objective The purpose of this study was to evaluate risk factors that may result patients with severe infection to acute kidney injury in receiving vancomycin treatment. Methods This was a single-center retrospective study of 53 patiens with severe infections who were receiving vancomycin from February 1st 2013 to August 1st 2013.Vancomycin trough concentrations and renal function were monitored during therapy.Date colected included the general conditions,vancomycin dose,length of vancomycin therapy.These were used to identify univariate for vancomycin associated acute kindey injury. The univariate analysis statisticaly significant factor Logistc regression analysis. Results Among 53 subjects,11(21.0%)develeped acute kidney injury,the mortality rate was 27.3%.The initial serum creatinine and Uremic nitrogen did not differ between the two groups.The patients in AKI group had lower initialy creatinine clearance(67.00±39.59ml/min vs 101.33±51.22ml/min,p=0.046),and the higher proportion of hypertension[6(54.5%) vs 5(11.9%),p=0.003]. The initial vancomycin through concentrations did not differ between the two groups .The average vancomycin trough concentrations and maximum trough concentration were higher among patients in AKI group than the patients in non-AKI group(17.88±4.90mg/L vs 13.95±4.44 mg/L,22.39±7.70 mg/L vs 17.23±6.01 mg/L,p=0.017 and p=0.027).Multivariate modeling identified that the average vancomycin trough concentrations[odd ratio(OR)1.247,95% confidence interval(95% CI 1.028-1.514),p=0.025]and hypotension[odd ratio(OR) 10.759,95% confidence interval(95% CI 1.667-69.442),p=0.013]were the independent predictors for vancomycin associated acute kidney injury. Conclusion The average vancomycin trough concentrations and hypertension were the independent predictors for induced acute kidney injury in patients with severe infection. Monitoring of drug concentration is necessary during the vancomycin therapy.
criticaly il patientsSevere infectionVancomycin AcuteKidney InjuryRisk factors
牛晓蓉、GU Qin、LIU Ning
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南京大学医学院 210000
Department of Intensive care uint,Affiliated Gulou Hospital of Nanjing University School of Medicine,Nanjing,210008,China
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