Relationships between creatinine increase and mortality rates in patients given vancomycin in 76 hospitals: The increasing role of infectious disease pharmacists

• Main Authors: Tabak, Y.P (Author), Vankeepuram, L. (Author), Yamaga, C. (Author), Yu, K.C (Author)
• Format: Article
• Language: English
• Published: Oxford University Press 2021
• Subjects: adult; Adult; Article; cohort analysis; communicable disease; Communicable Diseases; comorbidity; controlled study; creatinine; Creatinine; creatinine blood level; female; hospital; hospital patient; Hospitals; human; human tissue; Humans; infectious disease pharmacist; in-hospital mortality; kidney function; major clinical study; male; middle aged; mortality; mortality rate; mortality risk; pharmacist; Pharmacists; physiological stress; renal function; Retrospective Studies; retrospective study; risk assessment; stewardship; treatment duration; vancomycin; Vancomycin
• Online Access: View Fulltext in Publisher
• ISBN: 10792082 (ISSN)
• DOI: 10.1093/ajhp/zxab247

Purpose: Vancomycin is a commonly used antimicrobial with the potential for renal toxicity. We evaluated vancomycin duration, changes in renal function after vancomycin initiation ("post-vancomycin"renal function changes), and associated mortality risk among hospitalized patients. Methods: We analyzed data from 76 hospitals and excluded patients with a baseline serum creatinine concentration (SCr) of >3.35 mg/dL. We estimated mortality risk relative to vancomycin duration and the magnitude of post-vancomycin SCr change, controlling for demographics, baseline SCr, underlying diseases, clinical acuity, and comorbidities. Results: Among 128,993 adult inpatients treated with vancomycin, 49.0% did not experience SCr elevation. Among the remaining patients, 26.0%, 11.4%, 8.8% and 4.8% experienced increases in post-vancomycin SCr of 1% to 20%, 21% to 40%, 41% to 100%, and greater than 100%, respectively. Compared to mortality risk among patients with a vancomycin therapy duration between 4 and 5 days (the lowest-mortality group), longer vancomycin therapy duration was not independently associated with higher mortality risk after adjusting for confounders. In contrast, there was a graded relationship between post-vancomycin SCr elevation and mortality. Multivariable adjusted mortality odds ratios ranged from 1.60 to 13.66, corresponding to SCr increases of 10% and greater than 200%, respectively. Conclusion: Half of patients given vancomycin did not experience SCr elevation and had the lowest mortality, suggesting that vancomycin can be used safely if renal function is stabilized. In the large study cohort, vancomycin duration itself was not an independent predictor of mortality. Post-vancomycin SCr elevation appeared to be a driver of in-hospital mortality. Even a 10% post-vancomycin SCr increase was associated with an increased mortality risk. This finding stresses the importance of closely monitoring renal function and may support the value of pharmacokinetic dosing. © 2021 American Society of Health-System Pharmacists 2021.