• Kavitha K Prabaker, Thuong P-H Tran, Tamara Pratummas, Matthew Bidwell Goetz, and Christopher J Graber.
• Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
• J Hosp Med. 2012 Feb 1; 7 (2): 91-7.

BackgroundVancomycin troughs of 15-20 mg/L are recommended in the treatment of invasive staphylococcal disease, higher levels than previously recommended.Objective/SettingWe sought to determine if there was an association between vancomycin trough and nephrotoxicity, defined as 0.5 mg/L or 50% increase in serum creatinine, at a large Veterans Affairs medical center.Patients And MethodsWe reviewed records of 348 inpatients at our institution who received ≥5 days of vancomycin during 2 time periods when vancomycin dosing protocols differed (May 2005-April 2006 and January 2007-December 2007). Potential risk factors for nephrotoxicity were collected prior to nephrotoxicity onset, and all patients with nephrotoxicity events occurring within 5 days of starting vancomycin were excluded.ResultsOverall incidence of nephrotoxicity was 31/348 patients (8.9%). A similar percentage of patients experienced nephrotoxicity in 2005-2006 versus 2007 (16/201 vs 15/147, respectively; P = 0.57), despite a rise in mean (9.7 mg/L in 2005-2006 vs 13.2 mg/L in 2007; P < 0.0001) and highest (11.8 mg/L in 2005-2006 vs 15.7 mg/L in 2007; P < 0.0001) vancomycin trough levels achieved. In a multivariate logistic regression model, only receipt of intravenous contrast dye was significantly associated with nephrotoxicity (OR 4.01, P < 0.001), though there was a trend toward an association between maximum vancomycin trough ≥15 mg/L and nephrotoxicity (OR 2.05, P = 0.082). Overall reversibility of nephrotoxicity either prior to or within 72 hours of vancomycin discontinuation was 77.8%.ConclusionsWe conclude that nephrotoxicity, with higher trough levels occurring at ≥5 days of vancomycin therapy, was uncommon at our institution and typically reversible.Copyright © 2011 Society of Hospital Medicine.

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