ASSOCIATION OF SERUM VANCOMYCIN CONCENTRATION WITH RENAL DYSFUNCTION
Paula J Westrum, Ji M Koo, and Paul J Carson

OBJECTIVE: To evaluate the association of vancomycin-related renal dysfunction with age; serum vancomycin trough concentration; baseline serum creatinine concentration; duration of vancomycin treatment; comorbid medical conditions of congestive heart failure, chronic renal failure, diabetes mellitus, and hepatic cirrhosis; and the concurrent use of drugs that can cause impairment of renal function.

DESIGN: A retrospective analysis of medical records of hospitalized patients who received intravenous vancomycin was conducted.

SETTING: This study was conducted in a 125-bed, tertiary care, government teaching hospital.

METHODS: Data were collected on 122 men, ranging in age from 41 to 95 years, who received vancomycin during a five-year period starting in 1991. Vancomycin-related renal dysfunction, defined as an increase of >0.5 mg/dL in serum creatinine concentration from the baseline value, was examined for an association with age; baseline serum creatinine concentration; duration of vancomycin treatment; serum vancomycin trough concentrations >15 µg/mL; and comorbid conditions of congestive heart failure, chronic renal failure, diabetes mellitus, and hepatic cirrhosis. The concurrent use of aminoglycosides, amphotericin B, diuretics, angiotensin-converting enzyme (ACE) inhibitors, cimetidine, and intravenously administered contrast medium was also analyzed.

RESULTS: Stepwise logistic regression and odds ratio analyses failed to identify an association between vancomycin-related renal dysfunction and any factor examined except concurrent use of diuretics and ACE inhibitors.

CONCLUSIONS: Patients receiving intravenous vancomycin concurrently with diuretics or ACE inhibitors have a higher risk of renal impairment. No incident of renal dysfunction was attributed to vancomycin alone.

J Pharm Technol 1999;15:130-4.