Choi Yookyung Christy, Saw Stephen, Soliman Daniel, Bingham Angela L, Pontiggia Laura, Hunter Krystal, Chuang Linda, Siemianowski Laura A, Ereshefsky Benjamin, Hollands James M
1 University of the Sciences, Philadelphia, PA, USA.
2 University of Minnesota, Minneapolis, MN, USA.
Ann Pharmacother. 2017 Nov;51(11):937-944. doi: 10.1177/1060028017720946. Epub 2017 Jul 14.
A consensus statement recommends initial intravenous (IV) vancomycin dosing of 15-20 mg/kg every 8- 24 hours, with an optional 25- to 30-mg/kg loading dose. Although some studies have shown an association between weight and the development of vancomycin-associated nephrotoxicity, results have been inconsistent.
To evaluate the correlation between incidence of nephrotoxicity associated with weight-based IV vancomycin dosing strategies in nonobese and obese patients.
This retrospective cohort study evaluated hospitalized adult patients admitted who received IV vancomycin. Patients were stratified into nonobese (body mass index [BMI] <25 kg/m), obesity class I and II (BMI 30-39.9kg/m), and obesity class III (BMI≥40 kg/m) groups; patients who were overweight but not obese were excluded. Incidence of nephrotoxicity and serum vancomycin trough concentrations were evaluated.
Of a total of 62 documented cases of nephrotoxicity (15.1%), 13 (8.7%), 23 (14.3%), and 26 (26.3%) cases were observed in nonobese, obesity class I and II, and obesity class III groups, respectively ( P=0.002). Longer durations of therapy ( P<0.0001), higher initial maintenance doses in both total milligrams/day ( P=0.0137) and milligrams/kilogram ( P=0.0307), and any trough level >20 mg/L ( P<0.0001) were identified as predictors of development of nephrotoxicity. Concomitant administration of piperacillin/tazobactam, diuretics, and IV contrast were associated with development of nephrotoxicity ( P<0.005, all). Patients with class III obesity were 3-times as likely to develop nephrotoxicity when compared with nonobese patients (odds ratio [OR]=2.99; CI=1.12-7.94) and obesity class I and II patients (OR=3.14; CI=1.27-7.75).
Obesity and other factors are associated with a higher risk of vancomycin-associated nephrotoxicity.
一份共识声明建议初始静脉注射万古霉素的剂量为每8 - 24小时15 - 20mg/kg，可选择25 - 30mg/kg的负荷剂量。尽管一些研究表明体重与万古霉素相关肾毒性的发生之间存在关联，但结果并不一致。
评估非肥胖和肥胖患者中基于体重的静脉注射万古霉素给药策略与肾毒性发生率之间的相关性。
这项回顾性队列研究评估了接受静脉注射万古霉素的住院成年患者。患者被分为非肥胖组（体重指数[BMI]<25kg/m²）、I级和II级肥胖组（BMI 30 - 39.9kg/m²）以及III级肥胖组（BMI≥40kg/m²）；超重但不肥胖的患者被排除。评估肾毒性的发生率和血清万古霉素谷浓度。
在总共62例记录在案的肾毒性病例（15.1%）中，非肥胖组、I级和II级肥胖组以及III级肥胖组分别观察到13例（8.7%）、23例（14.3%）和26例（26.3%）（P = 0.002）。治疗时间更长（P < 0.0001）、初始维持剂量在每日总毫克数（P = 0.0137）和毫克/千克（P = 0.0307）方面更高，以及任何谷浓度>20mg/L（P < 0.0001）被确定为肾毒性发生的预测因素。同时使用哌拉西林/他唑巴坦、利尿剂和静脉造影剂与肾毒性的发生相关（P < 0.005，均如此）。与非肥胖患者相比，III级肥胖患者发生肾毒性的可能性是其3倍（比值比[OR]=2.99；可信区间[CI]=1.12 - 7.94），与I级和II级肥胖患者相比也是如此（OR = 3.14；CI = 1.27 - 7.75）。
肥胖和其他因素与万古霉素相关肾毒性的较高风险相关。
