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Pharmacy 2014, 2(4), 276-286; doi:10.3390/pharmacy2040276

Antimicrobial Renal Injury in a Pediatric Intensive Care Unit: β-Lactams vs. Vancomycin

1
St. Christopher's Hospital for Children, 160 East Erie Avenue, Philadelphia, PA 19134, USA
2
Drexel University College of Medicine, Philadelphia, PA 19129, USA
3
Alfred I duPont Hospital for Children, Wilmington, DE 19803, USA
4
Children's National Medical Center, Washington, DC 20010, USA
5
NYU Langone Medical Center, New York, NY 10016, USA
6
NYU School of Medicine, New York, NY 10016, USA
*
Author to whom correspondence should be addressed.
Received: 9 September 2014 / Revised: 3 November 2014 / Accepted: 14 November 2014 / Published: 28 November 2014
(This article belongs to the Special Issue Pharmacy Paediatrics)
View Full-Text   |   Download PDF [217 KB, uploaded 28 November 2014]

Abstract

Vancomycin trough (Vt) concentrations of 15–20 mcg/mL have been associated with an increased rate of renal injury in adults. Current data in pediatrics suggests Vts of 15–20 mcg/mL do not increase the risk of renal injury in children admitted to a pediatric intensive care unit (PICU). The primary objective was to determine if a difference exists in the incidence of renal injury in PICU patients receiving a β-lactam as compared with vancomycin therapy with Vts of 15–20 mcg/mL. This was a retrospective cohort study conducted within a PICU within a freestanding tertiary care pediatric hospital. The records of children admitted to the PICU between 10/2008–6/2009 who received vancomycin for ≥48 h targeting higher Vt concentrations of ≥15 mcg/mL for pneumonia, bacteremia, and meningitis were reviewed. This cohort (V group) was compared to children admitted from July 2009–July 2013 who received cefepime or piperacillin/tazobactam for ≥72 h (B group). Serum creatinine values were collected from 48 h before until 48 h after discontinuation of therapy for calculation of estimated glomerular filtration rate. Renal injury was categorized according to pRIFLE. 57 and 112 patients were included in the V and B groups, respectively. The mean (SD) therapeutic dose of vancomycin was 63.5(17.3) mg/kg/day and the mean (SD) trough was 17.8(3.1). The mean (SD) dose of cefepime was 51(26) mg/kg/dose with an every 8 h interval. The mean (SD) dose of piperacillin/tazobactam was 77(22) mg/kg/dose with an every 6 h interval. The mean (SD) PRISM scores were 10.9(10.2), 4.24(6.4) for the V and B groups, respectively (p < 0.001). Five of 57 and 10 of 112 patients in the V and B groups, respectively, were classified as having injury according to pRIFLE. No patient was classified as having a degree of renal injury greater than the pRIFLE injury. The incidence of renal injury was 8.8% in the V group and 8.9% in the B group, respectively (p = 1). Our observations suggest that maintaining Vt concentrations ≥15 mcg/mL is not associated with an increased rate of renal injury as compared with β-lactam monotherapy in a PICU population. View Full-Text
Keywords: renal injury; vancomycin; pediatric; β-lactam; pRIFLE renal injury; vancomycin; pediatric; β-lactam; pRIFLE
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Cies, J.J.; II, W.S.M.; Shankar, V.; Chopra, A. Antimicrobial Renal Injury in a Pediatric Intensive Care Unit: β-Lactams vs. Vancomycin. Pharmacy 2014, 2, 276-286.

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