• Balagangadhar R Totapally, Jacqueline Machado, Helen Lee, Ana Paredes, and Andre Raszynski.
• Division of Critical Care Medicine, Miami Children's Hospital, 3100 South West 62nd Avenue, Miami, FL 33155, USA. bala.totapally@mch.com
• Pharmacotherapy. 2013 Jun 1;33(6):598-602.

Study ObjectiveTo determine the rate, risk factors, and outcome of vancomycin-associated acute kidney injury (AKI) in critically ill children.DesignRetrospective cohort study.SettingTertiary care children's hospital.PatientsWe reviewed the charts of children admitted to the pediatric intensive care unit during a 2-year period who were treated with vancomycin. Courses of vancomycin interrupted by 3 days or more were counted separately. Patients were excluded if they received vancomycin treatment for fewer than 3 days, had preexisting renal failure, or had incomplete serum creatinine (Scr ) data.Measurements And Main ResultsDemographic and laboratory data; vancomycin dose, duration, and concentrations; and concurrent use of nephrotoxic drugs were recorded. Acute kidney injury was defined as a decrease in estimated glomerular filtration rate of 50% or more from the beginning of vancomycin therapy. Descriptive statistics, step-wise logistic regression, and repeated measures ANOVA were used to analyze the data. A total of 284 patients were included, for a total of 391 courses of vancomycin (272 children and 119 infants). The mean duration of vancomycin therapy was 6.9 ± 4.5 days. Forty nine (17.2%) patients developed AKI during 61 (15.6%) courses. Elevated Scr concentrations returned to baseline after stopping vancomycin in 53 (87%) courses. Mortality was higher in children who developed AKI (p<0.001; Fisher's exact test). Administration of nephrotoxic drugs (odds ratio 2.23, Confidence Interval 1.27-3.93) and presence of high blood urea nitrogen (BUN):Scr ratio before vancomycin therapy (p<0.05) were associated with AKI. The BUN and Scr concentrations significantly increased during vancomycin therapy and decreased after vancomycin was discontinued (p<0.05).ConclusionsIn critically ill children, the development of reversible AKI during vancomycin therapy is associated with administration of nephrotoxic drugs and an elevated BUN: Scr ratio.© 2013 Pharmacotherapy Publications, Inc.

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