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We present a case of vancomycin nephrotoxicity with simultaneous histological lesions of ATIN and ATN confirmed by renal biopsy, originated by vancomycin intoxication related to the highest plasma trough levels described in literature.
- Elevated Vancomycin Trough Concentration: Increased Efficacy and/or ...
Several risk factors have been identified for VIN, which...
- Elevated vancomycin trough levels in a tertiary health system ...
We found that elevated vancomycin levels were common, and...
- Elevated Vancomycin Trough Concentration: Increased Efficacy and/or ...
In adults with normal renal function, the half-life of vancomycin is 6 to 12 hours. 2 If steady state occurs within five half-lives (that is, in 30 to 60 hours), a vancomycin trough before the fourth dose is acceptable in a patient receiving every 8- or 12-hour dosing.
The 2020 vancomycin therapeutic guidelines recommends a move away from monitoring vancomycin trough levels to targeting an AUC 24:MIC (24-hour area under the curve (AUC) to minimum inhibitory concentration ratio). Dosing vancomycin using trough-only monitoring is no longer recommended.
Several risk factors have been identified for VIN, which high trough vancomycin level (especially >20 mg/L) or doses (>4 g/day), concomitant use of nephrotoxic agents, prolonged therapy (more than 7 days), and admission to an intensive care unit (especially prolonged stay) are the most common ones (1-4, 14).
We found that elevated vancomycin levels were common, and occurred more frequently when vancomycin was given for more than 7 days, when BMI was high, and when eGFR was low. Further, elevated levels of vancomycin were associated with higher risk of AKI and longer hospital stays.
Among the full matched cohort, a trough level of vancomycin higher than 30 mg/L was associated with longer hospital length of stay (relative risk, 1.14; 95% CI, 1.02-1.28; P=.03) but not higher risk of mortality (hazard ratio, 1.18; 95% CI, 0.88-1.58).
In this cohort study of 7422 hospitalized adults who received vancomycin with a trough concentration at least 8 hours after the previous dose, a significant association was found between trough levels greater than 30 mg/L and acute kidney injury (AKI) (P =.02). 4 These findings build on previous work attempting to link vancomycin trough concentr...
