Association Between Vancomycin Area Under the Curve and Nephrotoxicity: a single center, retrospective cohort study in a veteran population.

BACKGROUND: It is unclear which vancomycin area under the curve (AUC) values are most associated with risk for acute kidney injury (AKI).
METHODS: This retrospective cohort study was undertaken to determine if vancomycin AUC >550 is associated with a higher rate of AKI than an AUC <550. Patients treated with vancomycin for at least 4 days at the VA St. Louis Health Care System from 1/1/2016 to 9/31/2018 were included. The primary outcome was AKI (defined as an increase in serum creatinine by 0.3 mg/dL or 50% from baseline). Secondary outcomes included length of stay, readmission in 30 days, and mortality in 30 days. A bivariate analysis was used to determine other potential factors affecting AKI rate, with significant variables (P < .2) to be included in the multivariate logistic regression analysis to determine independent risk for AKI.
RESULTS: Two hundred patients were included in the analysis; 100 patients with an AUC ≥550 and 100 with an AUC <550. Only mean vancomycin dose (1722.50 mg vs 2361.25 mg; P < .05), mean AUC (465.88 vs 696.45; P < .05), and peak SCr (1.22 mg/dL vs 1.48 mg/dL; P = .015) were significantly different between groups (AUC <550 vs AUC ≥550, respectively). AKI occurred in 42% (42/100) of patients with AUC ≥550 compared with 2% (2/100) of patients with AUC <550 (P < .05). Secondary outcomes were not different between the groups. In the bivariate analysis, age ≥70, CrCl <50 mL/min, and AUC ≥550 (odds ratio, 49.5; 95% CI, 10.1-242.3; P < .05) were found to be independently associated with risk for developing AKI.
CONCLUSIONS: Patients with a vancomycin AUC ≥550 were found to have a significantly higher rate of AKI compared with those with an AUC <550. Published by Oxford University Press on behalf of Infectious Diseases Society of America 2021.