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. 2020 Nov 4;7(12):ofaa538.
doi: 10.1093/ofid/ofaa538. eCollection 2020 Dec.

Vancomycin Exposure and Acute Kidney Injury Outcome: A Snapshot From the CAMERA2 Study

Jiajun Liu  1   2   3 , Steven Y C Tong  4   5 , Joshua S Davis  5 , Nathaniel J Rhodes  1   2   3 , Marc H Scheetz  1   2   3 ; CAMERA2 Study Group
Collaborators, Affiliations

Vancomycin Exposure and Acute Kidney Injury Outcome: A Snapshot From the CAMERA2 Study

Jiajun Liu et al. Open Forum Infect Dis. .

Abstract

Among patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia from a prospective randomized clinical trial, acute kidney injury (AKI) rates increased with increasing vancomycin exposure, even within the therapeutic range. AKI was independently more common for the (flu)cloxacillin group. Day 2 vancomycin AUC ≥470 mg·h/L was significantly associated with AKI, independent of (flu)cloxacillin receipt.

Keywords: AUC; MRSA bacteremia; acute kidney injury; combination therapy; nephrotoxicity; pharmacokinetics; toxicodynamics; vancomycin; β-lactam.

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Figures

Figure 1.
Figure 1.
Day 2 vancomycin exposure–toxicity relationships (stratified by (flu)cloxacillin vs non-(flu)cloxacillin groups). Pr(AKI), probability of Stage 1 AKI as defined by modified KDIGO per the parent study (ie, CAMERA2): Stage 1 is serum creatinine 1.5–1.9 times baseline in the first 7 days (OR ≥26.5 μmol/L increase from baseline in the first 48 hours); Stage 2 is serum creatinine 2.0–2.9 times baseline in the first 7 days; Stage 3 is serum creatinine ≥3.0 times baseline in the first 7 days (OR ≥353.6 μmol/L increase from baseline in the first 48 hours OR new initiation of renal replacement therapy within 90 days). Urine output criteria were not included as data on urine output were not collected; analysis population, n = 291; solid lines represent LOWESS function for respective groups. Abbreviations: AKI, acute kidney injury; AUC, area under the concentration-time curve; Pr(AKI), probability of Stage 1 AKI.
Figure 2.
Figure 2.
Day 2 vancomycin exposure–toxicity relationships (stratified by vancomycin plus cefazolin vs vancomycin alone). Analysis population, n = 176; solid lines represent LOWESS function for respective groups. Abbreviations: AKI, acute kidney injury; AUC, area under the concentration-time curve; Pr(AKI), probability of Stage 1 AKI as defined by modified KDIGO criteria as detailed in Figure 1.
See this image and copyright information in PMC

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