Association between Vancomycin Area under the Curve and Nephrotoxicity: A single center, retrospective cohort study in a veteran population

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Open Forum Infectious Diseases


Background: It is unclear which vancomycin area under the curve (AUC) values are most associated with risk for acute kidney injury (AKI). Methods: This retrospective cohort study was undertaken to determine if vancomycin AUC>550 is associated with a higher rate of AKI than an AUC<550. Patients treated with vancomycin for at least 4 days at the VA St. Louis Health Care System from 1/1/2016 to 9/31/2018 were included. The primary outcome was AKI (defined as an increase in serum creatinine by 0.3 mg/dL or 50% from baseline). Secondary outcomes included length of stay, readmission in 30 days, and mortality in 30 days. A bivariate analysis was used to determine other potential factors affecting AKI rate, with significant variables (P<.2) to be included in the multivariate logistic regression analysis to determine independent risk for AKI. Results: Two hundred patients were included in the analysis; 100 patients with an AUC≥550 and 100 with an AUC<550. Only mean vancomycin dose (1722.50 mg vs 2361.25 mg; P<.05), mean AUC (465.88 vs 696.45; P<.05), and peak SCr (1.22 mg/dL vs 1.48 mg/dL; P=.015) were significantly different between groups (AUC<550 vs AUC≥550, respectively). AKI occurred in 42% (42/100) of patients with AUC≥550 compared with 2% (2/100) of patients with AUC<550 (P<.05). Secondary outcomes were not different between the groups. In the bivariate analysis, age≥70, CrCl<50 mL/min, and AUC≥550 (odds ratio, 49.5; 95% CI, 10.1-242.3; P<.05) were found to be independently associated with risk for developing AKI. Conclusions: Patients with a vancomycin AUC≥550 were found to have a significantly higher rate of AKI compared with those with an AUC<550.



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