STUDY OBJECTIVE: To determine the rate, risk factors, and outcome of 
vancomycin-associated acute kidney injury (AKI) in critically ill children.
DESIGN: Retrospective cohort study.
SETTING: Tertiary care children's hospital.
PATIENTS: We reviewed the charts of children admitted to the pediatric intensive 
care unit during a 2-year period who were treated with vancomycin. Courses of 
vancomycin interrupted by 3 days or more were counted separately. Patients were 
excluded if they received vancomycin treatment for fewer than 3 days, had 
preexisting renal failure, or had incomplete serum creatinine (Scr ) data.
MEASUREMENTS AND MAIN RESULTS: Demographic and laboratory data; vancomycin dose, 
duration, and concentrations; and concurrent use of nephrotoxic drugs were 
recorded. Acute kidney injury was defined as a decrease in estimated glomerular 
filtration rate of 50% or more from the beginning of vancomycin therapy. 
Descriptive statistics, step-wise logistic regression, and repeated measures 
ANOVA were used to analyze the data. A total of 284 patients were included, for 
a total of 391 courses of vancomycin (272 children and 119 infants). The mean 
duration of vancomycin therapy was 6.9 ± 4.5 days. Forty nine (17.2%) patients 
developed AKI during 61 (15.6%) courses. Elevated Scr concentrations returned to 
baseline after stopping vancomycin in 53 (87%) courses. Mortality was higher in 
children who developed AKI (p<0.001; Fisher's exact test). Administration of 
nephrotoxic drugs (odds ratio 2.23, Confidence Interval 1.27-3.93) and presence 
of high blood urea nitrogen (BUN):Scr ratio before vancomycin therapy (p<0.05) 
were associated with AKI. The BUN and Scr concentrations significantly increased 
during vancomycin therapy and decreased after vancomycin was discontinued 
(p<0.05).
CONCLUSIONS: In critically ill children, the development of reversible AKI 
during vancomycin therapy is associated with administration of nephrotoxic drugs 
and an elevated BUN: Scr ratio.