Vancomycin Linked to Increased AKI Risk in ICU Patients
Izak Yasrebi-de Kom, PhD
Credit: Amsterdam University Medical Center
Findings from a recent target trial emulation study suggest vancomycin causes a higher risk of acute kidney injury (AKI) than alternative antibiotics like clindamycin and linezolid, necessitating compliance with established prevention strategies.1
The research investigated the affect of initiating vancomycin versus initiating one of several minimally nephrotoxic alternative antibiotics on the 14-day risk of AKI in adult intensive care unit (ICU) admissions and found a heightened risk with vancomycin. Investigators recommend strategies like dosing vancomycin according to renal function, therapeutic drug monitoring, and considering a non-nephrotoxic alternative antibiotic where applicable.1
“AKI is a frequent syndrome in ICU patients and is often caused by drugs,” Izak Yasrebi-de Kom, PhD, of Amsterdam University Medical Center, and colleagues wrote.1 “Optimizing pharmacotherapy may reduce the risk of drug-induced AKI and associated negative outcomes.”
A tricyclic glycopeptide antibiotic used to treat severe gram-positive bacterial infections, vancomycin has been linked to several adverse side effects, including nephrotoxicity, hypotension, and hypersensitivity reactions. However, evidence regarding its potential to cause AKI in adult intensive care patients is conflicting.1,2
To estimate the effect of initiating vancomycin versus other minimally nephrotoxic alternative antibiotics on AKI risk, investigators conducted a target trial emulation study with an active comparator, new user design. They reused routinely collected electronic health record (EHR) data of admissions to 15 Dutch ICUs between January 2010 and December 2019 and linked them to data from the Dutch National Intensive Care Evaluation quality registry.1
The hypothetical trial enrolled adult, non-dialysis dependent AKI-free ICU admissions with a suspected bacterial infection that was perceived to be treatable with
- Yasrebi-de Kom I, et al. Effect of Vancomycin vs Minimally Nephrotoxic Antibiotics on Acute Kidney Injury in Intensive Care Unit Admissions: A Target Trial Emulation Study. JAMA Network open. 2024;7(9):e2431888.
- Vancomycin – drugbank Online Database. Accessed September 1, 2025. https://go.drugbank.com/drugs/DB00358