PT - JOURNAL ARTICLE AU - Jonathan E Constance AU - Alfred H Balch AU - Chris Stockmann AU - Matthew W Linakis AU - E Kent Korgenski AU - Jessica K Roberts AU - Robert M Ward AU - Catherine M T Sherwin AU - Michael G Spigarelli TI - A propensity-matched cohort study of vancomycin-associated nephrotoxicity in neonates AID - 10.1136/archdischild-2015-308459 DP - 2016 May 01 TA - Archives of Disease in Childhood - Fetal and Neonatal Edition PG - F236--F243 VI - 101 IP - 3 4099 - http://fn.bmj.com/content/101/3/F236.short 4100 - http://fn.bmj.com/content/101/3/F236.full SO - Arch Dis Child Fetal Neonatal Ed2016 May 01; 101 AB - Background The incidence of nephrotoxicity among vancomycin-treated neonates has been reported to range from 2% to 20%. These widely varying estimates have led to confusion and controversy regarding the safety of vancomycin among neonates.Objective Evaluate the incidence of nephrotoxicity among neonates receiving vancomycin concomitantly with gentamicin.Design Retrospective observational cohort study using propensity score matching to provide covariate balance between neonates who did or did not receive vancomycin based on factors known to be related to the development of renal dysfunction.Setting Hospitals (n=22) throughout the Intermountain West, including a quaternary care children's hospital.Patients Neonates ≤44 postmenstrual weeks (median gestational age: 31 (IQR 28–36) weeks) receiving intravenous gentamicin with or without exposure to vancomycin from January 2006 to December 2012.Main outcome measures Nephrotoxicity based on the modified Acute Kidney Injury Network criteria for acute kidney injury (AKI) or serum creatinine concentration ≥1.5 mg/dL persisting for ≥48 h.Results The final cohort was comprised of 1066 neonates (533 receiving vancomycin and gentamicin vs 533 receiving gentamicin). In a propensity score-matched cohort that was well balanced across 16 covariates, AKI was not associated with vancomycin use (16 neonates receiving vancomycin vs 7 controls experienced AKI; OR 1.5; 95% CI 0.6 to 4.0). However, the presence of a patent ductus arteriosus, concomitant non-steroidal anti-inflammatory drug use, ≥1 positive blood cultures, low birth weight and higher severity of illness and risk of mortality scores were associated with an increased risk of nephrotoxicity.Conclusions These results corroborate several earlier reports and much anecdotal evidence describing the infrequent occurrence of nephrotoxicity in neonates receiving concomitant vancomycin and gentamicin.