Infection and Drug Resistance (Jul 2018)
Extremely high levels of vancomycin can cause severe renal toxicity
Abstract
Jaime Barceló-Vidal,1 Eva Rodríguez-García,2 Santiago Grau3 1Department of Pharmacy, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; 2Department of Nephrology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; 3Department of Pharmacy, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain Abstract: Vancomycin has usually been associated with nephrotoxicity. Generally, this toxicity is presented as proximal tubular cells injury with or without necrosis and as acute interstitial nephritis. However, development of both lesions is uncommonly described in literature. We present a case of vancomycin-induced nephrotoxicity resulting in both acute interstitial nephritis and tubular cells damage confirmed by renal biopsy. Peak and trough levels of 77.11 and 63.60 μg /mL, respectively, were obtained at the first plasma determination. After 8 more plasma determinations and several hemodialysis sessions, vancomycin levels were undetectable 1 month after therapy was stopped. To our knowledge, this is the case report with the highest vancomycin trough levels developing both lesions and describing total vancomycin washout after a biopsy-proven vancomycin toxicity. In conclusion, early vancomycin therapeutic drug monitoring should be performed in order to avoid toxicities where, as seen in our patient, antibiotic exposure could last around 1 month after last dose administration. Keywords: vancomycin, therapeutic drug monitoring, nephrotoxicity
