• Calvin J Meaney, Lauren M Hynicka, and Mona G Tsoukleris.
• School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, New York.
• Pharmacotherapy. 2014 Jul 1;34(7):653-61.

ObjectiveThe prevalence of vancomycin-associated nephrotoxicity (VAN) is reported to vary from 1.0-42.6%, with most data from critically ill patients. Evaluation of VAN among internal medicine patients is lacking. Our objectives were to determine the incidence, time-course, outcomes, and risk factors of VAN in adult internal medicine patients.DesignRetrospective cohort.SettingTertiary care academic medical center.PatientsA total of 125 adult internal medicine patients receiving vancomycin treatment with mean baseline creatinine clearance of 84.6 ± 27.6 ml/min.InterventionVancomycin treatment for a minimum of 72 hours.Measurements And Main ResultsNephrotoxicity, defined as an increase in serum creatinine of 0.5 mg/dl or 50% above baseline (whichever was larger), occurred in 17 (13.6%) of 125 patients. No patients with VAN progressed to Loss or End stage as defined by the RIFLE criteria. The incidence rate of VAN was 0.02 cases/day of vancomycin treatment. Nephrotoxicity developed at a median of 4.5 days (interquartile range [IQR] 2.2-4.9) peaked at 5.7 days (IQR: 3.8-9.6), and resolved in 70.6% of the cases within 16.5 days (IQR: 6.0-17.8) after onset. On multivariable logistic regression analysis, after controlling for hypotensive episodes, Charlson Comorbidity Index, and baseline creatinine clearance, concomitant use of piperacillin-tazobactam was associated with increased VAN (adjusted odds ratio 5.36, 95% confidence interval 1.41-20.5).ConclusionsVancomycin-associated nephrotoxicity is prevalent among internal medicine patients, with 5.36-fold higher odds if piperacillin-tazobactam is concomitantly administered.© 2014 Pharmacotherapy Publications, Inc.

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