By Dr Riya Dave,Dr. Kamal Kant Kohli
Copyright medicaldialogues
A recent target trial emulation study found that vancomycin use in ICU patients is associated with a higher risk of acute kidney injury compared to alternatives such as clindamycin and linezolid, highlighting the importance of following established prevention strategies. The study was published in Pharmacoepidemiology & Drug Safety journal by Izak A. and colleagues.The analysis was founded on a hypothetical trial simulation employing routinely collected data from 15 Dutch ICUs over the period between 2010 and 2019. The data of 1,809 ICU admissions were analyzed. Patients who underwent vancomycin were compared with those that were treated with other minimally nephrotoxic antibiotics, such as clindamycin, linezolid, teicoplanin, meropenem, cefazolin, and daptomycin.Acute kidney injury was classified based on the KDIGO serum creatinine criteria. To adjust for confounding and selection bias, inverse probability of treatment and censoring weighting was used in the analysis. Risk estimates were reported at 2 days and 14 days after the start of antibiotics, taking into consideration the 24–48 hour delay between renal function worsening and detection by SCr.ResultsThe analysis revealed that vancomycin use was not related to a higher risk of AKI in the first 2 days. In 2 days, AKI risk was 0.10 (95% CI 0.06–0.12) among vancomycin users compared with 0.10 (95% CI 0.08–0.11) among alternative antibiotic users, with a risk difference of 0.00 (95% CI −0.03–0.03). By day 14, a definitive difference had emerged. The risk adjusted for AKI was 0.28 (95% CI 0.21–0.34) for vancomycin versus 0.17 (95% CI 0.14–0.20) for the alternative antibiotic. This represented a risk difference of 0.11 (95% CI 0.04–0.19), meaning that vancomycin was linked to a much increased risk of kidney damage over time.The research concluded that vancomycin was associated with a higher risk of acute kidney injury in comparison to other antibiotics when administered for 14 days in ICU patients. The authors suggest strict compliance with vancomycin-induced AKI preventive protocols and that less nephrotoxic alternatives should be considered where possible in order to protect renal function in critically ill patients.Reference:Yasrebi-de Kom, I. A. R., Jager, K. J., Stel, V. S., Chesnaye, N. C., Abu-Hanna, A., de Keizer, N. F., de Lange, D. W., Dongelmans, D. A., Klopotowska, J. E., Cinà, G., & the RESCUE Study Group. (2025). Vancomycin‐induced acute kidney injury in intensive care patients: A target trial emulation study using multicenter routinely collected data. Pharmacoepidemiology and Drug Safety, 34(9). https://doi.org/10.1002/pds.70205
