Vancomycin에 의한 신독성 발생에 영향을 미치는 위험인자 분석
Risk Factors for Vancomycin-induced Nephrotoxicity
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Vancomycin-associated nephrotoxicity(VAN) is a well-known adverse effect of vancomycin. The risk further increases in patients who are on concomitant nephrotoxic agents and/orwith higher vancomycin dose, longer duration of use, undergoing prolonged duration of therapy, etc. Although the 2009 consensus statements from American Society of Health-System Pharmacistsrecommended the target trough concentration of above 10 mg/L, the higher trough concentrationshave been associated with increased VAN. The purpose of this study is to determine the incidenceand risk factors for VAN. In retrospective analysis of adult patients who received vancomycin at Samsung Medical Center, wecollected data on patient characteristics as follows; treatment, including daily doses; duration ofvancomycin therapy and concomitant nephrotoxic agents; and serum creatinine and vancomycintrough levels. We excluded the patients with the baseline serum creatinine of >2 mg/dL or those witha known history of end-stage renal disease or dialysis at baseline. Clinical characteristics were compared between the patients with and without nephrotoxicity to identify the risk factors associatedwith VAN. The relationship was observed between the risk factors and the occurrence of nephrotoxicityby using multivariate logistic regression analysis. Of 191 vancomycin-treated patients, nephrotoxicity occurred in 17.8%. In multivariate analysis,higher vancomycin trough concentrations and the use of concomitant nephrotoxic agents were independentlyassociated with nephrotoxicity. Vancomycin trough concentrations of >20 mg/L appearedto be associated with a 6 to 8-fold increased risk of nephrotoxicity, compared to the trough concentrationsof <15 mg/L. Our findings suggest the need for additional studies to assess the relationship between the highervancomycin target trough concentrations and VAN.
Abstract
Vancomycin-associated nephrotoxicity(VAN) is a well-known adverse effect of vancomycin. The risk further increases in patients who are on concomitant nephrotoxic agents and/orwith higher vancomycin dose, longer duration of use, undergoing prolonged duration of therapy, etc. Although the 2009 consensus statements from American Society of Health-System Pharmacistsrecommended the target trough concentration of above 10 mg/L, the higher trough concentrationshave been associated with increased VAN. The purpose of this study is to determine the incidenceand risk factors for VAN. In retrospective analysis of adult patients who received vancomycin at Samsung Medical Center, wecollected data on patient characteristics as follows; treatment, including daily doses; duration ofvancomycin therapy and concomitant nephrotoxic agents; and serum creatinine and vancomycintrough levels. We excluded the patients with the baseline serum creatinine of >2 mg/dL or those witha known history of end-stage renal disease or dialysis at baseline. Clinical characteristics were compared between the patients with and without nephrotoxicity to identify the risk factors associatedwith VAN. The relationship was observed between the risk factors and the occurrence of nephrotoxicityby using multivariate logistic regression analysis. Of 191 vancomycin-treated patients, nephrotoxicity occurred in 17.8%. In multivariate analysis,higher vancomycin trough concentrations and the use of concomitant nephrotoxic agents were independentlyassociated with nephrotoxicity. Vancomycin trough concentrations of >20 mg/L appearedto be associated with a 6 to 8-fold increased risk of nephrotoxicity, compared to the trough concentrationsof <15 mg/L. Our findings suggest the need for additional studies to assess the relationship between the highervancomycin target trough concentrations and VAN.
참고문헌 (22)
- Meaney C.J., "Vancomycin-associated nephrotoxicity in adult medicine patients: incidence, outcomes,, risk factors", Pharmacotherapy, 34(7), pp.653~661 (2014)
- Cano E.L., "Incidence of nephrotoxicity, association with vancomycin use in intensive care unit patients with pneumonia: retrospective analysis of the IMPACT-HAP Database", Clin Ther, 34(1), pp.149~157 (2012)
- Geraci J.E., "Vancomycin", Mayo Clin Proc, 52(10), pp.631~634 (1977)
- Howden B.P., "Treatment outcomes for serious infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility", Clin Infect Dis, 38(4), pp.521~528 (2004)
- Rybak M.J., "Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America,, the Society of Infectious Diseases Pharmacists", Am J Health Syst Pharm, 66(1), pp.82~89 (2009)
- Bosso J.A., "Relationship between vancomycin trough concentrations, nephrotoxicity: a prospective multicenter trial", Antimicrob Agents Chemother, 55(12), pp.5475~5479 (2011)
- Lodise T.P., "Relationship between initial vancomycin concentration-time profile, nephrotoxicity among hospitalized patients", Clin Infect Dis, 49(4), pp.507~514 (2009)
- Sorrell T.C., "A prospective study of adverse reactions associated with vancomycin therapy", J Antimicrob Chemother, 16(2), pp.235~241 (1985)
- Lodise T.P., "Larger vancomycin doses (at least four grams per day) are associated with an increased incidence of nephrotoxicity", Antimicrob Agents Chemother, 52(4), pp.1330~1336 (2008)
- Hazlewood K.A., "Vancomycin-associated nephrotoxicity: grave concern or death by character assassination?", Am J Med, 123(2), pp.182.e1~182.e7 (2010)
- Hidayat L.K., "High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy, toxicity", Arch Intern Med, 166(19), pp.2138~2144 (2006)
- Elyasi S., "Vancomycininduced nephrotoxicity: mechanism, incidence, risk factors, special populations. A literature review", Eur J Clin Pharmacol, 68(9), pp.1243~1255 (2012)
- Naughton C.A., "Drug-induced nephrotoxicity", Am Fam Physician, 78(6), pp.743~750 (2008)
- Perazella M.A., "Drug-induced nephropathy:an update", Expert Opin Drug Saf, 4(4), pp.689~706 (2005)
- Nash K., "Hospitalacquired renal insufficiency", Am J Kidney Dis, 39(5), pp.930~936 (2002)
- Pritchard L., "Increasing vancomycin serum trough concentrations, incidence of nephrotoxicity", Am J Med, 123(12), pp.1143~1149 (2010)
- Roberts J.A., "Individualised antibiotic dosing for patients who are critically ill: challenges, potential solutions", Lancet Infect Dis, 14(6), pp.498~509 (2014)
- Carreno J.J., "Vancomycin-Associated Renal Dysfunction:Where Are We Now?", Pharmacotherapy, 34(12), pp.1259~1268 (2014)
- Jeffres M.N., "A retrospective analysis of possible renal toxicity associated with vancomycin in patients with health care-associated methicillin-resistant Staphylococcus aureus pneumonia", Clin Ther, 29(6), pp.1107~1115 (2007)
- van Hal S.J., "Systematic review, meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15, 20 milligrams per liter", Antimicrob Agents Chemother, 57(2), pp.734~744 (2013)
- Gupta A., "Vancomycin nephrotoxicity: myths, facts", Neth J Med, 69(9), pp.379~383 (2011)
- 22)Farber B. F., "Retrospective study of the toxicity of preparations of vancomycin from 1974 to 1981", Antimicrob Agents Chemother, 23(1), pp.138~141 (1983)