Outcomes and Nephrotoxicity Associated with Vancomycin Treatment in Patients 80 Years and Older

Abstract

Purpose

This retrospective observational study investigated the efficacy and safety of vancomycin to treat patients aged 80 years and older. In particular, the associations between vancomycin trough concentration (VTC) and treatment outcomes or nephrotoxicity were explored.

Patients and Methods

Patients aged ≥80 years had received ≥3 vancomycin treatments and ≥1 detection of VTC. Treatment outcomes were defined as success or failure. Nephrotoxicity was considered an increase in serum creatinine ≥ 44.2 mmol/L, or 50% above baseline, for ≥2 consecutive days. Univariate and multivariate analyses were performed to identify risk factors for treatment failure and nephrotoxicity.

Results

Of 349 patients, 120 (34.4%) experienced treatment failure. For patients with VTCs at <10, 10–15, 15–20, and ≥20 µg/mL, the clinical response rates were, respectively, 77.8, 77.0, 80.5, and 61.0%; the 30-day mortality rates were 2.8, 15.0, 15.3, and 37.8%; and the rates of persistent bacteremia were 16.7, 12.4, 11.9, and 11.0%. The multivariate analysis indicated that blood urea nitrogen ≥11 g/dL and heart failure were independently associated with treatment failure; but not VTC (P = 0.004, 0.016, 0.828, respectively). During vancomycin treatment, 42 (12.0%) patients experienced nephrotoxicity with recovery time 7.5 ± 4.5 days. Fewer than half of patients with nephrotoxicity recovered after suspending vancomycin application. The variables found independently associated with increased nephrotoxicity were: VTC ≥15 µg/mL; treatment duration ≥15 d; and concomitant aminoglycosides administration (P = 0.024, 0.035, 0.029).

Conclusion

In patients aged 80 years and older, elevated VTC level was not associated with favorable treatment outcomes. Patients with VTC ≥20 µg/mL appear to suggest a worsened prognosis compared with lower VTCs. The risk of nephrotoxicity increases with elevated VTC, longer treatment time, and concomitant aminoglycoside administration.

Keywords:

• elderly
• vancomycin trough concentration
• outcome
• nephrotoxicity

Acknowledgments

This work was supported by grants from Capital’s Funds for Health Improvement and Research [Grant No: 2020-2-1101]. We thank Dr. Wei Wang for his support in data collection. We thank Dr. Tang for contributing to the development of this article, and Dr. Tian for Complete Medical Communications.

Abbreviations

ACEI, angiotensin converting enzyme inhibitor; APACHE II, Acute Physiology and Chronic Health Evaluation II; ARB, angiotensin receptor blocker; β, regression coefficient; BMI, body mass index; BUN, blood urea nitrogen; CI, confidence interval; CKD, chronic kidney disease; CNS, coagulase negative staphylococcus; eGFR, estimated glomerular filtration rate; OR, odds ratio; MRSA, methicillin-resistant Staphylococcus aureus; NSAID, nonsteroidal anti-inflammatory drug; SCr, serum creatinine; SE, standard error; VTC, vancomycin trough concentration.

Data Sharing Statement

The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Disclosure

Dr Chunyan Jiang reports grants from Capital’s Funds for Health Improvement and Research (2020-2-1101), during the conduct of the study. The authors report no other conflicts of interest in this work.