Joseph J Carreno1,2,3, Rachel M Kenney2, George Divine4, Jose A Vazquez5,6, Susan L Davis1,2. 1. 1 Henry Ford Hospital Department of Pharmacy Services, Detroit, MI, USA. 2. 2 Wayne State University, Detroit, MI, USA. 3. 3 Albany College of Pharmacy and Health Sciences, Albany, NY, USA. 4. 4 Henry Ford Hospital Department of Public Health Sciences, Detroit, MI, USA. 5. 5 Henry Ford Hospital, Division of Infectious Diseases, Detroit, MI, USA. 6. 6 Georgia Regents University, Augusta, GA, USA.
Abstract
BACKGROUND: Use of alternative antimicrobials to vancomycin is a potential strategy to reduce acute kidney injury (AKI) in high-risk patients, but current data do not support widespread adoption of this practice. OBJECTIVE: To determine the efficacy of early switch to a nonnephrotoxic alternative for prevention of AKI in high-risk patients who receivevancomycin. METHODS: This was an IRB-approved, prospective randomized controlled trial in a single, tertiary care academic medical center. Patients initially prescribed vancomycinbetween October 2011 to April 2013 with at least 2 risk factors for AKI were included. Treatment randomization was stratified by indication for therapy. Patients were randomized to continuation of dose-optimized vancomycin or early switch to an alternative antimicrobial agent. The primary end point was nephrotoxicity by consensus guideline definition adjudicated by blinded review; the secondary end point was AKI network-defined AKI. RESULTS:A total of 103 patients were randomized; 100 were included in the modified intent-to-treat population, 51 in the vancomycin group and 49 in the alternative group. The incidence of nephrotoxicity was 6.1% in the alternative therapy arm and 9.8% in the vancomycin group ( P = 0.72). The incidence of AKI was 32.7% in the alternative therapy group and 31.4% in the vancomycin group ( P = 0.89). CONCLUSIONS: No significant difference in nephrotoxicity or AKI was detected among patients treated with alternative antimicrobials compared with vancomycin. The use of alternative antimicrobial therapy instead of vancomycin solely for the purpose of preventing AKI in high-risk patients does not appear to be warranted.
RCT Entities:
BACKGROUND: Use of alternative antimicrobials to vancomycin is a potential strategy to reduce acute kidney injury (AKI) in high-risk patients, but current data do not support widespread adoption of this practice. OBJECTIVE: To determine the efficacy of early switch to a nonnephrotoxic alternative for prevention of AKI in high-risk patients who receive vancomycin. METHODS: This was an IRB-approved, prospective randomized controlled trial in a single, tertiary care academic medical center. Patients initially prescribed vancomycin between October 2011 to April 2013 with at least 2 risk factors for AKI were included. Treatment randomization was stratified by indication for therapy. Patients were randomized to continuation of dose-optimized vancomycin or early switch to an alternative antimicrobial agent. The primary end point was nephrotoxicity by consensus guideline definition adjudicated by blinded review; the secondary end point was AKI network-defined AKI. RESULTS: A total of 103 patients were randomized; 100 were included in the modified intent-to-treat population, 51 in the vancomycin group and 49 in the alternative group. The incidence of nephrotoxicity was 6.1% in the alternative therapy arm and 9.8% in the vancomycin group ( P = 0.72). The incidence of AKI was 32.7% in the alternative therapy group and 31.4% in the vancomycin group ( P = 0.89). CONCLUSIONS: No significant difference in nephrotoxicity or AKI was detected among patients treated with alternative antimicrobials compared with vancomycin. The use of alternative antimicrobial therapy instead of vancomycin solely for the purpose of preventing AKI in high-risk patients does not appear to be warranted.
Authors: Doaa M Aljefri; Sean N Avedissian; Nathaniel J Rhodes; Michael J Postelnick; Kevin Nguyen; Marc H Scheetz Journal: Clin Infect Dis Date: 2019-11-13 Impact factor: 9.079
Authors: Kelsey B Billups; Erica E Reed; Gary S Phillips; Kurt B Stevenson; Steven M Steinberg; Claire V Murphy Journal: Int J Crit Illn Inj Sci Date: 2018 Jan-Mar