Table 1.
Characteristics of patients who developed Acute Kidney Injury to determine Vancomycin Therapeutic Drug Monitoring Program (TDM) safety compared to the historical control (CTRL)
| TDM (n = 173) | CTRL (n = 167) | P-value | |
|---|---|---|---|
| Patients with acute kidney injury, n (%) | 23 (13.3) | 20 (12) | 0.715 |
| Male, n (%) | 15 (65) | 16 (80) | 0.32 |
| Age, median (IQR) | 65 (48,75) | 66 (50,76) | 0.11 |
| Weight (kg), median (IQR) | 84 (74,114) | 85 (74,112) | 0.26 |
| Co-morbidity Score, median (IQR) | 8 (4,9) | 6 (3,10) | 0.29 |
| Co-morbidities | |||
| Chronic kidney disease (Stage III and IV), n (%) | 8 (34.8) | 5 (25) | 0.52 |
| Central nervous system, n (%) | 7 (30.4) | 9 (45) | 0.36 |
| Cardiovascular, n (%) | 18 (78) | 18 (90) | 0.42 |
| Pulmonary, n (%) | 8 (35) | 6 (30) | 1.0 |
| Diabetes, n (%) | 11 (48) | 6 (30) | 0.35 |
| Gastrointestinal, n (%) | 8 (35) | 4 (20) | 0.33 |
| Malignancy, n (%) | 8 (35) | 8 (40) | 0.76 |
| Rheumatologic, n (%) | 5 (22) | 3 (15) | 0.7 |
| Immunosuppression, n (%) | 3 (13) | 2 (10) | 1.0 |
| Site of infection | |||
| Respiratory, n (%) | 12 (52) | 13 (65) | 0.54 |
| Bacteremia, n (%) | 14 (61) | 12 (60) | 1.0 |
| Urinary Tract, n (%) | 2 (9) | 4 (20) | 0.39 |
| Skin and Soft Tissue, n (%) | 0 | 2 (10) | 0.21 |
| Bone/Joint, n (%) | 1 (4) | 3 (15) | 0.32 |
| Central Nervous System, n (%) | 0 | 0 | |
| Intra-abdominal, n (%) | 1 (4) | 0 | 1.0 |
| Sepsis/septic shock, n (%) | 12 (52) | 14 (70) | 0.35 |
| Culture result | |||
| MRSA, n (%) | 10 (43) | 4 (20) | 0.12 |
| MSSA, n (%) | 1 (4) | 2 (10) | 1.0 |
| Coagulase Negative Staphylococci, n (%) | 5 (22) | 4 (25) | 1.0 |
| S. pyogenes, n (%) | 0 | 1 (5) | 1.0 |
| E. faecalis, n (%) | 4 (17) | 3 (15) | 1.0 |
| Other gram positives, n (%) | 4 (17) | 5 (25) | 1.0 |
| Gram negatives, n (%) | 9 (39) | 11(55) | 0.37 |
| Cultures negative, n (%) | 2 (9) | 4 (20) | 0.39 |
| MRSA MIC (mg/L) | |||
| 2, n (%) | 0 | 0 | |
| Site of admission | |||
| ICU, n (%) | 16 (70) | 15 (75) | 0.74 |
| Medical Floor, n (%) | 3 (13) | 5 (25) | 0.45 |
| Surgical Floor, n (%) | 4 (17) | 0 | 0.11 |
| Concurrent antibiotics | |||
| β-Lactam, n (%) | 22 (96) | 18 (90) | 0.59 |
| Piperacillin/tazobactam, n (%) | 17 (74) | 11(55) | 0.22 |
| Cefepime, n (%) | 2 (9) | 6 (30) | 0.12 |
| Carbapenem, n (%) | 1 (4.3) | 1 (5) | 1.0 |
| Other, n (%) | 2 (9) | 0 | 0.49 |
| Fluoroquinolone, n (%) | 13 (57) | 9 (45) | 0.55 |
| Aminoglycoside, n (%) | 1 (4.3) | 2 (10) | 0.590 |
| Patients with initial VAN trough >20 mg/L, n (%)* | 6 (25) | 7 (27) | 0.74 |
| Trough value, median (IQR) | 22 (21,23) | 31 (25,51) | 0.05 |
| RIFLE criteria | |||
| Risk, n (%) | 7 (30.4) | 3 (15) | 0.294 |
| Injury, n (%) | 6 (26.1) | 8 (40) | 0.515 |
| Failure, n (%) | 8 (34.8) | 8 (40) | 0.761 |
| Loss, n (%) | 2 (8.7) | 1 (5) | 1.00 |
| ESRD, n (%) | 0 | 0 | |
| Clinician identified etiology of AKI | |||
| VAN implicated, n (%) | 2 (8.7) | 4 (19) | 0.32 |
| Etiology identified as multifactorial, n (%)* | 1 (50) | 2 (50) | 1.0 |
| VAN as the only cause, n (%)* | 1 (50) | 2 (50) | 1.0 |
| Acute interstitial nephritis from other antimicrobial, n (%) | 6 (26) | 2 (10) | 0.250 |
| Acute tubular necrosis, n (%) | 14 (60.9) | 14 (70) | 0.75 |
| Contrast nephropathy, n (%) | 1 (4.3) | 1 (5) | 1.00 |
| Other, n (%) | 3 (13) | 4 (20) | 0.687 |
| VAN implicated and initial trough >20 mg/L, n (%) | 2 (100) | 4 (100) | 1.0 |
| Concurrent nephrotoxins, n (%) | |||
| Vasopressors, n (%) | 6 (26.1) | 11 (55) | 0.07 |
| Diuretics, n (%) | 13 (56.5) | 12 (60) | 1.00 |
| Amphotericin B, n (%) | 0 | 1 (5) | 0.465 |
| Angiotensin-converting-enzyme inhibitor or Angiotensin II receptor blocker, n (%) | 6 (26.1) | 3 (15) | 0.467 |
* Percentages based on the total cases in which vancomycin was implicated in each group.