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Kidney Week

Abstract: TH-PO056

Incidence of AKI Among Critically Ill Patients with Brief Empiric Use of Anti-Pseudomonal Beta-Lactams with Vancomycin

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Schreier, Diana J., Mayo Clinic, Rochester, Minnesota, United States
  • Kashani, Kianoush, Mayo Clinic, Rochester, Minnesota, United States
  • Sakhuja, Ankit, Mayo Clinic, Rochester, Minnesota, United States
  • Mara, Kristin C., Mayo Clinic, Rochester, Minnesota, United States
  • Tootooni, Mohammad samie, Mayo Clinic, Rochester, Minnesota, United States
  • Personett, Heather A., Mayo Clinic, Rochester, Minnesota, United States
  • Leung, Sarah, Mayo Clinic, Rochester, Minnesota, United States
  • Rule, Andrew D., Mayo Clinic, Rochester, Minnesota, United States
  • Steckelberg, James, Mayo Clinic, Rochester, Minnesota, United States
  • Tande, Aaron J., Mayo Clinic, Rochester, Minnesota, United States
  • Barreto, Erin F., Mayo Clinic, Rochester, Minnesota, United States
Background

Nephrotoxins contribute to 20-40% of acute kidney injury (AKI) cases in the intensive care unit (ICU). The combination of piperacillin/tazobactam and vancomycin (PTZ/VAN) has been identified as nephrotoxic, but existing studies focus on extended durations of therapy rather than the brief empiric courses often used in the ICU. The objective of this study was to compare the risk of AKI with a short course of PTZ/VAN to other anti-pseudomonal beta-lactam/vancomycin combinations

Methods

Retrospective cohort of 3299 ICU patients that received at least 24 hours, but no more than 72 hours of an antipseudomonal beta-lactam and vancomycin [(PTZ/VAN, cefepime (CEF/VAN), or meropenem (MER/VAN)]. The risk of developing stage 2 or 3 AKI was compared between antibiotic groups with multivariable logistic regression adjusted for relevant confounders. We also compared the risk of persistent kidney dysfunction, dialysis dependence, or death at 60-days between groups.

Results

The overall incidence of stage 2 or 3 AKI was 9%. Brief exposure to PTZ/VAN did not confer a greater risk of stage 2 or 3 AKI after adjustment for demographics, baseline serum creatinine, AKI risk prediction score, severity of illness, or sepsis [PTZ/VAN vs. CEF/VAN: adjusted OR, 95% CI 1.11 (0.85, 1.45); PTZ/VAN vs. MER/VAN 1.04 (0.71, 1.42)]. No significant differences were noted between groups at 60-day follow up in the outcomes of persistent kidney dysfunction (P = 0.081), new dialysis dependence (P = 0.15), or death (P = 0.091).

Conclusion

Short courses of PTZ/VAN were not associated with a greater risk of short- or long-term adverse renal outcomes compared to other empiric broad-spectrum combinations.