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Original article
peer-reviewed

Evaluation of the Risk for Acute Kidney Injury in Adult Cystic Fibrosis Patients Receiving Concomitant Vancomycin and Tobramycin



Abstract

Background

The risk for acute kidney injury (AKI) has been associated with both tobramycin and vancomycin.

Objective

To determine whether the rate of drug therapy-related nephrotoxicity is greater in Cystic Fibrosis (CF) patients receiving concomitant vancomycin and tobramycin than patients receiving either agent alone.

Methods

Adult CF patients admitted for acute pulmonary exacerbation (APE) over a seven-year period (2008-2014), who received at least 72 hours of intravenous vancomycin, tobramycin or a combination of the two agents were evaluated for AKI. AKI was defined as a 1.5-fold increase in serum creatinine per RIFLE criteria. One hundred seventy-four hospital encounters from 72 unique patients were assessed in this single-center, cross-sectional study.

Results

AKI outcomes were not statistically different. AKI rates were 19% for vancomycin, 8.7% for tobramycin, and 19.7% for combination cohorts (p = 0.16).

Conclusion

Our data suggest there is no significant difference in AKI risk when vancomycin and tobramycin combination therapy is used.



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Original article
peer-reviewed

Evaluation of the Risk for Acute Kidney Injury in Adult Cystic Fibrosis Patients Receiving Concomitant Vancomycin and Tobramycin


Author Information

Corinne Muirhead Corresponding Author

Doernbecher, Oregon Health and Science University

Jeong Y. Lim

Knight Cancer Institute, Oregon Health and Science University

Department of Biostatistics, Oregon Health and Science University

Jodi Lapidus

Department of Biostatistics, Oregon Health and Science University

Kelvin MacDonald

Department of Pediatrics, Oregon Health and Science University


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Oregon Health and Science University Institutional Review Board issued approval 9567. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Acknowledgements

The authors acknowledge Jeffrey A Gold, MD and Michael A Wall, MD for their critical review and clinical insight.


Original article
peer-reviewed

Evaluation of the Risk for Acute Kidney Injury in Adult Cystic Fibrosis Patients Receiving Concomitant Vancomycin and Tobramycin


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Original article
peer-reviewed

Evaluation of the Risk for Acute Kidney Injury in Adult Cystic Fibrosis Patients Receiving Concomitant Vancomycin and Tobramycin

Corinne Muirhead">Corinne Muirhead , Jeong Y. Lim">Jeong Y. Lim, Jodi Lapidus">Jodi Lapidus, Kelvin MacDonald">Kelvin MacDonald

  • Author Information
    Corinne Muirhead Corresponding Author

    Doernbecher, Oregon Health and Science University

    Jeong Y. Lim

    Knight Cancer Institute, Oregon Health and Science University

    Department of Biostatistics, Oregon Health and Science University

    Jodi Lapidus

    Department of Biostatistics, Oregon Health and Science University

    Kelvin MacDonald

    Department of Pediatrics, Oregon Health and Science University


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Oregon Health and Science University Institutional Review Board issued approval 9567. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements

    The authors acknowledge Jeffrey A Gold, MD and Michael A Wall, MD for their critical review and clinical insight.


    Article Information

    Published: December 06, 2017

    DOI

    10.7759/cureus.1912

    Cite this article as:

    Muirhead C, Lim J Y, Lapidus J, et al. (December 06, 2017) Evaluation of the Risk for Acute Kidney Injury in Adult Cystic Fibrosis Patients Receiving Concomitant Vancomycin and Tobramycin. Cureus 9(12): e1912. doi:10.7759/cureus.1912

    Publication history

    Received by Cureus: July 14, 2017
    Peer review began: July 30, 2017
    Peer review concluded: December 01, 2017
    Published: December 06, 2017

    Copyright

    © Copyright 2017
    Muirhead et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background

The risk for acute kidney injury (AKI) has been associated with both tobramycin and vancomycin.

Objective

To determine whether the rate of drug therapy-related nephrotoxicity is greater in Cystic Fibrosis (CF) patients receiving concomitant vancomycin and tobramycin than patients receiving either agent alone.

Methods

Adult CF patients admitted for acute pulmonary exacerbation (APE) over a seven-year period (2008-2014), who received at least 72 hours of intravenous vancomycin, tobramycin or a combination of the two agents were evaluated for AKI. AKI was defined as a 1.5-fold increase in serum creatinine per RIFLE criteria. One hundred seventy-four hospital encounters from 72 unique patients were assessed in this single-center, cross-sectional study.

Results

AKI outcomes were not statistically different. AKI rates were 19% for vancomycin, 8.7% for tobramycin, and 19.7% for combination cohorts (p = 0.16).

Conclusion

Our data suggest there is no significant difference in AKI risk when vancomycin and tobramycin combination therapy is used.



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Create a free account to continue reading this article.

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Corinne Muirhead, Pharm.D.

Doernbecher, Oregon Health and Science University

For correspondence:
dustan@ohsu.edu

Jeong Y. Lim

Knight Cancer Institute, Oregon Health and Science University

Jodi Lapidus

Department of Biostatistics, Oregon Health and Science University

Kelvin MacDonald

Department of Pediatrics, Oregon Health and Science University

Corinne Muirhead, Pharm.D.

Doernbecher, Oregon Health and Science University

For correspondence:
dustan@ohsu.edu

Jeong Y. Lim

Knight Cancer Institute, Oregon Health and Science University

Jodi Lapidus

Department of Biostatistics, Oregon Health and Science University

Kelvin MacDonald

Department of Pediatrics, Oregon Health and Science University