• Wan-Chen Shen, Yi-Chun Chiang, Hsiang-Yin Chen, Tso-Hsiao Chen, Fang-Lan Yu, Chao-Hsiun Tang, and Yuh-Mou Sue.
• Department of Pharmacy, Wan Fang Hospital College of Pharmacy School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.
• Nephrology (Carlton). 2011 Nov 1;16(8):697-703.

AimVancomycin and teicoplanin are the two most used glycopeptides for the treatment of methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is suspected to have more nephrotoxicity but this has not been clearly established. The aim of this study was to assess its nephrotoxicity by a consensus definition of acute kidney injury (AKI): the risk (R), injury (I), failure (F), loss and end-stage renal disease (RIFLE) classification.MethodsPatients with MRSA bacteraemia who were prescribed either vancomycin or teicoplanin between 2003 and 2008 were classified. Patients who developed AKI were classified by RIFLE criteria. Variables such as comorbidities, laboratory data and medical cost information were also obtained from the database. Outcomes determined were: (i) the rate of nephrotoxicity and mortality; and (ii) the association of nephrotoxicity with the length of hospital stay and costs.ResultsThe study included 190 patients (vancomycin 33, teicoplanin 157). Fifteen patients on vancomycin and 27 patients on teicoplanin developed AKI (P = 0.0004). In the vancomycin group, four, eight and three patients were classified to RIFLE criteria R, I and F, respectively. In the teicoplanin group, 17, nine and one patient were classified to RIFLE criteria R, I and F, respectively. Kaplan-Meier analysis showed significant difference in time to nephrotoxicity for the vancomycin group compared to the teicoplanin group. No significant differences were found between the groups in terms of total mortality, length of hospital stay and costs.ConclusionThe study data suggest that vancomycin is associated with a higher likelihood of nephrotoxicity using the RIFLE classification.© 2011 The Authors. Nephrology © 2011 Asian Pacific Society of Nephrology.

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