AKI Frequency in Critically Ill Assessed for 2 Antibiotic Regimens
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SAN DIEGO—Acute kidney injury (AKI) is more common among patients in the intensive care unit (ICU) receiving concomitant piperacillin-tazobactam and vancomycin (TZP+VAN) than those receiving cefepime and vancomycin (CFP+VAN), according to findings from a retrospective, single-institution database study presented at IDWeek 2017.
“TZP+VAN therapy is associated with significant increases in AKI in critically ill patients compared to those who received CFP+VAN, independent of other AKI risk factors,” reported W. Cliff Rutter, PharmD, MS, of the University of Kentucky College of Pharmacy, Lexington, KY.
Previous research has indicated that TZP+VAN is associated with increased AKI incidence compared to CFP+VAN in non-critically-ill patients.
“We hypothesized that critically ill patients receiving TZP+VAN would have a higher AKI incidence compared to those receiving CFP+VAN,” Dr. Rutter said. The study authors gathered clinical and demographic data from the University of Kentucky Center for Clinical and Translational Science Enterprise Data Trust, for adults who received TZP+VAN or CFP+VAN for ≥48 hours in the ICU.
“Patients were excluded for: pregnancy, cystic fibrosis, chronic kidney disease, baseline creatinine clearance (CrCl <30mL/min)," Dr. Rutter noted. A total of 1,871 patients were included in the study: 1,205 had received TZP+VAN and 666 had received CFP+VAN.
At baseline, TZP+VAN patients were older (56 vs. 52 years; P<0.00001), while vasopressor exposure was more common in the CFP+VAN group (32.6% vs. 27.0%, P=0.013), the researchers cautioned.
Cormorbid hypertension and loop diuretic exposures were more common in the TZP+VAN group at baseline (59.4% vs. 52.4%, P=0.0039; 55.4% vs. 45.9%, P=0.0001), Dr. Rutter added.
“AKI incidence was higher in the TZP+VAN group” (31.8% vs. 18.0%, P<0.0001), Dr. Rutter reported.
After patients were matched for demographic criteria, 1,282 patients were included in the final analysis, with 641 patients in each group, Dr. Rutter said.
“AKI was significantly more common in TZP+VAN patients (34.2% vs 17.8%, P<0.0001) and after controlling for remaining confounders, TZP+VAN had 2.51 times the odds of experiencing AKI than those in the CFP+VAN” (95% CI: 1.9–3.34), his team reported.
Other factors associated with AKI included more severe illness, baseline renal function, exposure to calcineurin inhibitors, vasopressors, and loop diuretics, heart failure diagnosis, and antimicrobial therapy durations exceeding 7 days, Dr. Rutter reported.
Study authors called for additional research in AKI outcome characterization among the critically ill.
For continuous infectious disease news coverage from the IDWeek 2017, check back to MPR's IDWeek page for the latest updates.Reference:
Rutter CW, Burgess DS. Incidence of acute kidney injury among intensive care unit patients receiving vancomycin in combination with cefepime or piperacillin-tazobactam. Poster presented at IDWeek; October 4–8, 2017; San Diego, CA. IDWeek.org.