level of 24.35 µg/uL for which VIN prediction had an accuracy of 79.3 percent. Such a cutoff was likewise significantly correlated with VIN risk (OR, 3.519; p=0.006).