Cianferoni S, Devigili A, Ocampos-Martinez E, Penaccini L, Scolletta S, Abdelhadii A, De Backer D, Beumier M, Jacobs F, Vincent JL, Taccone FS.; Infection. 2013 Apr 10. [Epub ahead of print]

PURPOSE: Few data are available on the occurrence of renal failure during continuous infusion of vancomycin in critically ill patients.

METHODS: We reviewed the data of all patients admitted to the intensive care unit (ICU) between January 2008 and December 2009 in whom vancomycin was given as a continuous infusion for more than 48 h in the absence of renal replacement therapy. We collected data on the doses of vancomycin and blood concentrations during therapy. Acute kidney injury (AKI) was defined as a daily urine output <0.5 ml/kg/h and/or an increase in the serum creatinine of ≥0.3 mg/dl from baseline levels during vancomycin therapy or within 72 h after its discontinuation. Multivariable logistic regression analysis was performed to identify predictors of AKI.

RESULTS: Of 207 patients who met the inclusion criteria, 50 (24 %) developed AKI. These patients were more severely ill, had lower creatinine clearance at admission, were more frequently exposed to other nephrotoxic agents, had a longer duration of therapy, and had higher concentrations of vancomycin during the first 3 days of treatment (C mean). The C mean was independently associated with early AKI (within 48 h from the onset of therapy) and the duration of vancomycin administration with late AKI.

CONCLUSIONS: AKI occurred in almost 25 % of critically ill patients treated with a continuous infusion of vancomycin. Vancomycin concentrations and duration of therapy were the strongest variables associated with the development of early and late AKI during therapy, respectively.

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