2020 Volume 3 Issue 5 Pages 150-156
The incidence rate of bacterial meningitis caused by methicillin-resistant staphylococci is lower than that of bacterial meningitis caused by other gram-positive bacteria. However, considering the high mortality rate of staphylococcal infections, empirical vancomycin (VCM) therapy is often used. On the other hand, VCM is known to affect renal function. Therefore, it is necessary to understand the risks of empirical VCM therapy in patients with suspected bacterial meningitis. We aimed to investigate the risk of acute kidney injury (AKI) associated with empirical VCM therapy in patients with suspected bacterial meningitis. We reviewed the records of 35 suspected bacterial meningitis patients treated with empirical VCM therapy at Fukuoka University Hospital between 2011 and 2017. The incidence rate of AKI associated with empirical VCM therapy was evaluated based on Kidney Disease: Improving Global Outcome criteria. The patients were aged 65.0 (44.0-75.0) years, and had various underlying diseases such as subarachnoid hemorrhage, cerebral hemorrhage, other diseases of the head and community-acquired infection. Methicillin-resistant staphylococci were detected in only 3 patients. In 4 patients with negative culture results, empirical VCM therapy was continued for more than 1 week; this resulted in AKI. The incidence rate of AKI associated with empirical VCM therapy was 11.4%. For patients with suspected bacterial meningitis requiring empirical VCM therapy, it is important to check the necessity of VCM by bacterial culture tests and ensure the safety by monitoring blood concentrations in order to avoid the risk of AKI.
