Reducing acute kidney injury due to vancomycin in trauma patients.

Background: Supratherapeutic vancomycin trough levels are common after trauma and associated with both increased acute kidney injury (AKI) and mortality. We sought to limit the adverse effects of vancomycin in trauma patients through more frequent trough monitoring. Methods: Beginning in January 2011, trauma patients treated with vancomycin had trough levels (VT) monitored daily until steady-state was reached. Trauma patients admitted from January 2011 to May 2015 (POST) were compared to those admitted from January 2006 to December 2010 (PRE). Inclusion criteria required administration of intravenous vancomycin, admission serum creatinine (SCr), and SCr within 72 hours of highest VT. AKI was defined as an increase in SCr of at least 0.3 mg/dl or 50% from admission to post-vancomycin administration. Those in the POST group were prospectively followed until discharge or death. Results: 263 patients met inclusion criteria in the PRE-phase and 115 in the POST-phase. The two groups were similar in age, gender, race, BMI, pre-existing comorbidities, admission SBP, GCS, and head AIS. ISS was higher in the POST cohort (18 PRE vs. 25 POST, p20 mg/L) (34.6% PRE vs. 22.6% POST, p=0.02) and AKI (30.4% PRE vs. 19.1% POST, p=0.026). After adjusting for confounders, the POST group had a significantly lower risk of AKI with AOR of 0.457 (p=0.027). There was a trend towards decreased mortality in the POST cohort, but this did not reach significance (10% PRE vs. 5.2% POST, p=0.162). Conclusions: A reduction in AKI was observed in trauma patients with daily vancomycin trough levels monitored until steady-state. Increased awareness regarding closer surveillance of VT in trauma patients may limit the incidence of vancomycin related nephrotoxicity. Level of Evidence: Therapeutic study, level III. (C) 2016 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/1U0Kz62