Abstract: SA-PO018

AKI Associated with Antibiotic Exposure in Critically Ill Children

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Joyce, Emily Lauren, The University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Priyanka, Priyanka, The University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Kellum, John A., The University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Group or Team Name

  • Critical Care Nephrology, CRISMA
Background

Acute kidney injury (AKI) is associated with adverse outcomes including prolonged hospital stay, increased healthcare costs, and delay in other organ recovery as well as development of chronic kidney disease. It is unclear which medications are associated with increased risk of AKI in pediatric critically ill patients.

Methods

Data was obtained from a convenience sample taken from the Pediatric HiDenIC database which contains > 12,000 critically ill patient records from the Children’s Hospital of Pittsburgh between 2010 and 2014. Patients were categorized regarding exposure to any antibiotic within the first 24 hours of ICU admission with subsequent development of AKI using KDIGO staging.

Results

Out of 2890 critically ill pediatric patient encounters, 18% developed stage 2 or 3 AKI within the first week of admission to the ICU. Those who developed AKI had a longer ICU length of stay (p<0.001), longer hospital length of stay (p<0.01) and higher mortality rate (p<0.001). Within the cohort, 2254 patient encounters (78%) were exposed to any antibiotic within the first 24 hours of ICU admission. On univariate analysis, exposure to antibiotics including cefepime (OR 1.59, n=225, p<0.01), linezolid (OR 3.99, n=28, p<0.001), piperacillin/tazobactam (OR 2.04, n=546, p<0.001), and vancomycin (OR 1.45, n=1028, p<0.001) was associated with increased odds of developing AKI.

Conclusion

AKI is prevalent in critically ill children and associated with poor outcomes. Antibiotic use in this population is common and is associated with increased risk for development of AKI.

Descriptive Characteristics
 No AKI (Stage 0/1)
N = 2366
AKI (Stage 2/3)
N = 524
P-value
Age (years), mean ± SD9.2 ± 7.99.5 ± 9.10.415
Males, N (%)1322 (55.9)294 (56.1)0.923
ICU LOS (days),
median (Q1-Q3)
2.8 (1.4-5.8)4 (1.9-9.4)<0.001
Hospital LOS (days),
median (Q1-Q3)
7.3 (4.3-14.2)9.7 (5.4-18.4)0.009
Hospital Mortality, N (%)44 (1.9)36 (6.9)<0.001

SD, standard deviation ICU, Intensive care unit LOS, length of stay OR, Odds ratio

Funding

  • NIDDK Support