Incidence and Risk Factors Influencing the Development of Vancomycin Nephrotoxicity in Children

Objective To determine the incidence of vancomycin-associated nephrotoxicity in children and to examine potential risk factors for nephrotoxicity, including average serum trough concentrations >= 15 mg/L. Study design Patients >= 1 week old to <= 19 years with normal baseline serum creatinine values who received vancomycin for >= 48 hours between December 2007 and April 2009 were retrospectively evaluated. Nephrotoxicity was defined as a serum creatinine increase of >= 0.5 mg/dL or >= 50% baseline increase over 2 days. Patients with average serum trough concentrations >= 15 mg/L were compared with a lower trough group. Results Nephrotoxicity occurred in 14% of 167 patients. More patients who attained high average (>= 15 mg/L) rather than low average (<15 mg/L) vancomycin troughs had nephrotoxicity (28% versus 7.3%, P = .0001). Using multivariable regression analysis, patients with high troughs and those receiving furosemide in the intensive care unit were more likely to have nephrotoxicity (OR, 3.27 [95% CI, 1.19 to 8.95], P = .021, and odds ratio, 9.45 [95% confidence interval, 3.44 to 26.00], P < .0001, respectively). Conclusions Renal function and serum troughs in children receiving vancomycin, especially those with targeted troughs of >= 15 mg/L, in intensive care, and receiving furosemide, should be closely monitored. (J Pediatr 2011;158:422-6).