Safety and Efficacy of Strategy to Prevent Drug-Induced Nephrotoxicity in High-Risk Patients

Inclusion Criteria: * Aged 18 years or older * Receiving intravenous vancomycin for the treatment of healthcare associated pneumonia, osteomyelitis/septic arthritis, endocarditis/bacteremia, or acute bacterial skin and skin structure infections * Expected to receive vancomycin for at least 72 hours and are within the first 72 hours of therapy * Have at least two or more of the following risk factors for drug-induced nephrotoxicity: a) receipt high-dose vancomycin therapy (greater than or equal to four grams per day) b) receipt of vasopressors c) receipt of nephrotoxic drugs (i.e. aminoglycosides, furosemide, acyclovir, amphotericin b, colistin, and intravenous contrast dye) d) pre-existing renal dysfunction (i.e. SCr greater than or equal to 1.5 mg/dL). Exclusion Criteria: * Pregnancy * End-stage renal disease * Receipt of more than 4 grams of vancomycin prior to enrollment on current admission * Absolute neutrophil count \< 1000/mm3