Artificially Elevated Tacrolimus Concentrations Obtained From a Venous Catheter Previously Used for Tacrolimus Administration in a Pediatric Patient.

Intravenous (IV) administration of calcineurin inhibitors, cyclosporine (CsA) and tacrolimus (TAC), has been associated with spuriously high serum concentrations collected from central venous catheters (CVCs) used for medication administration, secondary to reversible adsorption of medication to the catheter. Thus, therapeutic drug monitoring of IV CsA and TAC via CVCs previously exposed to these agents should be interpreted cautiously and ideally avoided. The duration of this effect is poorly characterized and the risk for extension of this effect to unexposed lumens of the same central catheter remains uncertain. We describe a case of a pediatric patient with artificially elevated serum TAC concentrations obtained from previously exposed and unexposed lumens of a central catheter, 27 days after last IV TAC administration.

Nephrotoxic Exposures and Acute Kidney Injury in Noncritically Ill Children Stratified by Service.

OBJECTIVE: The Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) program is a multicenter, quality improvement initiative that identifies patients at risk for nephrotoxic medication-associated acute kidney injury (NTMx-AKI). The purpose of this study was to (1) evaluate the prevalence and types of NTMx exposures and (2) determine the prevalence of NTMx-AKI categorized by service. Exploratory analysis evaluated potential associations between hospital measures and NTMx-AKI. METHODS: This is a single-center, retrospective chart review of NTMx exposures from January 2019 to June 2020 in noncritically ill children. High NTMx exposures were defined as ≥3 simultaneous nephrotoxins or ≥3 days of either intravenous vancomycin or aminoglycoside. Prevalence of high NTMx and NTMx-AKI rate were normalized to 1000 patient days. A retrospective case-control analysis assessed for potential associations with development of NTMx-AKI. RESULTS: There were 609 NTMx exposures in 565 patients and 44 (7.2%) episodes of NTMx-AKI. The NTMx prevalence rate per 1000 patient days was highest among liver, neurosurgery, and gastroenterology services. The most commonly used NTMx were vancomycin, intravenous contrast, and nonsteroidal antiinflammatory drugs. The NTMx-AKI rate in exposed patients ranged from 0% to 14% across service lines. AKI was most often attributable to vancomycin. Univariable analyses suggest type and duration of NTMx exposure are associated with development of NTMx-AKI but not with severity. CONCLUSIONS: NTMx exposures and NTMx-AKI are variable across services. Partnerships with antimicrobial stewardship and multicenter studies are needed to modify NTMx-AKI risk. Ongoing surveillance is needed in patients who do not have normalization of creatinine before discharge.