These authors contributed equally to this study.
Nephrotoxicity of vancomycin in patients with methicillin-resistant Staphylococcus aureus bacteraemia
Article first published online: 27 OCT 2011
© 2011 The Authors. Nephrology © 2011 Asian Pacific Society of Nephrology
Volume 16, Issue 8, pages 697–703, November 2011
How to Cite
SHEN, W.-C., CHIANG, Y.-C., CHEN, H.-Y., CHEN, T.-H., YU, F.-L., TANG, C.-H. and SUE, Y.-M. (2011), Nephrotoxicity of vancomycin in patients with methicillin-resistant Staphylococcus aureus bacteraemia. Nephrology, 16: 697–703. doi: 10.1111/j.1440-1797.2011.01488.x
- Issue published online: 27 OCT 2011
- Article first published online: 27 OCT 2011
- Accepted manuscript online: 24 JUN 2011 01:14PM EST
- Accepted for publication 17 June 2011.; Accepted manuscript online 24 June 2011.
- acute kidney injury;
- hospital cost;
- Staphylococcus aureus;
Aim: Vancomycin and teicoplanin are the two most used glycopeptides for the treatment of methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is suspected to have more nephrotoxicity but this has not been clearly established. The aim of this study was to assess its nephrotoxicity by a consensus definition of acute kidney injury (AKI): the risk (R), injury (I), failure (F), loss and end-stage renal disease (RIFLE) classification.
Methods: Patients with MRSA bacteraemia who were prescribed either vancomycin or teicoplanin between 2003 and 2008 were classified. Patients who developed AKI were classified by RIFLE criteria. Variables such as comorbidities, laboratory data and medical cost information were also obtained from the database. Outcomes determined were: (i) the rate of nephrotoxicity and mortality; and (ii) the association of nephrotoxicity with the length of hospital stay and costs.
Results: The study included 190 patients (vancomycin 33, teicoplanin 157). Fifteen patients on vancomycin and 27 patients on teicoplanin developed AKI (P = 0.0004). In the vancomycin group, four, eight and three patients were classified to RIFLE criteria R, I and F, respectively. In the teicoplanin group, 17, nine and one patient were classified to RIFLE criteria R, I and F, respectively. Kaplan–Meier analysis showed significant difference in time to nephrotoxicity for the vancomycin group compared to the teicoplanin group. No significant differences were found between the groups in terms of total mortality, length of hospital stay and costs.
Conclusion: The study data suggest that vancomycin is associated with a higher likelihood of nephrotoxicity using the RIFLE classification.