Vancomycin-induced ototoxicity in very-low-birthweight infants. (28th May 2020)

• Record Type: Journal Article
• 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
• Is Part Of: Journal of antimicrobial chemotherapy. Volume 75:Number 8(2020)
• Page Start: 2291
• Page End: 2298
• Publication Date: 2020-05-28
• Subjects: Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; 615.58
• DOI: 10.1093/jac/dkaa156
• Languages: English
• ISSNs: 0305-7453

Abstract

Abstract: Background: Vancomycin is an extensively used anti-infective drug in neonatal ICUs. However, exposure–toxicity relationships have not been clearly defined. Objectives: To evaluate the risk profile for hearing deficits in vancomycin-exposed very-low-birthweight infants (VLBWI). Methods: 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. Results: 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). Conclusions: 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.