SPC365

Vancomycin therapy and acute kidney injury in patients with infective endocarditis

Session: SESSÃO DE POSTERS 15 - ENDOCARDITE INFECIOSA 2
Speaker: João Gouveia Fiuza

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 16. Infective Endocarditis
Subtheme: 16.4 Infective Endocarditis – Treatment
Session Type: Cartazes
FP Number: ---
Authors: João Gouveia Fiuza; Mariana Duarte Almeida; Gonçalo RM Ferreira; Oliver Kungel; Francisco Rodrigues Santos; Vanda Devesa Neto; Nuno Vicente; Nuno Craveiro; Jorge Bigotte Santos; Júlio Gil Pereira; António Costa

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:black">Introduction:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:black"> Infective endocarditis (IE) is a life-threatening condition requiring prompt and effective antimicrobial therapy. Vancomycin is one of the most often used antibiotic drugs to treat IE. However, nephrotoxicity is a concern given the relevant morbidity associated with it, requiring regular dose adjustments.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:black">Purpose:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:black"> To assess the association between vancomycin treatment and acute kidney injury (AKI) in patients with IE.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:black">Retrospective study of 30 patients admitted for IE and treated with vancomycin in a Cardiology Department, over a 5-year period. Baseline characteristics, laboratory results, vancomycin dosages and trough levels were obtained. Vancomycin levels &ge;21 &micro;g/mL were categorized as supratherapeutic. Timely vancomycin dose adjustment was defined as appropriate dose modifications accordingly to drug monitoring results within 24 hours.&nbsp;AKI was diagnosed according to the KDIGO criteria. Statistical analysis included Chi-square and Mann-Whitney U.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:black">Results: </span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:black">Mean age of 70 &plusmn; 12 years; 66.7% were male. Chronic kidney disease (CKD) was present in 30% (n=9) and mean admission creatinine was 1.35 mg/dL. In-hospital mortality was 23.3% (n=7). AKI occurred in 50% (n=15) of patients. Only 33.3% (n=10) of patients had timely vancomycin dose adjustments and 50% had supratherapeutic vancomycin levels on the first measurement. Patients without timely vancomycin dose adjustments (87.5% vs. 10%, &chi;&sup2; = 15.143, p &lt; 0.001), atrial fibrillation (76.9% vs. 29.4%; &chi;&sup2; = 6.652, p = 0.01), treated with diuretics (75% vs. 35.7%; &chi;&sup2; = 4.013, p = 0.045) and with supratherapeutic vancomycin trough levels at the third measurement (91.7% vs. 20.0%; &chi;&sup2; = 8.731, p = 0.001) had a significantly higher prevalence of AKI. Additionally, vancomycin levels at the second and third measurements were significantly higher in patients with AKI (32 &micro;g/mL vs. 20 &micro;g/mL, p = 0.037; 30 &micro;g/mL vs. 18 &micro;g/mL, p = 0.019, respectively).&nbsp;Discharge creatinine levels remained increased in the AKI group (2.17 mg/dL vs. 1.39 mg/dL, p = 0.029).&nbsp; Additionally, patients with AKI had a significantly longer duration of vancomycin therapy (40 vs. 9 days, p = 0.003). While gentamicin use showed a near-significant trend (p = 0.065), no significant associations were observed for previous CKD (p = 0.7), HF (0.251), DM (p=1) or concomitant radiocontrast use (p = 0.396).&nbsp;In-hospital mortality was 23.3%, and it was not significantly higher in those who developed AKI (p=0.390).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:black">Conclusion:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"><span style="color:black"> In patients with IE treated with vancomycin, we observed a higher incidence of AKI than typically reported in the general inpatient population. However, this did not contribute to additional in-hospital mortality.&nbsp;Our findings emphasize the importance of close vancomycin monitoring and timely adjustments to prevent AKI. Future studies should explore alternative monitoring strategies and interventions to minimize nephrotoxicity.</span></span></span></span></span></p>