1. A propensity-matched cohort study of vancomycin-associated nephrotoxicity in neonates.
- Author
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Constance JE, Balch AH, Stockmann C, Linakis MW, Korgenski EK, Roberts JK, Ward RM, Sherwin CM, and Spigarelli MG
- Subjects
- Acute Kidney Injury epidemiology, Anti-Inflammatory Agents, Non-Steroidal administration & dosage, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Bacteremia epidemiology, Cohort Studies, Creatinine blood, Drug Therapy, Combination, Ductus Arteriosus, Patent epidemiology, Female, Gentamicins administration & dosage, Humans, Infant, Low Birth Weight, Infant, Newborn, Male, Propensity Score, Retrospective Studies, Risk Factors, Severity of Illness Index, United States epidemiology, Acute Kidney Injury chemically induced, Anti-Bacterial Agents adverse effects, Vancomycin adverse effects
- Abstract
Background: The incidence of nephrotoxicity among vancomycin-treated neonates has been reported to range from 2% to 20%. These widely varying estimates have led to confusion and controversy regarding the safety of vancomycin among neonates., Objective: Evaluate the incidence of nephrotoxicity among neonates receiving vancomycin concomitantly with gentamicin., Design: Retrospective observational cohort study using propensity score matching to provide covariate balance between neonates who did or did not receive vancomycin based on factors known to be related to the development of renal dysfunction., Setting: Hospitals (n=22) throughout the Intermountain West, including a quaternary care children's hospital., Patients: Neonates ≤44 postmenstrual weeks (median gestational age: 31 (IQR 28-36) weeks) receiving intravenous gentamicin with or without exposure to vancomycin from January 2006 to December 2012., Main Outcome Measures: Nephrotoxicity based on the modified Acute Kidney Injury Network criteria for acute kidney injury (AKI) or serum creatinine concentration ≥1.5 mg/dL persisting for ≥48 h., Results: The final cohort was comprised of 1066 neonates (533 receiving vancomycin and gentamicin vs 533 receiving gentamicin). In a propensity score-matched cohort that was well balanced across 16 covariates, AKI was not associated with vancomycin use (16 neonates receiving vancomycin vs 7 controls experienced AKI; OR 1.5; 95% CI 0.6 to 4.0). However, the presence of a patent ductus arteriosus, concomitant non-steroidal anti-inflammatory drug use, ≥1 positive blood cultures, low birth weight and higher severity of illness and risk of mortality scores were associated with an increased risk of nephrotoxicity., Conclusions: These results corroborate several earlier reports and much anecdotal evidence describing the infrequent occurrence of nephrotoxicity in neonates receiving concomitant vancomycin and gentamicin., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
- Published
- 2016
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