Impact of Higher Vancomycin Troughs on Vancomycin-Induced Nephrotoxicity.

Background: Guidelines published in 2009 by the Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists recommended targeting vancomycin troughs of 15 to 20 mg/L. No previous studies exist examining the effect of implementing these guidelines on kidney function. The objective of this study was to evaluate the effect of a dosing nomogram that incorporated recommendations for higher vancomycin goal trough vancomycin-induced nephrotoxicity (VIN). Methods: This study evaluated 300 adult inpatients with a pharmacokinetics consultation for vancomycin dosing. Two periods were evaluated: phase I (2008) assessed practice preguideline vancomycin dosing nomogram change, and phase II (2012) assessed practice postguideline vancomycin dosing nomogram change reflecting the higher trough targets. Groups were compared using [chi]2 or Fisher exact tests for categorical variables and Mann-Whitney U tests for continuous variables. The a priori level of significance was set at 0.05. Results: A total of 300 inpatients (150 in 2008 and 150 in 2012) were included in the analysis. More patients from the 2012 group experienced VIN, according to the guideline definition (P = 0.03), but not per the 2007 Acute Kidney Injury Network definition (P = 0.88). There was no change in other adverse outcomes, including dialysis initiation (2 vs 0; P = 0.16), discharge on dialysis (1 vs 0; P = 0.32), transfer to another hospital for higher level of care (33 vs 34; P = 0.89), or death (15 vs 11; P = 0.41). Conclusions: Targeting higher vancomycin troughs resulted in transient VIN but did not cause adverse sequelae. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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