Vancomycin의 TDM을 의뢰한 환자에서 신기능 변화에 대한 위험인자 분석
Risk Factors for Vancomycin Associated Nephrotoxicity in Patients Managed Through Therapeutic Drug Monitoring
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Background : Recent guidelines recommend that vancomycin trough concentrations should be maintained above 10mg/L and 15-20mg/L for complicated infections. Several studies have suggested that higher trough values are associated with higher risk of nephrotoxicity. The aim of this study was to determine the incidence and risk factors for vancomycin associated nephrotoxicity, among patients managed through therapeutic drug monitoring (TDM). Method : A retrospective study was conducted among adult patients who received vancomycin TDM service more than twice, at Seoul National University Hospital between July, 2009 and December, 2009. Patients were excluded, if they had a baseline serum creatinine level of 〉1.4mg/dl, were in ICU when they initiated vancomycin therapy, or received vancomycin with nephrotoxic agents during therapy. Vancomycin associated nephrotoxicity was defined as an increase in serum creatinine of 0.5mg/dl from the baseline, on at least two consecutive days. Risk factors for nephrotoxicity are classified into patient-related factors, underlying disease-related factors, drug-related factors, and TDM-related factors. Univariate and multivariate analyses were performed for comparison of the patients. Results : The incidence of vancomycin associated nephrotoxicity is 21/173 (12.1%) in patients managed through vancomycin therapeutic monitoring. Patients with nephrotoxicity had higher average and 1st trough concentration (19.9mg/L vs. 12.2mg/L, p=0.005; 20.6mg/L vs. 19.9mg/L, p=0.015), than patients without nephrotoxicity. Vancomycin duration therapy of ≥14days (76.2% vs. 50%, p=0.024) were associated with increasing nephrotoxicity. Presence of underlying diseases (diabetes, heart failure, hepatic disease) was likely to be associated with development of nephrotoxicity, though this was not statistically significant. Conclusions : Vancomycin trough concentration (≥15mg/L) and duration of therapy (≥14days) are identified to be significant predictors of nephrotoxicity. It is necessary to carry out more studies, focusing in particular on the association between vancomycin nephrotoxicity and underlying disease.
Abstract
Background : Recent guidelines recommend that vancomycin trough concentrations should be maintained above 10mg/L and 15-20mg/L for complicated infections. Several studies have suggested that higher trough values are associated with higher risk of nephrotoxicity. The aim of this study was to determine the incidence and risk factors for vancomycin associated nephrotoxicity, among patients managed through therapeutic drug monitoring (TDM). Method : A retrospective study was conducted among adult patients who received vancomycin TDM service more than twice, at Seoul National University Hospital between July, 2009 and December, 2009. Patients were excluded, if they had a baseline serum creatinine level of 〉1.4mg/dl, were in ICU when they initiated vancomycin therapy, or received vancomycin with nephrotoxic agents during therapy. Vancomycin associated nephrotoxicity was defined as an increase in serum creatinine of 0.5mg/dl from the baseline, on at least two consecutive days. Risk factors for nephrotoxicity are classified into patient-related factors, underlying disease-related factors, drug-related factors, and TDM-related factors. Univariate and multivariate analyses were performed for comparison of the patients. Results : The incidence of vancomycin associated nephrotoxicity is 21/173 (12.1%) in patients managed through vancomycin therapeutic monitoring. Patients with nephrotoxicity had higher average and 1st trough concentration (19.9mg/L vs. 12.2mg/L, p=0.005; 20.6mg/L vs. 19.9mg/L, p=0.015), than patients without nephrotoxicity. Vancomycin duration therapy of ≥14days (76.2% vs. 50%, p=0.024) were associated with increasing nephrotoxicity. Presence of underlying diseases (diabetes, heart failure, hepatic disease) was likely to be associated with development of nephrotoxicity, though this was not statistically significant. Conclusions : Vancomycin trough concentration (≥15mg/L) and duration of therapy (≥14days) are identified to be significant predictors of nephrotoxicity. It is necessary to carry out more studies, focusing in particular on the association between vancomycin nephrotoxicity and underlying disease.
참고문헌 (16)
- Stevens D.L, "The role of vancomycin in the treatment paradigm", Clinical infectious diseases, 42, pp.51~57 (2006)
- Lodise T.P, "Relationship between vancomycin MIC and failure among patients with methicillin-resistant Staphylococcus aureus bacteremia treated with vancomycin", Antimicrob Agents Chemother, 52, pp.3315~3320 (2008)
- Rybak M, "Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American society of health-system pharmacists, the infectious disease society of America, and the society of infectious disease pharmacists", American journal of health-system pharmacists, 66, pp.82~322 (2009)
- Hermsen E.D, "Clinical outcomes and nephrotoxicity associated with vancomycin trough concentrations during treatment of deep-seated infection", Expert opinion, 9, pp.9~14 (2010)
- Jeffres M.N, "A retrospective analysis of possible renal toxicity associated with vancomycin in patients with health care-associated methicillinresistant Stapylococcus aureus pneumonia", Clinical therapeutics, 29, pp.1107~1115 (2007)
- Hazlewood K.A, "Vancomycin-associated nephrotoxicity: Grave concern or death by character assassination?", the American journal of medicine, 123(182), pp.1~7 (2010)
- Elting L.S, "Mississippi mud in the 1990s- risks and outcomes of vancomycin- associated toxicity in general oncology practice", Cancer, 83(12), pp.2597~2607 (1998)
- Farber B.F, "Retrospective study of the toxicity of preparations of vancomycin from 1974 to 1981", Antibicrob Agents Chemother, 23, pp.138~141 (1983)
- Lodise T.P, "Larger vancomycin doses (at least four grams per day) are associated with an increased incidence of nephrotoxicity", Antimicob Agents Chemother, 52, pp.1330~1336 (2008)
- Lodies T.P, "Relationship between initial vancomycin concentration-time profile and nephrotoxicity among hospitalized pateints", Clinical infectious diseases, 49, pp.507~514 (2009)
- Pritchard L, "Increasing vancomycin serum trough concentrations and incidence of nephrotoxicity", the American journal of medicine, 123(12), pp.1143~1149 (2010)
- Naughton C.A, "Drug induced nephrotoxicity", American academy of family physicians, 78(6), pp.743~750 (2008)
- Tisdale J.E, "druginduced diseases : prevention, detection, and management, second edition, In American society of health-system pharmacists, SectionⅨ, Chapter43"
- Moellering RCJr, "A 50- year reassessment", Clinical infectious diseases, 42, pp.3~4 (2006)
- Hidayat L.K, "High dose vancomycin therapy for methicillin resistant Staphylococcus aureus infections - efficacy and toxicity", Arch Intern Med, 166, pp.2138~2144 (2006)
- 김해숙, "Vancomycin Therapeutic Drug Monitoring 운영 실태 조사와 업무 개선 방안", 한국임상약학회지, 19(2), pp.120~130 (2009), 한국임상약학회