Analysis of occurrence and risk factors of vancomycin-associated acute kidney injury in patients in the pediatric intensive care unit
10.3760/cma.j.issn.1008-5734.2018.02.002
- VernacularTitle:儿科重症患者万古霉素相关急性肾损伤发生状况及危险因素分析
- Author:
Xiaoju SHEN
1
;
Jiawei ZENG
1
;
Haiyan WU
1
;
Jie CHEN
1
;
Xiao CHEN
1
Author Information
1. 中山大学附属第一医院药学部,广州,510080
- Publication Type:Journal Article
- Keywords:
Vancomycin;
Intensive care units,pediatric;
Acute kidney injury;
Risk factors
- From:
Adverse Drug Reactions Journal
2018;20(2):83-90
- CountryChina
- Language:Chinese
-
Abstract:
Objective To understand the occurrence of vancomycin-associated acute kidney injury (AKI)in patients in the pediatric intensive care unit(PICU)and explore the risk factors. Methods Medical records data of children in the PICU receiving vancomycin treatment,treatment course>48 h,and having vancomycin trough concentration monitoring data in the First Affiliated Hospital of Sun Yat-sen University from January 2013 to July 2017 were collected from the hospital information system and retrospectively analyzed. Occurrence of AKI was judged based on Pediatric-Modified RIFLE(pRIFLE) criteria. The children were divided into the AKI group and non-AKI group. The risk factors of vancomycin-associated AKI were analyzed using the multivariable logistic regression model. Results A total of 170 patients were entered in this study. Of them,104 patients were male and 66 were female with ages from 5 days to 15.4 years and the median age was 1.3 years. Thirty-six patients(21.05%)developed AKI, including 31 patients(18.24%)with risk of kidney injury,4 patients(2.35%)with kidney injury,and 1 patient(0.59%)with kidney failure,no patient with kidney loss and end-stage kidney disease. The results of multivariate logistic regression analysis showed that the elevated estimated creatinine clearance (OR=1.010,P<0.001),more than 5 kinds of concomitant nephrotoxic drugs(OR=2.808,P=0.019), average vancomycin trough level ≥17 mg/L(OR =10.426,P <0.001),combined with carbapenems antibacterial drugs(OR=4.263,P=0.013),and combined with voriconazole injection(OR=3.165,P=0.038)were all the independent risk factors of AKI occurrence. Conclusions The incidence of vancomycin-associated AKI was 21.18% in PICU patients in our hospital. Vancomycin trough level ≥17 mg/L and more than 5 kinds of concomitant nephrotoxic drugs would increase risk of AKI in PICU patients.
