الفهرس 
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Abstract
Vancomycin associated neprhotoxicity is defined as the increase in S.cr by a minimum of 0.5 mg/dL or more than or equal 50% from baseline for at least 2 successive measures from the start of medication and till 72 hours after its end. VAN was found to occur in about 10-20% following the conventional dose (1gm/12hr) and 30-40% following the high dose (15-20 mg/kg).
Numerous risk factors are accompanied with VAN development, some are vancomycin related such as total dose per day (>4gm/day), duration of remedy (7-14 days), administration methode (Intermittent> continuous), and trough level (>15mg/L). Other factors are patient related such as pre-existing kidney disease, obesity (>101.4kg), severity of sickness, ICU stay and concurrent nephrotoxins (e.g. aminoglycosides, NSAIDs, furosemide, cyclosporine, amphotericin B and ACEIs.
The present cohort study was designed to assess VAN incidence and its correlation to the co-adminstration of piperacillin/tazobactam. This cohort was held on 98 critically ill patients suffering from resistant gram positive infections and requiring vancomycin treatment.
group 1: 70 patients who didn’t suffer AKI after vancomycin intravenous treatment.
group 2: 28 patients who suffer AKI after receiving vancomycin intravenous treatment.
All patients were subjected to a thorough history taking and the following parameters were evaluated at baseline and routinely for the two groups.
The current study showed that:
• The incidence of vancomycin associated nephrotoxicity is high in the critically ill patients in Egypt, around 30%.
• Piperacillin/tazobactam was found to increase the risk of VAN by approximately 3 folds.
• Vancomycin associated nephrotoxicity increased the odds of mortality.
Oxidative stress and free radicals are the anticipated VAN mechanism. has The belief of the role of oxidative stress in renal dysfunction has led to the concept that antioxidants can be beneficial in the nephro-protection approach against VAN. Animal studies addressing the use of antioxidants in protection from vancomycin induced nephropathy showed the advantageous effects of several antioxidants, such as ascorbic acid, erdosteine, N-acetylcysteine, alpha tocopherol, caffeic acid phenethyl ester, and erythropoietin
The present trial was designed to appraise the usefulness of ascorbic acid at a dose of 2 gm twice daily in preventing the incidence of VAN. This was accomplished by assessing ascorbic acid effect on the parameters of renal function (S.cr, BUN and creatinine clearance).
The study was a prospective, RCT that was held on 41 critically ill patients suffering from resistant gram positive infections and requiring vancomycin treatment.
Intervention group: 21 patients receiving ascorbic acid 2 gm twice daily just before vancomycin intravenous (15-20 mg/kg) by half an hour.
Control group: 20 patients receiving vancomycin intravenous treatment (15-20 mg/kg).
All patients were subjected to a thorough history taking and the following parameters were evaluated at baseline and routinely for the two groups.
The current study showed that:
• The incidence of vancomycin associated nephrotoxicity is high in the critically ill patients in Egypt.
• There was no noteworthy variance among groups concerning demographics.
• Vancomycin related factors (dose, duration and daily dose per weight), APACHE II score, comorbidities and concurrent potential nephrotoxins were all equivalent in both groups.
• There was no noteworthy variance among groups at baseline concerning all laboratory investigations.
• After one week, serum creatinine increased significantly in the control group while there was no important increase in the intervention group.
• The absolute difference of serum creatinine was significantly different among groups.
• Creatinine clearance decreased by the end of the monitoring period (one week) significantly in the control group while insignificantly in the intervention group.
• The absolute difference of creatinine clearance was significantly different between both groups.
• Mortality was greater in the control than the intervention group, though non-statistically significant.