Age and body weight-adjusted infusion rate (mg/kg/h) as risk factors for vancomycin infusion reaction in patients receiving perioperative antimicrobial prophylaxis: a retrospective cohort study.

BACKGROUND

Vancomycin infusion reaction (VIR) is a common adverse reaction to vancomycin. We aimed to investigate the effects of infusion rate, age, infusion time, renal function and history of allergy on the incidence of VIR.

METHODS

We conducted a single-centre retrospective cohort study with 153 patients (aged 0-92.7 years) who received a single intravenous dose of vancomycin for perioperative prophylaxis. Patients treated for active infections were excluded. Medical records were retrospectively evaluated for VIR occurrence, defined as itching, flushing or rash documentation.

RESULTS

VIR incidence was 46.7% (7/15) in patients aged <10 years, 47.4% (9/19) in those aged 10-20 years and 44.4% (4/9) in those aged 20-30 years, versus 2.7% (2/74) in those aged ≥60 years. Multivariable logistic regression identified younger age [adjusted odds ratio (aOR) 0.95, 95% CI 0.93-0.97] and higher weight-adjusted infusion rate (aOR 1.22 per mg/kg/h increase, 95% CI 1.04-1.43) as independent risk factors for VIR. Receiver operating characteristic analysis of the infusion rate by age group showed that the optimal cut-off value for patients aged 30-60 years was 14.8 mg/kg/h, whereas for those aged <30 years, it was 14.0 mg/kg/h. No patients developed VIR when the infusion rate was <9.4 mg/kg/h.

CONCLUSIONS

Age and higher weight-adjusted infusion rate were key risk factors for VIR. Tailoring infusion rate to age and weight may reduce VIR incidence without unnecessarily prolonging administration time.