Vancomycin-induced ototoxicity in very-low-birthweight infants

Marissen J, Fortmann I, Humberg A, Rausch TK, Simon A, Stein A, Schaible T, Eichhorn J, Roll C, Herting E, Göpel W, Härtel C, Göpel W, Bendiks M, Berghäuser MA, Gebauer C, Bockenholt K, Boettger R, Bohnhorst B, Brune T, Dawczynski K, Dördelmann M, Ehlers S, Eichhorn JG, Ursula-Felderhoff-Müser , Franz A, Gerleve H, Gortner L, Guthmann F, Haase R, Heitmann F, Heldmann M, Hepping N, Hentschel R, Hillebrand G, Hubert M, Hummler H, Jensen R, Kannt O, Koerner T, Küster H, Kribs A, Linnemann K, Möller J, Mueller D, Olbertz D, Orlikowsky T, Reese J, Roll C, Rossi R, Rüdiger M, Schaefer S, Schaible T, Schmidtke S, Seeliger S, Segerer H, Teig N, Topf HG, Urlichs F, Vochem M, Weller U, von der Wense A, Werner C, Wieg C, Wintgens J, Schneider W, Rieger-Fackeldey E, Ebinger F, Sinnecker G (2020)

Publication Type: Journal article

Publication year: 2020

Journal

Book Volume: 75

Pages Range: 2291-2298

Journal Issue: 8

DOI: 10.1093/jac/dkaa156

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.

Involved external institutions

Universitätsklinikum Köln Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Klinikum Südstadt Rostock Germany (DE) Universität Witten/Herdecke Germany (DE) Ruhr-Universität Bochum (RUB) Germany (DE) Klinikum rechts der Isar Germany (DE) Vivantes Klinikum im Friedrichshain Germany (DE) AMEOS Klinikum Eutin Germany (DE) St. Vincenz-Kliniken GmbH Germany (DE) Klinikum Lippe Germany (DE) Klinikum Leverkusen Germany (DE) Klinikum Dortmund Germany (DE) Klinikum Nürnberg Germany (DE) Klinikum Stuttgart Germany (DE) DRK-Kinderklinik Siegen Germany (DE) Westküstenkliniken Brunsbüttel und Heide gGmbH Germany (DE) Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen Germany (DE) Klinikum Bielefeld Germany (DE) Christian-Albrechts-Universität zu Kiel Germany (DE) Vestische Kinder- und Jugendklinik Datteln Germany (DE) Altonaer Kinderkrankenhaus (AKK) Germany (DE) Technische Universität Dresden Germany (DE) Universität Ulm Germany (DE) Albert-Ludwigs-Universität Freiburg Germany (DE) Universität Münster (ehem. Westfälische Wilhelms-Universität (WWU)) Germany (DE) HELIOS Kliniken Germany (DE) Gesundheit Nordhessen Holding AG Germany (DE) Helios Hospital Schwerin Germany (DE) Universität Greifswald Germany (DE) Martin-Luther-Universität Halle-Wittenberg (MLU) Germany (DE) Universität zu Lübeck Germany (DE) Universitätsklinikum Essen Germany (DE) Universitätsklinikum des Saarlandes (UKS) Germany (DE) Florence Nightingale Hospital / Florence-Nightingale-Krankenhaus Germany (DE) GFO Kliniken Bonn Germany (DE) Otto-von-Guericke-Universität Magdeburg Germany (DE) Diakonissenkrankenhaus Flensburg Germany (DE) Universität Duisburg-Essen (UDE) Germany (DE) Universität Mannheim Germany (DE) Friedrich-Schiller-Universität Jena Germany (DE) Christophorus-Kliniken Germany (DE) Bürger­hospital Frankfurt Germany (DE) Kinder- und Jugendkrankenhaus Auf der Bult Germany (DE) Eberhard Karls Universität Tübingen Germany (DE) Universität Leipzig Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Heinrich-Heine-Universität Düsseldorf Germany (DE) Vivantes Klinikum Neukölln Germany (DE) Georg-August-Universität Göttingen Germany (DE) Städtische Kliniken Mönchengladbach GmbH / Elisabeth-Krankenhaus Rheydt Germany (DE) KJF Klinik St. Elisabeth Germany (DE) Vital Klinik GmbH & Co. KG Germany (DE) St. Franziskus-Hospital Münster Germany (DE) Barmherzige Brüder Klinik St. Hedwig Regensburg Germany (DE) Asklepios Klinik Barmbek Germany (DE) Klinikum Links der Weser Germany (DE)

How to cite

APA:

Marissen, J., Fortmann, I., Humberg, A., Rausch, T.K., Simon, A., Stein, A.,... Sinnecker, G. (2020). Vancomycin-induced ototoxicity in very-low-birthweight infants. Journal of Antimicrobial Chemotherapy, 75(8), 2291-2298. https://doi.org/10.1093/jac/dkaa156

MLA:

Marissen, Janina, et al. "Vancomycin-induced ototoxicity in very-low-birthweight infants." Journal of Antimicrobial Chemotherapy 75.8 (2020): 2291-2298.

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