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- Title
Vancomycin-induced ototoxicity in very-low-birthweight infants.
- Authors
Marissen, Janina; Fortmann, Ingmar; Humberg, Alexander; Rausch, Tanja K; Simon, Arne; Stein, Anja; Schaible, Thomas; Eichhorn, Joachim; Wintgens, Jürgen; Roll, Claudia; Heitmann, Friedhelm; Herting, Egbert; Göpel, Wolfgang; Härtel, Christoph; German Neonatal Network
- Abstract
<bold>Background: </bold>Vancomycin is an extensively used anti-infective drug in neonatal ICUs. However, exposure-toxicity relationships have not been clearly defined.<bold>Objectives: </bold>To evaluate the risk profile for hearing deficits in vancomycin-exposed very-low-birthweight infants (VLBWI).<bold>Methods: </bold>In a large cohort study of the German Neonatal Network (GNN; n = 16 967 VLBWI) we assessed the association of vancomycin treatment and pathological hearing tests at discharge and at 5 year follow-up. We performed audits on vancomycin exposure, drug levels, dose adjustments and exposure to other ototoxic drugs in a subgroup of 1042 vancomycin-treated VLBWI.<bold>Results: </bold>In the GNN cohort, 28% (n = 4739) were exposed to IV vancomycin therapy. In multivariable logistic regression analysis, vancomycin exposure proved to be independently associated with pathological hearing test at discharge (OR 1.18, 95% CI 1.03-1.34, P = 0.016). Among vancomycin-treated infants, a cumulative vancomycin dose above the upper quartile (>314 mg/kg bodyweight) was associated with pathological hearing test at discharge (OR 2.1, 95% CI 1.21-3.64, P = 0.009), whereas a vancomycin cumulative dose below the upper quartile was associated with a reduced risk of pathological tone audiometry results at 5 years of age (OR 0.29, 95% CI 0.1-0.8, P = 0.02, n = 147).<bold>Conclusions: </bold>Vancomycin exposure in VLBWI is associated with an increased, dose-dependent risk of pathological hearing test results at discharge and at 5 years of age. Prospective studies on long-term hearing impairment are needed.
- Subjects
OTOTOXICITY; INFANTS; EVOKED response audiometry; LOGISTIC regression analysis; HEARING disorders; ENTEROCOCCAL infections; INTRAVENOUS therapy; AUDIOMETRY; RESEARCH; RESEARCH methodology; VANCOMYCIN; MEDICAL cooperation; EVALUATION research; COMPARATIVE studies; BIRTH weight; LONGITUDINAL method
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2020, Vol 75, Issue 8, p2291
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dkaa156