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Volume 4 Issue 5 (September - October, 2016)

Original Articles

CLINICAL ASSESSMENT OF NEPHROTOXICITY ASSOCIATED WITH VANCOMYCIN TROUGH CONCENTRATIONS DURING TREATMENT OF DEEP-SEATED INFECTIONS- A RETROSPECTIVE ANALYSIS
Anand Kumar Singh, Poonam Verma

Background: Ever since of its introduction in early 1950s, one of the common associated features observed with vancomycin is nephrotoxicity. Use of vancomycin was limited in early years due to lingering safety concerns and availability of methicillin and cephalothin. It was after 1961 that the use of Vancomycin began to increase after the emergence of methicillin-resistant Staphylococcus aureus (MRSA). Hence; we aim to evaluate whether elevated serum vancomycin trough concentrations (>15 mg/l) are required for the treatment of pneumonia, endocarditis or osteomyelitis caused by MRSA. Materials & methods: The present retrospective was conducted in the department of physiology of the medical institution and included all those patients who had a minimum history of 20 years old pneumonia, endocarditis osteomyelitis caused by MRSA, who received treatment with vancomycin for at least 5 days and had at least one vancomycin trough concentration obtained during therapy. Evaluation of the data regarding the potential confounding factors for acute renal failure was done which included assessment of concomitant nephrotoxins, hypotension, sepsis, cardiac arrest and radiographic contrast exposure. Worsening, recurrent, or new signs and symptoms of infection; or the need for additional antibiotic therapy; or when a change in antibiotic therapy was needed; or positive culture of MRSA at the end of vancomycin therapy; or infection-related readmission within 90 days; or death included the category of failure. Results: Mean age of the patients in the two study groups was 61.5 and 58.2 years respectively. Male percentage in patients with high trough and low trough group was 52 and 64 percent respectively. Pneumonia was the most prevalent among the two study group (52% and 53 % respectively). Non-significant correlation was obtained while comparing the clinical and demographic parameters of the patients. 26 percent of the cases of pneumonia in high trough group showed completely cure following the treatment while in low trough group 62 percent of the cases showed completely cure result. Statistically non-significant results were obtained while comparing the clinical outcome in between patients of the two study groups. Conclusion: No significant correlation exist in the clinical outcome of the patients although an increased risk of nephrotoxicity is associated with patients with vancomycin trough concentrations of more than 15 mg/l.
Key words: Nephrotoxicity, Vancomycin

Corresponding Author: Dr. Anand Kumar Singh, Associate Professor Department of Physiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun
This article may be cited as: Singh AK,  Verma P. clinical assessment of nephrotoxicity associated with vancomycin trough concentrations during treatment of deep-seated infections: A retrospective analysis. J Adv Med Dent Scie Res 2016;4(5):126-130.

 
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