retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients回顾性评估可能的肾毒性与连续注入万古霉素的危重病人.pdfVIP

Spapen et al. Annals of Intensive Care 2011, 1:26 /content/1/1/26 RESEARCH Open Access Retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients 1* 2 1 3 1 1 Herbert D Spapen , Karin Janssen van Doorn , Marc Diltoer , Walter Verbrugghe , Rita Jacobs , Nadia Dobbeleir , Patrick M Honoré1 and Philippe G Jorens3 Abstract Background: Continuous infusion of vancomycin is increasingly preferred as an alternative to intermittent administration in critically ill patients. Intermittent vancomycin treatment is associated with an increased occurrence of nephrotoxicity. This study was designed to determine the incidence and risk factors of acute kidney injury (AKI) during continuous infusion of vancomycin. Methods: This was a retrospective, observational, two-center, cohort study in patients with microbiologically documented Gram-positive pneumonia and/or bacteremia and normal baseline renal function. Vancomycin dose was adjusted daily aiming at plateau concentrations of 15-25 μg/mL. AKI was defined as an increase in serum creatinine of 0.3 mg/dL or a 1.5 to 2 times increase from baseline on at least 2 consecutive days after the initiation of vancomycin. Primary data analysis compared patients with AKI with patients who did not develop AKI. A binary logistic regression analysis using the forward stepwise method was used to assess the risk factors associated with AKI. Results: A total of 129 patients were studied of whom 38 (29.5%) developed AKI. Patients with AKI had higher body weight (77.3 ± 15 vs. 70.5 ± 15.2 kg; p = 0.02), more diabetes (79% vs. 54%; p = 0.01), and a higher vasopressor need (87% vs. 59%; p = 0