The association between vancomycin trough concentrations and acute kidney injury in the neonatal intensive care unit

Background: Vancomycin has recently gained popularity as an empiric therapy for late onset sepsis in the NICU. Changes in resistance patterns in common organisms has resulted in targeting higher trough concentrations of vancomycin. Consequently, an increase in vancomycin associated nephrotoxicity has been speculated. The objective of this study is to compare the incidence of acute kidney injury (AKI) in neonates with serum vancomycin trough concentrations less than 10 mg/L, 10-15 mg/L, or greater than 15 mg/L. Methods: A retrospective chart review of patients in the neonatal intensive care unit (NICU) was conducted to determine the incidence of AKI in neonates receiving vancomycin. Results: The overall incidence of AKI was 2.7%. Comparison of the incidence of AKI in the three groups using Mantel-Haenszel Chi-Square test showed a statistically significant association between increasing vancomycin trough concentration and incidence of AKI. Conclusion: There is a low incidence of AKI in neonates receiving vancomycin. However, there is a positive correlation between increasing vancomycin trough concentrations and an increasing serum creatinine.