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Journal of Antimicrobial Chemotherapy (1994) 33, 811-821
© 1994 The British Society for Antimicrobial Chemotherapy

other

A comparative assessment of vancomycin-associated nephrotoxicity in the young versus the elderly hospitalized patient

Kyle Vance-Bryana,c, John C. Rotschafera,c, Susan S. Gillilandc, Keith A. Rodvoldb, Colleen M. Fitzgeralda and David R. P. Guaya,c

aColleges of Pharmacy; University of Minnesota, Minneapolis MN, Chicago, Illinois bColleges of Pharmacy; University of Illinois Chicago, Illinois cColleges of Pharmacy; St Paul-Ramsey Medical Center St Paul, Minnesota, 55101-2595, USA

Received 8 June 1993; accepted 1 November 1993

The incidence of vancomycin-associated nephrotoxicity was determined in a younger (age < 60 y) versus elderly (age ≥ 60 y) hospitalized adult population to identify associated drug- and nondrug-related risk factors. Nephrotoxicity was defined as an acute increase in serum creatinine of ≥ 44•2 µimol/L if baseline serum creatinine was ≤ 221 µimol/L or an increase in serum creatinine of ≥ 88•4 µimol/L if baseline serum creatinine > 221 µimol/L. A total of 289 patients, 141 younger (mean age,±S.D. 37•9 ± 12•4 y) and 148 elderly (73•6 ± 8•5 years), was retrospectively reviewed. Nephrotoxicity occurred in 7•8% younger vs 18•9% elderly patients (P = 0•003). Using multivariate logistic regression models for the pooled patient population, concurrent loop diuretic use was significantly associated with vancomycin-associated nephrotoxicity (relative risk (R.R.) = 5•06); for the younger population, only concurrent amphotericin B use was significantly associated with vancomycin-associated nephrotoxicity (R.R. = 6{dot}65); and for the elderly population, only concurrent loop diuretic use was significantly associated with vancomycin-associated nephrotoxicity (R.R. = 9•70). These data suggest that elderly patients are at significantly greater risk of vancomycin-associated nephrotoxicity than are younger patients. However, because age was not a significant risk factor for nephrotoxicity in comparing the pooled vancomycin-associated nephrotoxicity group compared to the non-nephrotoxicity group, the differences observed between age groups probably reflect differences in risk factor prevalence.


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