Vancomycin Linked to Higher Kidney Injury Risk in ICU Patients

Research from a recent study indicates that the antibiotic vancomycin poses a higher risk of acute kidney injury (AKI) compared to alternative antibiotics such as clindamycin and linezolid in intensive care unit (ICU) patients. The findings underscore the importance of adhering to prevention strategies to mitigate this risk.

The study, spearheaded by Izak Yasrebi-de Kom, PhD, at the Amsterdam University Medical Center, examined the implications of starting treatment with vancomycin versus several other minimally nephrotoxic antibiotics on the 14-day risk of AKI among adult ICU admissions. The results revealed a significantly heightened risk associated with vancomycin, prompting researchers to advocate for specific dosing practices and monitoring to protect patient health.

AKI is a common occurrence among ICU patients and is often linked to medication usage. As noted by the research team, “Optimizing pharmacotherapy may reduce the risk of drug-induced AKI and associated negative outcomes.” Vancomycin, a tricyclic glycopeptide antibiotic employed to combat severe gram-positive bacterial infections, has been connected to various side effects, including nephrotoxicity, hypotension, and hypersensitivity reactions. Despite its widespread use, evidence regarding its potential to induce AKI in ICU settings has been inconsistent.

To assess the risk associated with vancomycin, investigators executed a target trial emulation study utilizing data from 15 Dutch ICUs collected between January 2010 and December 2019. They linked electronic health records to the Dutch National Intensive Care Evaluation quality registry to identify eligible patients. The study focused on adult, non-dialysis dependent patients free from AKI at the time of ICU admission, all suspected of having a bacterial infection potentially treatable with vancomycin or one of six alternative antibiotics: clindamycin, linezolid, teicoplanin, meropenem, cefazolin, or daptomycin.

Eligible ICU admissions were assessed after 24 hours and within a week of their admission. A baseline serum creatinine measurement was also required. The follow-up for the study commenced upon treatment assignment and continued until one of several endpoints occurred, including diagnosis of AKI, loss to follow-up, or death.

The research cohort consisted of 176,489 ICU admissions, with 30,510 patients initiating one of the treatment strategies. Out of this group, 1,809 met all eligibility criteria, including 887 who began treatment with vancomycin and 922 who started on an alternative antibiotic.

After adjustments, the initiation of vancomycin correlated with a higher risk of AKI at 14 days compared to the alternative antibiotics (0.28; 95% CI, 0.21 to 0.34 versus 0.17; 95% CI, 0.14 to 0.20), with a risk difference of 0.11 (95% CI, 0.04 to 0.19). Notably, no difference in AKI risk was detected at the 2-day follow-up.

In further analyses, investigators focused on those patients who were followed up and initiated treatment within the specified timeframe. They found that both lower and higher doses of vancomycin were linked to an increased risk of AKI at 14 days when compared to alternative antibiotics, with the higher dose demonstrating a more substantial risk difference (0.17; 95% CI, 0.05 to 0.25 versus 0.10; 95% CI, 0.01 to 0.19).

The researchers concluded, “Our findings indicate that vancomycin causes a higher risk of AKI compared to the investigated alternative antibiotics. We recommend clinicians to be compliant with clinical vancomycin-induced AKI prevention strategies. Future research on dose–response relationships is warranted.”

This study provides crucial insights for healthcare professionals, emphasizing the need to weigh the benefits and risks of antibiotic treatments in critically ill patients.