Nephrotoxicity With Vancomycin in the Pediatric Population
| Autor: | Kerry L. LaPlante, Theresa M. Fiorito, Kelly L. Matson, Megan K. Luther, Penelope H. Dennehy |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Methicillin-Resistant Staphylococcus aureus
0301 basic medicine Microbiology (medical) medicine.medical_specialty 030106 microbiology MEDLINE Kidney Nephrotoxicity 03 medical and health sciences 0302 clinical medicine Risk Factors Vancomycin Internal medicine Odds Ratio Humans Medicine 030212 general & internal medicine Child Randomized Controlled Trials as Topic Retrospective Studies business.industry Retrospective cohort study Odds ratio Staphylococcal Infections biochemical phenomena metabolism and nutrition Anti-Bacterial Agents Intensive Care Units Observational Studies as Topic Infectious Diseases Meta-analysis Pediatrics Perinatology and Child Health Kidney Diseases Staphylococcus aureus infections business Pediatric population medicine.drug |
| Zdroj: | Pediatric Infectious Disease Journal. 37:654-661 |
| ISSN: | 0891-3668 |
| Popis: | Vancomycin is frequently used to treat methicillin-resistant Staphylococcus aureus infections in pediatric patients. Vancomycin exposure may lead to an increase in frequency of nephrotoxicity. Our aim was to conduct a systematic review to describe predictors of nephrotoxicity associated with vancomycin, including documented trough concentrations ≥15 mg/L. We also aimed to use a meta-analysis to assess the impact of a vancomycin trough ≥15 mg/L on nephrotoxicity.A literature search was performed using PubMed, Cochrane Library, Embase and Web of Sciences database. We included randomized clinical trials and observational studies evaluating the relationship between vancomycin troughs and nephrotoxicity in pediatric-age patients. Studies not measuring troughs or defining a different cut-off point than 15 mg/L were excluded. Data on age, exclusion criteria, nephrotoxicity definition, risk factors for nephrotoxicity and vancomycin trough levels were extracted from selected papers.Ten studies were identified for meta-analysis. All subjects had comparatively normal baseline serum creatinine values. Common risk factors identified included elevated (≥15 mg/L) trough levels, renal impairment, hypovolemia and concurrent use of nephrotoxic medications. Troughs ≥15 mg/L increased nephrotoxicity by 2.7-fold (odds ratio (OR), 2.71; 95% confidence interval: 1.82-4.05; I(2) = 40%; Q = 0.09). These odds were further increased among patients in the pediatric intensive care unit (OR, 3.61; 95% confidence interval: 1.21-10.74; I(2) = 45%; Q = 0.18).Though the rate of vancomycin-induced nephrotoxicity is increased in pediatric patients with higher vancomycin troughs, other factors such as intensive care unit admission, hypovolemia and concurrent nephrotoxic drug use appear to contribute to the development of nephrotoxicity. |
| Databáze: | OpenAIRE |
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