Vancomycin associated acute kidney injury in patients with infectious endocarditis: a large retrospective cohort study.

Background: Vancomycin remains the cornerstone antibiotic for the treatment of infective endocarditis (IE). Vancomycin has been associated with significant nephrotoxicity. However, vancomycin associated acute kidney injury (AKI) has not been evaluated in patients with IE. We conducted this large retrospective cohort study to reveal the incidence, risk factors, and prognosis of vancomycin-associated acute kidney injury (VA-AKI) in patients with IE. Methods: Adult patients diagnosed with IE and receiving vancomycin were included. The primary outcome was VA-AKI. Results: In total, 435 of the 600 patients were enrolled. Of these, 73.6% were male, and the median age was 52 years. The incidence of VA-AKI was 17.01% (74). Only 37.2% (162) of the patients received therapeutic monitoring of vancomycin, and 30 (18.5%) patients had reached the target vancomycin trough concentration. Multiple logistic regression analysis revealed that body mass index [odds ratio (OR) 1.088, 95% CI 1.004, 1.179], duration of vancomycin therapy (OR 1.030, 95% CI 1.003, 1.058), preexisting chronic kidney disease (OR 2.291, 95% CI 1.018, 5.516), admission to the intensive care unit (OR 2.291, 95% CI 1.289, 3.963) and concomitant radiocontrast agents (OR 2.085, 95% CI 1.093, 3.978) were independent risk factors for VA-AKI. Vancomycin variety (Lai Kexin vs. Wen Kexin, OR 0.498, 95% CI 0.281, 0.885) were determined to be an independent protective factor for VI-AKI. Receiver operator characteristic curve analysis revealed that duration of therapy longer than 10.75 days was associated with a significantly increased risk of VA-AKI (HR 1.927). Kidney function was fully or partially recovered in 73.0% (54) of patients with VA-AKI. Conclusion: The incidence of VA-AKI in patients with IE was slightly higher than in general adult patients. Concomitant contrast agents were the most alarmingly nephrotoxic in patients with IE, adding a 2-fold risk of VA-AKI. In patients with IE, a course of vancomycin therapy longer than 10.75 days was associated with a significantly increased risk of AKI. Thus, closer monitoring of kidney function and vancomycin trough concentrations was recommended in patients with concurrent contrast or courses of vancomycin longer than 10.75 days.

Impact of pharmacist intervention in reducing vancomycin-associated acute kidney injury: A systematic review and meta-analysis.

AIMS: The aim was to quantify the relationship between pharmacist intervention and vancomycin-associated acute kidney injury (AKI). METHODS: Electronic databases were searched up to August 2020 for meta-analyses of cohort studies and/or randomized controlled trials. Studies that compared the incidence of AKI in patients between post- and prepharmacist intervention were investigated. The primary outcome was incidence of AKI. We also evaluated the influence of pharmacist intervention in risk factors of vancomycin-associated AKI. RESULTS: The search strategy retrieved 1744 studies and 34 studies with 19 298 participants were included (22 published articles and 12 abstracts from conference proceedings). Compared with the preintervention group, the postintervention group patients had a significantly lower incidence of vancomycin-associated AKI: 7.3% for post- and 9.6% for preintervention (odds ratio [OR] 0.52, 95% confidence interval [CI]; 0.41, 0.67], P < .00001). The rate of attaining target concentration was significantly higher in the post- than preintervention group (OR 2.86, 95% CI [2.23, 3.67], P < .00001). The postintervention group significantly improved the percentage of serum creatinine laboratory tests than preintervention group (OR = 3.24, 95% CI 2.02, 5.19], P < .00001). Patients postintervention had markedly lower risk of mortality than preintervention patients (OR 0.47, 95% CI [0.31, 0.72], P = .0004). CONCLUSION: Pharmacist intervention in vancomycin treatment significantly decreased the rate of vancomycin-associated AKI, while improving efficacy and reducing mortality. We speculate that this is because the pharmacist interventions optimized the rationality of vancomycin therapy, monitoring of vancomycin trough concentration and the monitoring of patients' renal function.

Vancomycin Associated Acute Kidney Injury: A Longitudinal Study in China.

Background: Vancomycin-associated acute kidney injury (VA-AKI) is a recognizable condition with known risk factors. However, the use of vancomycin in clinical practices in China is distinct from other countries. We conducted this longitudinal study to show the characteristics of VA-AKI and how to manage it in clinical practice. Patients and Methods: We included patients admitted to hospital, who received vancomycin therapy between January 1, 2016 and June 2019. VA-AKI was defined as a patient having developed AKI during vancomycin therapy or within 48 h following the withdrawal of vancomycin therapy. Results: A total of 3719 patients from 7058 possible participants were included in the study. 998 patients were excluded because of lacking of serum creatinine measurement. The incidence of VA-AKI was 14.3%. Only 32.3% (963/2990) of recommended patients performed therapeutic drug monitoring of vancomycin. Patients with VA-AKI were more likely to concomitant administration of cephalosporin (OR 1.55, 95% CI 1.08-2.21, p = 0.017), carbapenems (OR 1.46, 95% CI 1.11-1.91, p = 0.006) and piperacillin-tazobactam (OR 3.12, 95% CI 1.50-6.49, p = 0.002). Full renal recovery (OR 0.208, p = 0.005) was independent protective factors for mortality. Compared with acute kidney injury stage 1, AKI stage 2 (OR 2.174, p = 0.005) and AKI stage 3 (OR 2.210, p = 0.005) were independent risk factors for fail to full renal recovery. Conclusion: Lack of a serum creatinine measurement for the diagnosis of AKI and lack of standardization of vancomycin therapeutic drug monitoring should be improved. Patient concomitant with piperacillin-tazobactam are at higher risk. Full renal recovery was associated with a significantly reduced morality.

Systematic Review of Drug-induced Acute Kidney Injury in Chinese Population / 中国药房

OBJECTIVE：To study clinical situation and influential factors for prognosis of drug-i nduced acute kidney injury （DIAKI）in Chinese population ，and to provide reference for early detection ，early intervention and prognosis improvement of DIAKI. METHODS ：Retrieved from PubMed ，Embase，Cochrane Library ，CNKI，Wanfang database and VIP ，clinical studies related to DIAKI were collected during the inception to Apr. 16th，2020. After the data extraction and quality evaluation of included studies，the results were analyzed descriptively ，and Meta-analysis was carried out by Rev Man 5.3 software. RESULTS ：A total of 29 studies were included ，including 1 870 patients. The results showed that DIAKI accounted for 32.2％（877/2 721）of the patients developed AKI in the same period. Antibacterial drugs were the main cause of DIAKI ，accounting for 47.5％（773/1 629）. The top five drugs by case number were classified as aminoglycoside antibiotics ，diuretics or dehydrating agents ，cephalosporin antibiotics，non-steroidal anti-inflammatory drugs and traditional Chinese medicine. The pathological type of DIAKI was mainly acute interstitial nephritis ，accounting for 51.9％（70/135）. The mortality of DIAKI patients was 14.4％（240/1 677）. A total of 70.4％（1 176/1 670）of patients had renal recovery. Compared with conservative treatment ，the mortality of patients receiving dialysis treatment was significantly lower [OR ＝0.30，95％CI（0.10，0.91），P＝0.003]. Compared with patients without anemia ， patients with anemia had a significantly delayed renal recovery [OR ＝0.25，95％CI（0.09，0.65），P＝0.004]. Lower levels of retinol binding protein was significantly related to rapid renal recovery [MD ＝－15.84，95％CI（－22.34，－9.34），P＜0.01]. CONCLUSIONS：Clinicians need to continuously strengthen antibiotic management and use drugs that induce AKI with caution. For patients with DIAKI ，receiving dialysis treatment as soon as possible may help reduce mortality. Timely correction of the basic anemia status of patients with DIAKI will help patients withrapid renal recovery ，and lower retinol binding protein levels may be a potential biomarker for predicting patients ’rapidrenal recovery.

Interpretation of the list of alternative medications for high-risk medications in the elderly and potentially harmful drug-disease interactions based on the Beers criteria / 中华老年医学杂志

The National Committee for Quality Assurance(NCQA)and the Pharmacy Quality Alliance(PQA)used the American Geriatrics Society(AGS)Beers Criteria to establish the quality measure system of high-risk medications and potentially harmful drug-disease interactions in the elderly.Medications included may be harmful to elderly adults,and negatively affect health care plans' quality ratings.AGS experts conducted a comprehensive literature review and prepared a list of drug-therapy alternatives with supporting references.NCQA,PQA,the 2015 AGS Beers Criteria panel,and the Executive Committee of the AGS reviewed the drug therapy alternatives and nonpharmacological approaches.Prescribers,pharmacists,patients,and health care plans may benefit from this list.