医学
内科学
急性肾损伤
回顾性队列研究
入射(几何)
万古霉素
胃肠病学
队列
逻辑回归
金黄色葡萄球菌
细菌
光学
遗传学
物理
生物
作者
Kassem Hammoud,Michael Brimacombe,Alan S.L. Yu,Neil Goodloe,Wael N. Haidar,Wissam El Atrouni
出处
期刊:American Journal of Nephrology
[S. Karger AG]
日期:2016-01-01
卷期号:44 (6): 456-461
被引量:16
摘要
<b><i>Background:</i></b> The association between vancomycin trough (VT) and acute kidney injury (AKI) at the recommended doses remains controversial. <b><i>Methods:</i></b> The authors conducted a retrospective, observational cohort study of 500 adult patients who received vancomycin for ≥72 h. Data collected included 2 main predictors: average VT (including only VTs before the occurrence of AKI), first VT and other possible risk factors for AKI. The baseline characteristics/variables between patients with AKI and patients with no AKI were compared. Logistic regression models were used to develop multivariate models. The authors divided the patients into 4 subgroups: (1) VT <10, (2) 10 ≤ VT < 15, (3) 15 ≤ VT < 20 and (4) VT ≥20 µg/ml. All subgroups were compared to subgroup 2 (reference group). <b><i>Results:</i></b> AKI occurred in 12.85% of patients while on vancomycin. The incidence of AKI in subgroups 1-4 was 8.02, 13.61, 13.70 and 31.82%, respectively, using the first VT, that is significantly higher in subgroup 4. Using average VT, AKI incidence was 5, 10.38, 19.01 and 25.58%, respectively, that is significantly higher in subgroups 3 and 4. On multivariate logistic regression, average VT, first VT, average VT >15, first VT >15, methicillin-resistant <i>Staphylococcus aureus</i> infection and morbid obesity were significantly associated with increased incidence of AKI. <b><i>Conclusion:</i></b> Clinicians should be careful when aiming for a VT >15 μg/ml as this is associated with increased incidence of AKI.
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