Outcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older

Yunchao Wang,1 Ning Dai,1 Wei Wei,2 Chunyan Jiang1 1Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Clinical Epidemiology and EBM, Beijing Friendship Hospital, Capital Medical Unive...

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Autores principales:	Wang Y, Dai N, Wei W, Jiang C
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	elderly vancomycin trough concentration outcome nephrotoxicity Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/de13b13e29a04294a959b9cb66207eb6
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spelling	oai:doaj.org-article:de13b13e29a04294a959b9cb66207eb62021-12-02T15:50:41ZOutcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older1178-1998https://doaj.org/article/de13b13e29a04294a959b9cb66207eb62021-06-01T00:00:00Zhttps://www.dovepress.com/outcomes-and-nephrotoxicity-associated-with-vancomycin-treatment-in-pa-peer-reviewed-fulltext-article-CIAhttps://doaj.org/toc/1178-1998Yunchao Wang,1 Ning Dai,1 Wei Wei,2 Chunyan Jiang1 1Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Clinical Epidemiology and EBM, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Chunyan JiangDepartment of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, Beijing, 100050, People’s Republic of ChinaTel + 86 10 63137648Fax + 86 10 63138795Email chunyan_jiang@ccmu.edu.cnPurpose: This retrospective observational study investigated the efficacy and safety of vancomycin to treat patients aged 80 years and older. In particular, the associations between vancomycin trough concentration (VTC) and treatment outcomes or nephrotoxicity were explored.Patients and Methods: Patients aged ≥ 80 years had received ≥ 3 vancomycin treatments and ≥ 1 detection of VTC. Treatment outcomes were defined as success or failure. Nephrotoxicity was considered an increase in serum creatinine ≥ 44.2 mmol/L, or 50% above baseline, for ≥ 2 consecutive days. Univariate and multivariate analyses were performed to identify risk factors for treatment failure and nephrotoxicity.Results: Of 349 patients, 120 (34.4%) experienced treatment failure. For patients with VTCs at < 10, 10– 15, 15– 20, and ≥ 20 μg/mL, the clinical response rates were, respectively, 77.8, 77.0, 80.5, and 61.0%; the 30-day mortality rates were 2.8, 15.0, 15.3, and 37.8%; and the rates of persistent bacteremia were 16.7, 12.4, 11.9, and 11.0%. The multivariate analysis indicated that blood urea nitrogen ≥ 11 g/dL and heart failure were independently associated with treatment failure; but not VTC (P = 0.004, 0.016, 0.828, respectively). During vancomycin treatment, 42 (12.0%) patients experienced nephrotoxicity with recovery time 7.5 ± 4.5 days. Fewer than half of patients with nephrotoxicity recovered after suspending vancomycin application. The variables found independently associated with increased nephrotoxicity were: VTC ≥ 15 μg/mL; treatment duration ≥ 15 d; and concomitant aminoglycosides administration (P = 0.024, 0.035, 0.029).Conclusion: In patients aged 80 years and older, elevated VTC level was not associated with favorable treatment outcomes. Patients with VTC ≥ 20 μg/mL appear to suggest a worsened prognosis compared with lower VTCs. The risk of nephrotoxicity increases with elevated VTC, longer treatment time, and concomitant aminoglycoside administration.Keywords: elderly, vancomycin trough concentration, outcome, nephrotoxicityWang YDai NWei WJiang CDove Medical Pressarticleelderlyvancomycin trough concentrationoutcomenephrotoxicityGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 16, Pp 1023-1035 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	elderly vancomycin trough concentration outcome nephrotoxicity Geriatrics RC952-954.6
spellingShingle	elderly vancomycin trough concentration outcome nephrotoxicity Geriatrics RC952-954.6 Wang Y Dai N Wei W Jiang C Outcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older
description	Yunchao Wang,1 Ning Dai,1 Wei Wei,2 Chunyan Jiang1 1Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Clinical Epidemiology and EBM, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Chunyan JiangDepartment of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, Beijing, 100050, People’s Republic of ChinaTel + 86 10 63137648Fax + 86 10 63138795Email chunyan_jiang@ccmu.edu.cnPurpose: This retrospective observational study investigated the efficacy and safety of vancomycin to treat patients aged 80 years and older. In particular, the associations between vancomycin trough concentration (VTC) and treatment outcomes or nephrotoxicity were explored.Patients and Methods: Patients aged ≥ 80 years had received ≥ 3 vancomycin treatments and ≥ 1 detection of VTC. Treatment outcomes were defined as success or failure. Nephrotoxicity was considered an increase in serum creatinine ≥ 44.2 mmol/L, or 50% above baseline, for ≥ 2 consecutive days. Univariate and multivariate analyses were performed to identify risk factors for treatment failure and nephrotoxicity.Results: Of 349 patients, 120 (34.4%) experienced treatment failure. For patients with VTCs at < 10, 10– 15, 15– 20, and ≥ 20 μg/mL, the clinical response rates were, respectively, 77.8, 77.0, 80.5, and 61.0%; the 30-day mortality rates were 2.8, 15.0, 15.3, and 37.8%; and the rates of persistent bacteremia were 16.7, 12.4, 11.9, and 11.0%. The multivariate analysis indicated that blood urea nitrogen ≥ 11 g/dL and heart failure were independently associated with treatment failure; but not VTC (P = 0.004, 0.016, 0.828, respectively). During vancomycin treatment, 42 (12.0%) patients experienced nephrotoxicity with recovery time 7.5 ± 4.5 days. Fewer than half of patients with nephrotoxicity recovered after suspending vancomycin application. The variables found independently associated with increased nephrotoxicity were: VTC ≥ 15 μg/mL; treatment duration ≥ 15 d; and concomitant aminoglycosides administration (P = 0.024, 0.035, 0.029).Conclusion: In patients aged 80 years and older, elevated VTC level was not associated with favorable treatment outcomes. Patients with VTC ≥ 20 μg/mL appear to suggest a worsened prognosis compared with lower VTCs. The risk of nephrotoxicity increases with elevated VTC, longer treatment time, and concomitant aminoglycoside administration.Keywords: elderly, vancomycin trough concentration, outcome, nephrotoxicity
format	article
author	Wang Y Dai N Wei W Jiang C
author_facet	Wang Y Dai N Wei W Jiang C
author_sort	Wang Y
title	Outcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older
title_short	Outcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older
title_full	Outcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older
title_fullStr	Outcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older
title_full_unstemmed	Outcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older
title_sort	outcomes and nephrotoxicity associated with vancomycin treatment in patients 80 years and older
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/de13b13e29a04294a959b9cb66207eb6
work_keys_str_mv	AT wangy outcomesandnephrotoxicityassociatedwithvancomycintreatmentinpatients80yearsandolder AT dain outcomesandnephrotoxicityassociatedwithvancomycintreatmentinpatients80yearsandolder AT weiw outcomesandnephrotoxicityassociatedwithvancomycintreatmentinpatients80yearsandolder AT jiangc outcomesandnephrotoxicityassociatedwithvancomycintreatmentinpatients80yearsandolder
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Outcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older

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