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

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