Long-term vancomycin use had low risk of ototoxicity


Autoři: Clayton Humphrey aff001;  Michael P. Veve aff001;  Brian Walker aff001;  Mahmoud A. Shorman aff001
Působiště autorů: University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, United States of America aff001;  University of Tennessee Health Sciences Center, Knoxville, Tennessee, United States of America aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224561

Souhrn

Background

Vancomycin is a commonly used antibiotic with potent activity against Gram-positive organisms, but prolonged use and high doses can lead to toxicity. While vancomycin-associated nephrotoxicity is widely reported, few cases of ototoxicity have been described. The objective of this study was to determine the prevalence of negative changes in audiograms in patients receiving long-term intravenous (IV) vancomycin and to identify high-risk patients who need audiogram monitoring.

Methods

This was an IRB approved, cross-sectional study performed at an academic medical center from 1/2012-3/2019. Patients who were prescribed IV vancomycin for ≥ 14 days and had baseline and follow-up weekly audiometry were included. All data was extracted from the electronic medical record. The primary endpoint was worsening audiogram while on vancomycin. Descriptive and bivariate statistics were used to describe the patient population.

Results

424 patients were screened for inclusion; 92 received at least two audiograms while on vancomycin. Fifty-three percent of patients were men, the median (IQR) patient age was 44 (34–58) years, and 8% of patients had an estimated Cockcroft-Gault creatinine clearance ≤ 30 mL/min or received hemodialysis. The median (IQR) vancomycin exposure up until the last recorded audiogram was 30 (17–42) days. Vancomycin indications were: 53 (58%) bone and joint infections, 17 (18%) infective endocarditis, 10 (11%) bacteremia, 12 (13%) other infections. Seven (8%) patients experienced a worsening change in hearing from baseline, two (2%) of them suffered mild loss, two (2%) had mild to moderate loss, and three (3%) developed moderate-to-severe hearing loss. In bivariate analyses, no variables were found to be associated with a worsening change in audiogram, including baseline abnormal audiogram, age ≥ 40 years, elevated serum vancomycin levels, or vancomycin doses ≥ 4 grams/day.

Conclusions

The prevalence of negative changes in audiograms among patients receiving long-term intravenous vancomycin was low. The utility of routine audiogram testing in this population remains questionable except in high-risk patients; however, larger prospective studies with controls may be warranted to further explore the risk of ototoxicity.

Klíčová slova:

Antibiotics – Audiology – Creatinine – Deafness – Hearing – Methicillin-resistant Staphylococcus aureus – Vancomycin – Bivariate analysis


Zdroje

1. Rybak MJ, Lomaestro BM, Rotschafer JC, Moellering RC Jr, Craig WA, Billeter M, et al. Therapeutic Monitoring of Vancomycin in Adults: Summary of Consensus Recommendations from the American Society of Health -System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2009 Nov;29(11):1275–9.

2. Kirby WMM. Vancomycin Therapy in Severe Staphylococcal Infections. Rev Infect Dis. 1981 Nov-Dec;3 suppl:S236–9.

3. Levine DP. Vancomycin: A History. Clin Infec Dis. 2006;42(Supplement_1):S5–S12.

4. Elting LS, Rubenstein EB, Kurtin D, Rolston KV, Fangtang J, Martin CG, et al. Mississippi mud in the 1990s: risks and outcomes of vancomycin- associated toxicity in general oncology practice. Cancer: Interdisciplinary International Journal of the American Cancer Society. 1998 Dec 15;83(12):2597–607.

5. Farber BB. Vancomycin: Renewed interest in an old drag. Eur J Clin Microbiol. 1984 Feb;3(1):1–3. doi: 10.1007/bf02032805 6705767

6. Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med. 2006;166(19):2138–44. doi: 10.1001/archinte.166.19.2138 17060545

7. Lodise TP, Lomaestro B, Graves J, Drusano GL. Larger Vancomycin Doses (at Least Four Grams per Day) Are Associated with an Increased Incidence of Nephrotoxicity. Antimicrob Agents Chemother. 2008 Apr;52(4):1330–6. doi: 10.1128/AAC.01602-07 18227177

8. Bamgbola O. Review of vancomycin-induced renal toxicity: an update. Ther Adv Endocrinol Metab. 2016 Jun;7(3):136–47. doi: 10.1177/2042018816638223 27293542

9. Traber PG. Vancomycin Ototoxicity in a Patient with Normal Renal Function. Ann Intern Med. 1981 Oct;95(4):458–60. doi: 10.7326/0003-4819-95-4-458 7283300

10. Brummett RE, Fox KE. Vancomycin- and erythromycin-induced hearing loss in humans. Antimicrob Agents Chemother. 1989 Jun;33(6):791–6. doi: 10.1128/aac.33.6.791 2669623

11. Lackner TE. Relationship of Vancomycin Concentrations and Ototoxicity. Arch Intern Med. 1984 Feb;144(2):419.

12. Bailie GR, Neal D. Vancomycin ototoxicity and nephrotoxicity. A review. Med Toxicol Adverse Drug Exp. 1988 Sep-Oct;3(5):376–86. doi: 10.1007/bf03259891 3057327

13. Kavanagh KT, McCabe BF. Ototoxicity of Oral Neomycin and Vancomycin.] Laryngoscope. 1983;93(5):649–53. doi: 10.1002/lary.1983.93.5.649 6843260

14. Seng JJ, Yong MH, Peh ZX, Soong JL, Tan MH. Appropriateness of vancomycin therapeutic drug monitoring and its outcomes among non-dialysis patients in a tertiary hospital in Singapore. Int J Clin Pharm. 2018 Oct;40(5):977–981. doi: 10.1007/s11096-018-0670-4 29948742

15. Lanvers-Kaminsky C, Zehnhoff-Dinnesen AGa, Parfitt R, Ciarimboli G. Drug-induced ototoxicity: Mechanisms, Pharmacogenetics, and protective strategies. Clin Pharmacol Ther. 2017 Apr;101(4):491–500. doi: 10.1002/cpt.603 28002638

16. Martin JH, Norris R, Barras M, Roberts J, Morris R, Doogue M, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society Of Infectious Diseases Pharmacists. Clin Biochem Rev. 2010 Feb;31(1):21–4. 20179794

17. Forouzesh A, Moise PA, Sakoulas G. Vancomycin ototoxicity: a reevaluation in an era of increasing doses. Antimicrob Agents Chemother. 2009;53(2):483–6. doi: 10.1128/AAC.01088-08 19001107

18. Trosman SJ, Geelan-Hansen K, Anne S. A charge comparison of audiometric testing in the pediatric population. Otolaryngol Head Neck Surg. 2016 Jun;154(6):1068–72. doi: 10.1177/0194599816635144 26932960

19. Shields RK, Martello JL, Potoski BA, Sakoulas G, Moise PA. Is Vancomycin Ototoxicity a Significant Risk? Antimicrob Agents Chemother. 2009 Oct;53(10):4572; author reply 4572–3. doi: 10.1128/AAC.00537-09 19770289

20. James CW, Gurk-Turner C. Recommendations for monitoring serum vancomycin concentrations. Proceedings (Baylor University. Medical Center). 2001 Apr;14(2):189.

21. Mellor JA, Kingdom J, Cafferkey M, Keane CT. Vancomycin toxicity: a prospective study. J Antimicrob Chemother. 1985 Jun;15(6):773–80. doi: 10.1093/jac/15.6.773 4030539

22. Miner LJ, Faix RG. Large vancomycin overdose in two premature infants with minimal toxicity. Am J Perinatol. 2004 Nov;21(8):433–8. doi: 10.1055/s-2004-835959 15580538

23. Reyes MP, Ostrea EM Jr, Cabinian AE, Schmitt C, Rintelmann W. Vancomycin during pregnancy: does it cause hearing loss or nephrotoxicity in the infant? Am J Obstet Gynecol. 1989 Oct;161(4):977–81. doi: 10.1016/0002-9378(89)90766-7 2801848

24. Rybak LP, Ramkumar V. Ototoxicity. Kidney Int. 2007 Oct;72(8):931–5. doi: 10.1038/sj.ki.5002434 17653135

25. Campbell K. C., and Durrant J. Audiologic monitoring for ototoxicity. Otolaryngol Clin North Am. 1993 Oct;26(5):903–14. 8233496

26. Alexander TH, Harris JP. Incidence of sudden sensorineural hearing loss. Otol Neurotol. 2013 Dec 1;34(9):1586–9. doi: 10.1097/MAO.0000000000000222 24232060


Článek vyšel v časopise

PLOS One


2019 Číslo 11