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Background and Objective: Vancomycin is a broad-spectrum antimicrobial used intravenously for the treatment of Gram-positive pathogens, including Methicillin-resistant Staphylococcus aureus (MRSA) infection. Nephrotoxicity is a commonly feared and largely preventable adverse effect of vancomycin therapy. This study aimed to determine the effect of using estimated glomerular filtration rate (eGFR) as a Trigger tool to prevent vancomycin induced nephrotoxicity and to explore potential confounding factors that may increase the risk of nephrotoxicity in patients receiving vancomycin.
Methods: This study was a retrospective study. Data were compared before and after the trial of the eGFR trigger tool system in patients receiving intravenous vancomycin for at least 48 hours in the Central Chest Institute of Thailand with a period of 1 year, during October, 2017 to September, 2019 were included. Patients will be monitored until the drug is discontinued. The incidence of nephrotoxicity, defined as a decrease in eGFR by ≥25%, and/or an increase in serum creatinine (SCr) of 1.5-fold from its baseline value.
Results: The 336 hospitalized adults treated with intravenous vancomycin at least 48 hours in hospital during October, 2017 to September, 2019 were included. There were 157 patients in before using the eGFR trigger tool group and 179 patients in after using the eGFR trigger tool group. The present study found that the incidence of acute kidney injury before and after using a eGFR trigger tool were 34.4% and 19%, respectively (p = 0.002). Elderly patients (>70 yrs.), prolonged therapy of vancomycin (>14 days), concomitant treatment with nephrotoxic agents (gentamicin and colistin) and was also associated with an increased risk of nephrotoxicity (p = 0.012, p = 0.043, p = 0.044 and p = 0.048, respectively).
Conclusions: After initiation of the eGFR trigger tool, patients treated with vancomycin had a significantly lower incidence of acute renal failure than before using the eGFR trigger tool. Factors associated with vancomycin induced nephrotoxicity included patients older than 70 years, patients treated for more than 14 days, and concomitant exposure to other nephrotoxic drugs.
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